When surgery is necessary for scoliosis, the Weill Cornell Brain and Spine
Center takes the least invasive approach possible. The goal of surgery
is to straighten the curve, halt its progression, fuse the spine, and
insert implants. The surgeon will choose specific surgical procedures
for the patient depending on the details of the diagnosis. Our spine surgeons
have developed expertise in some of the most technically advanced surgery
Minimally Invasive Lumbar Fusion: This surgery fuses the bones of the spine in the lower back together so
that there is no longer any motion between them. This reduces spinal pressure,
pain, and nerve damage and fixes the deformity. Minimally invasive lumbar
fusions do not require the large incision or the muscle retraction typically
used in conventional fusions. Patients undergoing this procedure have
a fast recovery time. A recent advance is the use of a computerized image
guidance system for many patients undergoing lumbar fusion. This has the
advantage of aiding the surgeon in optimal placement of screws and avoiding
injury to delicate nerve tissue.
Until recently, all patients undergoing lumbar fusion required a bone graft
either from the hip region or from a bone bank. Currently, many patients
are candidates for BMP, a synthetic protein which encourages bone growth.
One major advantage of the BMP is that it eliminates the need for a second
operative site for bone grafting. In most patients undergoing lumbar spinal
fusion, metal titanium instrumentation is also used. This will typically
involve placing pedicle screws into the bone and connecting these with a rod.
Posterior Cervical Laminectomy: Laminectomy is surgical procedure used to treat severe cases of cervical
scoliosis. Surgery is performed under general anesthesia, and the pressure
of the spine is decreased by removing the portion of the vertebrae that
is compressing the spine and nerve structures. Bone grafts are inserted
into the spine and held in place by rods and screws, which stabilizes
the neck and creates a fusion of the vertebrae. Over time, as the neck
heals, new bone grows around the screws and fuse the spine. Patients usually
wear a hard, cervical collar for 6 weeks after surgery.
In the XLIF procedure, a neurosurgeon approaches the spine from the side
and inserts a spacer to correct curvature.
XLIF (Extreme Lateral Interbody Fusion): This advanced method of minimally invasive surgery approaches the spine
from the side, avoiding the major muscles of the back. A spine surgeon
makes a small incision in the patient’s side, between the lower
ribs and pelvis, and inserts a special surgical instrument just above
the disc space. The surgeon removes the damaged disc tissue and inserts
a spacer between the vertebrae. The surgical team monitors the position
and correct placement of the spacer, sometimes using special screws or
a plate on the side of the spine to offer additional stability. Patients
typically are walking within a few hours of the XLIF procedure and are
then discharged the next day. Most patients are back to work within approximately
two weeks. (Download the “About Lateral Access Surgery” brochure here)
In the X STOP procedure, a spacer inserted in a minimally invasive procedure
corrects the curvature of the spine.
X STOP Procedure: The X STOP is a new FDA-approved device for the treatment of lumbar scoliosis.
The X STOP device is a titanium spacer that can be inserted between the
spine and ligaments and tendons as an alternative to laminectomy and/or
fusion. Unlike a laminectomy, no bone removal is required. Generally placement
of the X STOP can be performed under local anesthesia in under one hour.
Many patients are up and walking that same day.