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Technique offers gentler scoliosis surgery option

By Laurie Holloway
July 2009

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Joseph Cheng, M.D., director of the Neurosurgery Spine Program at Vanderbilt University Medical Center, and Kurt Eichholz, M.D., assistant professor of Neurosurgery, are two of just a handful of surgeons in the nation who are performing a new, less-invasive scoliosis surgery.

The advanced procedure realigns the spine through several much smaller incisions, using retractor tubes and specialized instruments and implants.

During the surgery, Cheng carefully works through a three-inch incision. Using an osteotome, a chisel-like tool used to cut bone, and a rubber mallet, he chips away at the spine. Beside him, titanium hardware sits arrayed on a tray. When the procedure is finished, he uses two metal rods, 17 screws and two cross-link plates to reconstruct the backbone.

The technique takes 20 percent to 30 percent longer than the open-spine method.

The result: Patients are up walking more quickly, require less pain medication, lose less blood and leave the hospital sooner. “The recovery is typically three to five days versus seven to 10 for open surgery,” Eichholz said.

“This really isn’t a revolutionary idea,” Cheng said. “It’s an evolution. That’s the trend in medicine, asking ‘what can we do to help our patients and get them better faster?’

“Over time, we’ve started readapting our surgical techniques to ask, ‘can we do this better, with less trauma to the patient, and still accomplish the same goals?’”

The surgery itself isn’t different, Cheng explained.

“At the end of the day, what we’re trying to accomplish is all the same,” he said. “The only difference is that we’re trying to do it in a kinder, gentler way. We’re getting our patients out of the hospital sooner, they’re feeling better, they’re recovering better and they seem to recover faster.”

Cheng estimated that about 15 percent of deformity surgeries could be performed this way.

“The patients benefiting the most seem to be those who would not have done well with a longer hospitalization stay,” he said. “That includes patients who need to return to work quickly or want to stay more active, as well as older patients who are at higher risk of complications from a longer hospital stay, such as pneumonia.”

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