Surgeons with Emory Orthopaedics & Spine Center Can Handle the Most Difficult Cases
Every week, the surgical team at Emory Orthopaedics & Spine Center meets to discuss complex cases. They collaborate with other world-class specialists within the Emory Healthcare system and develop individualized treatment plans for adults suffering from scoliosis and other spinal deformities. This focused approach helps them tackle the toughest cases and bring relief to patients who never imagined they had any treatment options.
A 68-year-old female was referred to the Emory Orthopaedics & Spine Center after living with scoliosis for over 55 years. She had experienced pain for most of her adult life but learned how to adapt and improvise as her spine gradually deteriorated.
When this patient presented to the Emory team, she was quite debilitated. Her spine was so curved that it was no longer able to hold her head up over her pelvis. She was having trouble breathing, her legs numbed out often, and her balance was so severely compromised that it was impossible to walk short distances without assistance.
X-rays, CT-scans and MRIs were reviewed. The patient had a significant curve (almost an 80-degree scoliosis) with a compensatory curve above it. The deformity led to a shortening of the patient’s trunk, which minimized space in the abdomen for her organs. The patient’s ribs were on top of her pelvis, making it very difficult to take deep breaths. In the lumbar region, the breakdown of the discs had resulted in compression of the nerves; this stenosis further compromised her ability to walk and complete simple activities of daily living.
Treatment & Outcome
A two-stage complex reconstructive surgery with an anterior and posterior spinal fusion with instrumentation was recommended for the patient. This type of surgery involves an approach through the abdominal cavity to access the anterior spine (disc and vertebra) and remove several discs. Those discs are then replaced with spacers.
The second stage approaches through the back, where the paraspinal muscles are elevated off the spine, arthritic joints are resected and screws are placed into the vertebrae to correct the scoliosis. The whole construct is held in place with two rods on either side of the spine. Bone grafting is then performed. The instrumentation holds the spine in position while the spine fuses together in one long column of bone. This fusion takes at least nine months to heal.
Before the surgery, an entire multi-disciplinary team of non-operative providers and physical therapists at Emory Orthopaedics & Spine Center ran a battery of tests and evaluated the patient to make sure she was fit for the operation. The clinicians made decisions together and guided the patient through pre-operative therapy to prepare her physically, mentally and environmentally for the difficult procedure and recovery.
The surgery itself was tailored to the patient's unique circumstances. It reduced the primary curve by almost 20 percent, which took pressure off the lungs and allowed for a more erect posture. Six months of recuperation enabled the fusion to heal. Then, the patient began a customized physical therapy regimen to expand the muscles in the rib cage that help with breathing, build core strength, work on leg strengthening and relearn body mechanics.
A year after surgery, the patient's breathing and digestion have improved immensely. She can walk unaccompanied again and has resumed an active lifestyle. She still sees a physical therapist and personal trainer every week to finesse minor residual issues but is doing well and has had no complications from the surgery.
Representative scoliosis X-rays of a patient with severe adult thoracic scoliosis, with shift of the chest to the right.
MRI showing curvature of the lumbar spine with decrease in the space for abdominal contents, including kidneys. Red circle shows cyst off of the fact joint causing nerve compression.
Two years post-operative X-rays of thoracolumbar fusion reconstructive surgery, showing improvement in alignment of trunk, decrease of scoliosis (less than 50% of original curve).
Who to Refer
Many patients with spinal deformities and scoliosis live a lifetime believing there is nothing they can do to improve their quality of life, but there are options. Even if a patient is not a candidate for surgery, there are other less-aggressive treatments that can help improve function and decrease pain such as scoliosis-specific physical therapy, injections, pain management and more.
It is reasonable to refer a patient of any age to the orthopedic spine group at Emory for a scoliosis evaluation when they meet the following criteria:
- X-ray shows over 20 degrees of scoliosis
- The patient is experiencing back pain, leg pain or other difficulties of daily living that encroach on the patient's lifestyle
Patients are first seen by a non-operative provider who can offer an expert opinion and consult with the surgical team if appropriate. This focused approach ensures each patient receives a treatment program that is unique to his or her specific situation. Plus, the Emory team circles back with referring physicians so they understand their patient's next steps and how to spot any medical complications related to the prescribed treatments.
To refer a scoliosis patient to the Emory Orthopaedics & Spine Center, call 404-778-3350 and a representative from Emory Healthcare will help schedule an appointment. Please reference ‘Scoliosis.'
Emory Orthopaedics & Spine Center is committed is committed to the continued health and safety of all patients. During this time, we are taking all necessary precautions to screen for coronavirus (COVID-19) and to prevent its potential spread. We continue to monitor the evolving COVID-19 pandemic and are working with experts throughout Emory Healthcare to keep your patients safe. For the most up-to date information for our referring partners, click here.