Our Summary

This research paper is about a study that was done to understand if patients with severe and rigid scoliosis are at risk of aortic injury during corrective surgery. Scoliosis is a condition where the spine curves in an unnatural way and in severe cases, the spine can curve more than 90 degrees. The aorta, the main blood vessel in the body, can be at risk during surgery to correct this curve.

The study involved 27 patients with severe right thoracic or thoracolumbar scoliosis. The researchers examined how close the aorta was to the spine at different points along the curve, and used this information to estimate the risk of injuring the aorta during surgery.

They found that the aorta moves to the side and backwards as it goes down from the top of the curve, and then moves back towards the middle and forwards from the peak of the curve.

The risk of aortic injury was found to be higher when the direction or length of the surgical screw was incorrect. However, the size of the screw didn’t seem to significantly affect the risk. The risk was highest at the top and bottom of the curve when the screw was 40mm long, 5mm in diameter, and the direction was off by 30 degrees. The risk was lowest at the peak of the curve.

The researchers concluded that in patients with severe and rigid scoliosis, the aorta moves more to the side and backwards, and the risk of injury is lower at the peak of the curve compared with moderate scoliosis. They suggest that careful planning before surgery and the use of technology during surgery could minimize these risks.

FAQs

  1. What is the potential risk of aortic injury during scoliosis correction surgery?
  2. How is the position of the aorta relative to the spine evaluated in patients with severe and rigid scoliosis?
  3. How can the risk of aortic injury during scoliosis surgery be minimized?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about scoliosis surgery is to ensure careful preoperative planning and consider the use of intraoperative navigation or robotics to minimize the potential risk of aortic injury during correction surgery, especially in cases of severe and rigid scoliosis. It is important to be aware of the spatial relationship between the aorta and spine, as well as the potential risks associated with pedicle screw misplacement. By taking these precautions, the risk of complications during surgery can be reduced.

Suitable For

Patients who are typically recommended for scoliosis surgery include those with severe and rigid scoliosis, with a main curve Cobb angle greater than 90° and flexibility less than 30%. These patients may experience significant spinal deformity and curvature that can lead to pain, difficulty breathing, and other complications. In such cases, surgery may be necessary to correct the curvature and prevent further progression of the condition. Additionally, patients with severe scoliosis may be at a higher risk of aortic injury during surgery, so careful preoperative planning and the use of navigation or robotics can help minimize this risk.

Timeline

Before scoliosis surgery, a patient with severe and rigid scoliosis will undergo imaging tests such as computed tomography to assess the position of the aorta relative to the spine. This is done to evaluate the risk of aortic injury during the correction surgery. The patient will also undergo preoperative planning to determine the optimal placement of pedicle screws.

During the surgery, the patient will be placed under general anesthesia and the surgeon will carefully navigate around the aorta to avoid injury. Pedicle screws will be inserted into the vertebrae to correct the spinal curvature. Intraoperative navigation or robotics may be used to assist in the placement of the screws.

After the surgery, the patient will be closely monitored in the hospital for any complications. Physical therapy and rehabilitation will be initiated to help the patient regain strength and mobility. Follow-up appointments will be scheduled to assess the patient’s progress and ensure proper healing of the spine.

What to Ask Your Doctor

  1. What is the position of my aorta relative to my spine and is there a risk of aortic injury during the surgery?
  2. How will you ensure that the pedicle screws are placed accurately to minimize the risk of aortic injury?
  3. Are there any specific techniques or technologies you will be using during the surgery to prevent injury to the aorta?
  4. What are the potential complications or risks associated with aortic injury during scoliosis surgery?
  5. How common is aortic injury during scoliosis surgery and what is the success rate in preventing it?
  6. What is the recovery process like if aortic injury occurs during the surgery?
  7. Are there any alternative treatment options available that may reduce the risk of aortic injury?
  8. What steps can I take to help minimize the risk of aortic injury before and after the surgery?
  9. How will you monitor my aorta during the surgery to ensure its safety?
  10. Are there any specific warning signs or symptoms I should watch out for that may indicate aortic injury post-surgery?

Reference

Authors: Yang H, Liu Z, Guan L, Liu Y, Liu T, Hai Y. Journal: World Neurosurg. 2020 Jul;139:e626-e634. doi: 10.1016/j.wneu.2020.04.065. Epub 2020 Apr 24. PMID: 32339734