Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
In Situ Fusion
The surgical choice for a progressive kyphotic deformity is a solid fusion or arthrodesis of the deformed vertebrae. The fusion may also include one normal vertebra above and one normal vertebra below this area. Bone graft from the patient or tissue bank is placed posteriorly, on the back of the spine, along the area of the abnormality. In severely angulated curves, additional bone graft may be placed anteriorly, on the front of the spine, as well as from behind.
Often the fusion is done without the use of instrumentation and without attempting any correction of the abnormality. This is called an in situ fusion- to fuse as is. The bone graft will require 4-6 months to mature into a solid fusion mass. During the postoperative period the fusion must be protected with a cast or brace until x-rays demonstrate a solid fusion.
Fusion, Instrumentation, and Osteotomy/Vertebral Body Resection
With progressive kyphotic curves in older children, surgery may include instrumentation (rods, hooks, and screws) that helps to correct the deformity. If the spinal cord is unable to tolerate the manipulative techniques that "straighten" the spine, the surgeon may consider the removal of the mis-shapened vertebrae to realign the spine. The postoperative course remains the same until the fusion mass is determined by x-ray to be solid.
|Figure 1: Preoperative x-ray of a failure of formation kyphotic spinal deformity (Courtesy John Killian, MD).||Figure 2: Postoperative x-ray of the instrumentation and fusion of the spine anteriorly and posteriorly.|