I have moderate scoliosis, a curvature of the spine. Fortunately for me, my curve is S-shaped and both curves are balanced. This means that I stand upright, my movement and everyday life is not affected (aside from back pain) and you wouldn’t be able to tell that I have the condition if you saw me out buying a coffee. However others with scoliosis are not so lucky and surgery is an unavoidable path that they must trudge, in order to improve their quality of life.
But what does spine surgery look like? Many surgeries involve fusing the vertebrae of the spine around the area affected, or inserting rods and screws, as seen in Figure 1. Surgeries are highly invasive and can require extensive recovery periods, with original flexibility near impossible to regain in some cases.
Fig 1. University of Utah Hospital, Radiology Department. X-ray of U.S. girl, age 16 years 10 months, with post-operative scoliosis. Front, standing, clothed. 5 February 2010. X-Ray Image. Wikimedia Commons. Web. 12 Mar. 2015.
Is this all we can hope for? Will I need to have my back completely split open, my spine melted together or drilled into, them stitched back together? Quite the dramatization but I like to think that the answer to this question is no. With the advances in medical science, I would like to expect technology to advance in leaps and bounds across all areas, including spinal surgery.
Aside from the fact that currently a person’s main supportive skeletal structure can be morphologically changed without them falling apart (pretty incredible as it is), evidence of surgical development can be seen already. An Internet search will lead you to the Bonati Institute, which proudly claims to be the “1st U.S. FDA-Approved Laser Assisted Spine Procedures” as of 1991. Laser technique allows for less invasive surgery, claiming to avoid the open spine aspect and offer a much quicker recovery time.
Dig a little deeper and you will find even more enticing and promising publications. For example Waleed A. Alsunbul et al. recently published a paper discussing the use of an inflatable device to extend the spine appropriately during cervical surgery (2014). This device would improve on previous techniques used which are often inadequate in situations when components need to have their position adjusted mid-surgery (Alsunbul et al., 2014). While this device is newly proposed and has yet to infiltrate mainstream surgical practices, it is evidence that the tools used for spine surgery are continually being improved.
Beyond the physical realm of surgery, there are the psychological effects that come with a radical post-operative change in posture and quality of life. This is an area that I do not think many (including myself) would consider initially; it is logical to think that when the structural issue is fixed, the pain and discomfort will be alleviated also. However it is a known phenomenon that surgical success does not always result in a perceived success for the patient. It turns out that there are psychological factors at work.
Jake Epker and Andrew Block have suggested that screening patients to assess psychological status before spine surgery can help to reduce “failed” surgeries (2014). These results can help to guide patient support and recovery after surgery, to cater to individual psychological needs as well as nurturing the body back to full health. Studies such as Epker and Block’s are important for the development of the field of spine surgery as they prompt the use of a wider lens to view what would appear to be a mono-dimensional, purely physical problem.
I make no claim to be an expert in the area of spine surgery. Much of what I know stems from my personal experience of regular consultations with a scoliosis specialist, discussions with a relative who performs spine surgeries (what a coincidence!) and curiosity-fuelled Google searches. I may not be an expert but I am very involved, biologically even. And I like what I see. Progress is being made and will continue to be made over the coming years and decades.
Perhaps when I need my spine fixed, the surgical techniques of today will be entirely antiquated. I wonder, what’s next?
Epker, Jake, and Andrew R. Block. "Psychological Screening before Spine Surgery: Avoiding Failed Surgery Syndrome." Psychological Injury and Law 7.4 (2014): 317-24. Print.
For more information on the Bonati Institute:
http://www.bonati.com
This is a really interesting topic and its future is exciting. It is obvious that there needs to be much more research and proven results from clinical trials. Some things that I am curious about are: How many/what kinds of people does this affect in the general population? And what would you prioritize in going through with a surgery: achieving better visual appearance of your spine, better flexibility, or less back pain?
ReplyDeleteThe personal story associated with this blog post made this entry especially fascinating. I knew very little about scoliosis and spinal surgery prior to reading. The psychological effects of spinal surgery were interesting as well because they were something I had never considered before. It goes to show that there are many aspects that doctors and patients need to consider before undergoing surgery.
ReplyDeleteI agree with Megan in that your personal experience really enhances this research's significance. I always thought that psychological complications of surgery would mostly dictate recovery time, not the perceived success level of the treatment itself. Additionally, as innovations like robotic surgery become commonplace, I wonder if the psychological dangers will be mitigated.
DeleteThe ability to transform a structural aspect of the human body with a minimally invasive surgery makes me wonder if we can live in a future without surgery. I understand that is unlikely; however, I feel as thought physicians are trying to transition to less invasive surgeries or laser-based surgeries. When I shadowed a surgeon, he performed a minimally-invasive surgery and completed all of his major tasks by looking at a video of the inside of his patient. With that in mind, I wonder how many different surgeries are/ can become minimally invasive?
ReplyDeleteThe ability to transform a structural aspect of the human body with a minimally invasive surgery makes me wonder if we can live in a future without surgery. I understand that is unlikely; however, I feel as thought physicians are trying to transition to less invasive surgeries or laser-based surgeries. When I shadowed a surgeon, he performed a minimally-invasive surgery and completed all of his major tasks by looking at a video of the inside of his patient. With that in mind, I wonder how many different surgeries are/ can become minimally invasive?
ReplyDeleteThis is a really optimistic post, and it makes me happy that there is significant progress being made in the field of spinal surgery! I was particularly interested in how they would screen patients in order to reduce failed surgeries. If they could do this for spinal surgery, would it be possible to screen for other orthopedic surgeries?
ReplyDeleteThis was a very intriguing post! My dad has scoliosis and as a kid they highly recommended surgery, however, he didn't want to have to deal with the extensive recovery and cumbersome brace and opted not to have the surgery. Now later in life he is still feeling the effects of this decision, but had these new options been available perhaps things would be different.
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