Which vertebrae will be fused in the average scoliosis correction
Glen Burnie, MD
The vertebral levels fused during adult or pediatric scoliosis surgery varies. Some of the determining factors include: location of the curve, flexibility of the curve, and the patient’s overall balance. The "average" scoliosis correction typically requires 6-12 thoracic/lumbar vertebral levels to be fused.
St. Louis, MO
In the average scoliosis correction of the thoracic spine, the fusion starts at T3 or T4 and ends at T12 or L1. If there are thoracic and lumbar curves which need to be fused, then the distal levels typically are at L3 or L4.
Fusion levels are very important to your scoliosis surgeon. He or she will want to fuse as few levels as necessary to control the deformity of the spine. This is even more important in the mobile lumbar spine.
New York, NY
University of Utah Department of Orthopaedic Surgery
Typically, the vertebrae that are fused are those that are involved in the major structural curves associated with the scoliosis.
Texas Scottish Rite Hospital Orthopedic Group
In a single curve, about 8 vertebrae are fused, from the 5th thoracic to the first lumbar.
Because scoliosis is a highly variable disease, the question of what is an average correction is a very difficult one to answer. In general, a patient's curvature is defined by a very rigid segment that does not change with bending forward or to the side, and a non-rigid part that is called compensatory. This will change or straighten when the patient bends to one side or bends forward. In general, the scoliosis correction will encompass the entire rigid part of the curve. In adolescents this is typically in the part of the spine with ribs or just below this. In adults, it can extend to near the pelvis.
New York, NY
For a typical thoracic curvature, fusion will be from T5-T12, a total of eight vertebrae when done through a thoracoscopic approach. When done by the posterior approach, typically two or three more vertebrae will be included in the fusion. Thus, a significant advantage of the anterior and endoscopic approaches is that fewer levels are fused by a minimum of one to two segments. Often, when performing an anterior fusion for a thoracolumbar curve, a short segment fusion can be performed and achieve a very powerful correction in fewer segments of the spine. When doing a similar curve with a posterior approach two to three levels more are often included. With newer techniques using thoracic and lumbar pedicle screws, we can often limit fusion levels as well. An important goal of scoliosis surgery is to preserve the maximum number of segments of the spine in order to preserve long-term flexibility and function.
All of the vertebrae that are straightened with instrumentation are fused in their new and straightened position.
In general, the areas fused include some of the vertebra that are attached to ribs and are included in the curve itself. There is no "average" scoliosis correction or operation. It is difficult to make a blanket statement.
Everybody's curve is a little different. Typically we fuse at least the "Cobb curve" and sometimes we have to do a little more. You surgeon will talk to you about this.
Dr. Thomas G. Lowe
Woodridge Orthopaedics & Spine Center, P.C.
When the surgery can be done from the front, which is my preference at this point, usually only 4-5 vertebra will need to be fused. This allows for a normal full range of flexibility, full activity levels if it is in the thoracic spine or upper back. On average , 4-5 vertebra are fused in the lower part of the back when the surgery is done from the front. This may result in a slight restriction of motion, but in general will allow for return to full activities than perhaps contact sports.
New York, NY
The number of vertebrae fused depends on the severity of the scoliosis, the stiffness and length of the curve in the spine. In some cases only a few vertebrae may be fused, such as in a congenital curve in a young child or a flexible thoracolumbar curve. In general, for adolescent idiopathic scoliosis (thoracic and lumbar) 6 to 12 vertebrae are fused to provide correction and balance of the spine.
The vertebrae involved in the curvature will be fused – typically, the vertebrae toward the center of the back.
The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.
It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.