Dr. Miller: Surgery for spinal scoliosis. We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke, he's an orthopedic surgeon at the University of Utah. He's also a spine specialist. Darrel, after conservative therapy some patients may not do as well as expected and they end up in your hands again where you may advise surgery. Tell us a little bit about that expectation and what happens.
Dr. Brodke: Patients often with adult scoliosis often caused by degenerative disease, degenerative disc disease, and therefore in a subsequent deformity also have other problems related to that lumbar spine. Specifically low back pain and pain radiating into their legs. They may also have pain with associated numbness and weakness and fatigue. All of that may progress despite non-operative treatment, despite physical therapy, medications, even injections. And it's then that we start to talk about surgical intervention. And surgery often necessitates a big surgery, not a little surgery, and by big surgery I mean surgery that may take many hours and require several days in the hospital and several months of recovery.
Dr. Miller: This is because you're operating on multiple levels of the spine, trying to straighten that curve that shouldn't be there.
Dr. Brodke: Exactly. We're working both on making room for the nerves, decompressing anything that's pressing on the nerves, and then straightening the spine and holding it there with metal instrumentation: screws and rods and spacers.
Dr. Miller: So this is a long surgery, but I imagine the recovery is also long.
Dr. Brodke: Yes. The surgery itself can take many hours. It varies depending on how many levels of the spine are involved and how much we need to do. The recovery, likewise, can vary but usually is on the order of months, not on the order of hours or days.
Dr. Miller: So tell us how you advise, sounds like the rehabilitation after the surgery is a significant part of the treatment. So do you send a patient to just physical therapy or do you send them to a physical therapy physician? Tell us a little bit about that.
Dr. Brodke: Postoperatively we're working with physical therapy immediately after surgery. While still in the hospital, patients are getting up and walking and learning techniques of movement and balance with a physical therapist. Once they leave the hospital, some patients go straight home and can walk as their main therapy and their therapy for the next few months as the bone is healing is walking. Some patients aren't quite ready to go home and will end up in a rehab facility where they work every day with physical therapy until their strength and balance has come around.
Dr. Miller: And that's very intensive
Dr. Brodke: It can be very intensive, several hours a day work in order to get to the point where they're ready to be walking around the home and even outside the home.
Dr. Miller: Now you mentioned you put some hardware in the back and to straighten the spine, I think you use metal rods and hooks and things like that and it sounds kind of daunting and it actually really helps straighten that spine.
Dr. Brodke: Yes, it does sound daunting and it's rather impressive when patients and their families see the X-rays but the screws and rods that we use, mostly made out of titanium today, really help us straighten the spine and hold it there while the spine is healing from the surgery.
Dr. Miller: So the hardware once it's implanted doesn't cause pain. It actually helps prevent it.
Dr. Brodke: Exactly. It helps prevent the pain, it helps hold the position that we want to hold, and it doesn't really hurt long-term either. Most patients don't need their hardware removed. It just goes along for the ride for the rest of however long that ride is.
Dr. Miller: So for our audience, it sounds like a small number of patients would need to have surgery to repair scoliosis. Basically this is a long and complex procedure followed by several months of rehabilitation but at the end of that if everything is going correctly you're going to feel better, you're going to have a better . . . going to have less pain, and you're going to be more functionable with your life.
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