Procedures San Francisco
Kyphosis is another type of spinal deformity. It usually involves deformity in the side plane (lateral plane) or viewing the patient from the side. Patients frequently complain of not being able to stand upright and also complain of falling forward. Sometimes patients have difficulty making horizontal gaze and have difficulty seeing what is in front of them. Patients can end up with kyphosis for a number of different reasons. They can have genetic predisposition for it and have onset of kyphosis in adolescent years (so-called Scheuermann’s kyphosis), which is actually a research interest ours. We have published on Scheuermann’s kyphosis in the past. Another form of kyphosis can be congenital and related to spina bifida. This is a rare form of kyphosis but also is a research interest of ours, and we do have prior publications on surgical techniques for correction of spina bifida deformities. The more frequent types of kyphosis would be a case of so-called flat back or fixed sagittal imbalance. Sometimes it is due to progressive disc degeneration. Sometimes it is due to prior surgery. Occasionally it is due to trauma and fracture. Whatever the cause, surgical correction usually is uniform. The patient’s spine needs to be rebalanced in both the side plane and the frontal plane. Usually, surgery for the correction of kyphosis is quite lengthy. It does require meticulous preoperative planning with full-length scoliosis radiographs on a 36″ cassette, MRI to assess the integrity of the spinal cord and the nerves, and preoperative CT to assist with robotic guidance for the surgery. Surgery for the correction of kyphosis can be quite long, anywhere from four to 12 hours. It does require placement of surgical instrumentation, at times requires blood transfusions and postoperative monitoring in the ICU. The results after surgical correction of kyphosis or flat-back deformity are very gratifying; however, it does take anywhere from six to twelve months for the patient to get over the surgery.
Scoliosis San Francisco
Scoliosis is a common condition. Several types of scoliosis are commonly seen. Some patients develop scoliosis in childhood. If it is developed before age 10, usually it is called juvenile onset. If it is developed after age 10 but before skeletal maturation, it is usually called adolescent idiopathic scoliosis (AIS).
Occasionally, there are some conditions that result in scoliosis to be present at the time of birth; this is called congenital scoliosis; it usually results from the bone not forming properly (failure of formation) or the spine not segmenting properly (failure of segmentation). In adults, another form commonly seen is what is called adult-onset scoliosis, which usually results from advanced degeneration and asymmetric disc space collapse. Even though the vast majority of adult-onset degenerative scoliosis involves the lumbar spine, occasionally we do see primarily thoracic scoliosis that might have been present in adolescence or childhood that has progressed due to superimposed degeneration. The majority of scoliosis is treated nonsurgically; however, in adulthood some patients do require surgery. The two most common indications for surgery in an adult for scoliosis are progression of the deformity or significant pain unresponsive to conservative management. If surgical treatment of scoliosis is undertaken, usually very careful planning is necessary.
It frequently involves obtaining cross-sectional imaging studies to visualize the status of the spinal cord and the nerve roots. It may be an MRI scan or CT scan, or a CT myelogram. Also, frequently measurement of the bone density of the patient is required. Also, we do obtain special scoliosis radiographs, also known as a long standing film or 36″ cassette film. This provides invaluable information about the balance of the spine in both the frontal plane and the side plane and assists in presurgical planning. Also, if surgery is contemplated, normally we do require a CT scan for robotic guidance. We are proud to offer the Mazor Renaissance robotic guidance system that we have used at St. Mary’s for over a year in more than a hundred cases. The surgery itself for scoliosis is usually quite lengthy and quite involved. It requires the participation of an experienced surgical team. We have been doing surgical correction of scoliosis at St. Mary’s Hospital for almost three decades and have an extremely experienced team of surgeons, surgical assistants, anesthesiologists, scrub technicians, and nurses both in the operating room and on the surgical wards.
The surgery for correction of scoliosis in adults typically is much longer and much more involved than surgery in adolescents or children and may take anywhere from six to twelve hours. As part of the surgery, occasionally it is necessary to remove part of the bone and performed so-called osteotomy to improve surgical correction. Another part of the procedure is placement of instrumentation or pedicle screws; this frequently is done with the assistance of robotic guidance or fluoroscopic guidance. The next part of the surgery involves placements of the rods and corrective maneuvers. At times, decompression of the neural elements (spinal cord or nerve roots) is required. After the surgery, patients at times need to go to the intensive care unit. The hospital stay after surgical correction of spinal deformity can be anywhere from three to ten days. Postoperative bracing sometimes is required.
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