Sometimes a combination of medication and physical therapy may not effectively alleviate pain or improve your ability to participate in daily activities. If this occurs, NYU Langone spine surgeons may recommend a spinal reconstructive surgery to correct an abnormal curve, take pressure off a pinched nerve, and stabilize the spine by fusing vertebrae together.
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Your surgical team may include an orthopedic surgeon, a neurosurgeon, and a plastic surgeon in addition to experienced anesthesiologists. This team of spine experts collaborates to determine the most effective and least invasive surgical approach to spine surgery based on factors including your age, overall health, and the severity of the spinal curvature.
There are several different spinal reconstructive procedures, all of which have the same goals: to restore as much normal curvature to the spine as possible and prevent a curve from worsening, to remove pressure from the nerves, and to protect the nerves and spine from further damage.
Every spine is affected by scoliosis or kyphosis differently, so surgery is customized to your needs. Regardless of the technique your surgeon decides is most appropriate, all surgery for adult scoliosis or kyphosis includes spinal decompression and spinal fusion and is performed using general anesthesia.
Decompression is a technique that relieves pressure on nerve roots traveling through and near the spine. If a nerve root is pinched by part of the spine due to an unusual curve, pain signals may travel up the spinal cord to the brain, resulting in the sensation of pain in the back or legs. Relieving pressure on the nerve root can alleviate pain and improve function in the spine.
Our surgeons may use one of several decompression techniques when correcting an overly pronounced spinal curvature. These include procedures to remove part or all of the lamina, which is the bony roof of each vertebra, or bone in the spine. This is called a laminectomy.
Surgeons may also enlarge the opening in the spinal canal through which nerve roots travel to other parts of the body. This opening is called the foramen, and the surgical procedure is called a foraminotomy.
A third type of decompression allows surgeons to remove part or all of a spinal disc—the cushion-like material between the bones of the spine—that has collapsed or is pinching a nerve. This is called a discectomy.
Any or all three of these decompression techniques may be required during surgery for scoliosis or kyphosis.
An important part of spine surgery in people with scoliosis or kyphosis is to restore as much normal curvature to the spine as possible. Surgeons use strong, durable plates, rods, and screws to correct the spine’s alignment. A spine with more normal curvature is also less likely to pinch a nearby nerve root, because surgical correction restores a clear path in the spinal canal for the nerves to travel through.
In order to permanently correct a spine that is excessively curved, doctors also perform a spinal fusion.
Surgeons perform spinal fusion as part of every spinal reconstructive surgery in people with adult scoliosis or kyphosis. Spinal fusion stabilizes the spine by permanently joining two vertebrae together, eliminating movement between them. Typically, small pieces of bone taken from other parts of the body, called "grafts," are placed in between vertebrae to help them fuse together. In time, new bone grows over the graft. The main job of the screws and rods placed during surgery is to hold the vertebrae solidly together while the bone growth occurs.
Spinal fusion may be performed to join two or more vertebrae together. Severe scoliosis or kyphosis may require fusion of multiple vertebrae in order to stabilize and straighten the spine.
Most spinal reconstructive surgeries take six to eight hours. You can expect to remain at NYU Langone for a minimum of five days while your body heals.
In the days immediately following surgery, pain management specialists ensure that you have the medication you need to remain comfortable while you recover. In addition, physical medicine doctors assess your level of mobility. Many people are able to stand or walk the day after surgery, though movement may be minimal at first, and older people may need more time to recover in bed.
Within one week of surgery, most people are able to walk and return home. However, some people may require additional care and assistance after leaving the hospital, until they can walk and move with ease. NYU Langone doctors can refer you to appropriate at-home or inpatient support services as needed.
For 8 to 10 weeks following surgery, physical activity should be limited to gentle, low-impact movements as the spine fuses and heals. However, total bed rest is not recommended. Walking and moving at least a little bit every day can help to speed recovery and prevent complications. At 10 to 12 weeks, you can begin physical therapy, strengthening core muscles and improving flexibility and movement. For best results, physical therapy should continue for a year after surgery.
Follow-up appointments with your surgeon occur at least every three months for the first year after surgery to make sure the fusion heals correctly. An X-ray is usually conducted during these appointments so your doctors can confirm that the spine is stable and the nerves are decompressed.
The majority of people who have spine surgery for adult scoliosis or kyphosis feel a significant reduction in pain and can move more easily within three to six months after surgery. However, every person’s recovery timeline is different. Your doctors ensure that you are making the appropriate progress and can help you to prevent any complications or setbacks.
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