Combined Anterior and Posterior Instrumented Scoliosis Correction

Benefits of Combined Anterior and Posterior Instrumented Scoliosis Correction

This surgical technique offers several advantages over traditional single-approach scoliosis surgeries and non-surgical treatments.

• Greater Correction of Severe Curves – This dual approach allows better control over complex and rigid spinal deformities.

• Enhanced Spinal Stability – Anterior and posterior instrumentation provide superior long-term stability for conditions like congenital, neuromuscular, or syndromic scoliosis, reducing the risk of curve progression.

• Lower Risk of Revision Surgery – The combined approach ensures a complete correction, decreasing the likelihood of needing additional surgeries.

• Improved Pulmonary Function – This procedure enhances breathing capacity for curves affecting lung expansion by restoring proper spinal alignment.

• More potent Bone Fusion – Spinal fusion is more effective when the spine's front and back are stabilised, promoting solid bone growth.

• Faster Recovery and Rehabilitation—The overall healing process is optimised by addressing all aspects of spinal deformity in one surgery.

What Health Conditions Require Combined Anterior and Posterior Instrumented Scoliosis Correction?

This procedure is recommended for scoliosis cases that require extensive correction due to complexity or severity. The decision to perform a combined approach depends on the degree of curvature, rigidity, and underlying medical conditions.

Idiopathic Scoliosis

This is the most common form of scoliosis with no identifiable cause. If your spinal curvature exceeds 50 degrees and continues to progress despite bracing, surgical intervention may be necessary. The combined approach helps correct rigid curves and restores spinal balance for improved posture and mobility.

Congenital Scoliosis

This condition arises from spinal abnormalities present at birth. Vertebral malformations can lead to severe deformities as you grow. Since congenital scoliosis often involves complex structural issues, a combined anterior and posterior correction is preferred to achieve better alignment and fusion.

Neuromuscular Scoliosis

Conditions such as cerebral palsy, muscular dystrophy, and spinal cord injuries can weaken spinal muscles, leading to progressive curvature. If scoliosis affects your sitting balance, lung function, or overall quality of life, this combined procedure ensures optimal correction and spinal stability.

Syndromic Scoliosis

Certain genetic conditions, like Marfan syndrome or Ehlers-Danlos syndrome, cause connective tissue disorders that result in severe spinal deformities. A combined surgical approach provides better control over spinal alignment and minimises complications associated with these syndromes.

Degenerative Scoliosis

Age-related spinal degeneration can lead to scoliosis in older adults, causing pain, nerve compression, and mobility issues. This procedure offers long-term relief if conservative treatments fail by stabilising the spine and preventing further curvature progression.

Indications for the Surgery

This procedure is recommended when a single surgical approach is insufficient for proper spinal alignment. Your doctor may suggest this surgery under the following conditions:

• Severe or Rigid Scoliosis – If your spinal curvature exceeds 70 degrees or has become too rigid, this combined approach offers better correction.

• Progressive Scoliosis – Surgical intervention may be necessary if scoliosis worsens despite bracing or conservative treatments.

• Congenital Vertebral Malformations—If you were born with structural spinal abnormalities, this procedure effectively corrects and stabilises the spine.

• Neuromuscular Scoliosis – If your condition is caused by muscle weakness from cerebral palsy, muscular dystrophy, or spinal cord disorders, this approach provides enhanced stability.

• Syndromic or Degenerative Scoliosis – If scoliosis is linked to genetic syndromes or age-related degeneration, this surgery helps restore spinal balance

• Failed Previous Surgery—A combined approach provides a more comprehensive realignment if a previous spinal surgery did not achieve the desired correction.

How Does Combined Anterior and Posterior Instrumented Scoliosis Correction Work?

This procedure is a carefully planned, multi-step process that involves two surgical approaches to achieve optimal spinal alignment and stability.

• Preoperative Planning: A detailed evaluation, including X-rays, MRIs, and CT scans, determines the severity of scoliosis and the most effective correction strategy. Your surgeon will decide the best incision sites and surgical techniques based on your spinal condition.

• Anterior Approach: The surgeon makes an incision in the chest or abdomen, depending on the curve’s location. Intervertebral discs are removed to increase spinal flexibility and bone grafts or spacers are placed to promote fusion.

• Posterior Approach: After repositioning you for posterior surgery, the surgeon makes an incision along the spine. Metal rods, screws, and additional bone grafts are placed to stabilise the corrected spinal curvature.

• Spinal Fusion: Bone grafts stimulate new bone growth and permanently join the treated vertebrae. This prevents further curvature progression and strengthens spinal stability.

• Instrumentation Placement: Titanium rods and screws hold the spine in its corrected position while fusion occurs. These implants provide immediate structural support.

• Postoperative Monitoring: You are closely monitored after surgery to ensure a smooth recovery. Pain management, physical therapy, and gradual mobilisation are key components of postoperative care.

This dual approach maximises correction potential and enhances long-term functional outcomes, especially in rigid or severe scoliosis cases.

Preoperative Guidelines

Proper preparation before surgery ensures a smoother procedure and better recovery. Following these preoperative guidelines will help optimise surgical outcomes.

Medical Evaluation

Your healthcare provider will conduct a comprehensive evaluation, including a review of your medical history, current medications, and overall health status. Blood tests assess infection risks, blood clotting ability, and nutritional status to minimise complications.

Imaging and Diagnostic Tests

Advanced imaging, such as X-rays, MRIs, and CT scans, helps in surgical planning. These scans provide a clear view of your spine, allowing your surgeon to determine the exact curvature and the best approach for correction.

Adjusting Medications

Certain medications, including blood thinners, anti-inflammatory drugs, and specific herbal supplements, may increase surgical risks. Your doctor will guide you on which medications to stop or adjust before surgery to reduce bleeding and ensure safe anaesthesia administration.

Nutritional Preparation

A well-balanced diet strengthens the body for surgery and supports postoperative healing. Nutritional supplements may be recommended to enhance bone health and immune function. Adequate hydration is also essential.

Lifestyle Modifications

Maintaining a healthy weight, avoiding smoking, and engaging in light physical activity can improve surgical outcomes. Smoking cessation is crucial, as tobacco use can impair bone healing and increase the risk of complications.

Informed Consent

Before surgery, your doctor will discuss the procedure, expected outcomes, potential risks, and recovery process. You will have the opportunity to ask questions and address concerns. Signing an informed consent form confirms your understanding and agreement to proceed with the surgery.

The Surgical Procedure: Step-by-Step

Combined anterior and posterior instrumented scoliosis correction is a highly specialised procedure performed in multiple stages to achieve optimal spinal alignment and stability. Your surgical team follows a precise step-by-step approach to ensure a safe and effective outcome.

Anaesthesia and Positioning

Before surgery, general anaesthesia is administered to keep you wholly unconscious and pain-free. You are then carefully positioned according to the surgical approach. The anterior approach requires a side-lying or supine position, while the posterior approach involves a prone position to allow access to the back of the spine. Special padding and supports minimise pressure on the body during the procedure.

Anterior Approach: 

A controlled incision is made in the chest or abdomen to access the front of the spine. The affected intervertebral discs are carefully removed to allow for spinal flexibility. Bone grafts or interbody spacers are placed between vertebrae to promote fusion. Specialised screws and plates secure the spinal alignment while fusion occurs.

Posterior Approach: 

Once the anterior procedure is complete, you are repositioned, and an incision is made along the back. The surgeon places titanium rods and screws into the vertebrae to provide additional stability. Any remaining spinal curvature is corrected by adjusting the rods, ensuring proper alignment. Additional bone grafts are applied to enhance fusion.

Spinal Fusion and Stabilisation

Bone grafts stimulate new bone growth between vertebrae, permanently stabilising the corrected spinal structure. Over time, the grafts fuse with existing bone, preventing further spinal curvature. The combination of anterior and posterior fusion ensures long-term spinal strength.

Closing the Incisions and Postoperative Monitoring

The incisions are carefully closed using sutures or surgical staples. Temporary drainage tubes may be placed to prevent fluid accumulation. You are then transferred to a recovery unit, where your vital signs are monitored closely. Pain management and early mobilisation strategies begin as part of postoperative care.

Recovery and Rehabilitation

Recovery after scoliosis surgery requires a structured rehabilitation plan to restore mobility, strength, and spinal stability. Your recovery journey includes several key phases, each focusing on gradual improvement and long-term well-being.

Immediate Postoperative Care

You will be monitored in the intensive care unit (ICU) for the first 24–48 hours to ensure stable vitals and pain control. Temporarily, a catheter and drainage tubes may be placed. Within a few days, physiotherapists will help you begin early mobilisation.

Pain Management

A combination of intravenous medications and oral pain relievers helps control post-surgical discomfort. Your medical team tailors pain management strategies to ensure comfort while minimising side effects.

Physical Therapy and Rehabilitation Plan

Within the first week, a customised physiotherapy program begins to prevent stiffness and improve mobility. Exercises focus on strengthening core muscles, improving posture, and protecting the spine.

Return to Daily Activities

It is encouraged to resume daily activities gradually. For support, you may temporarily need to wear a spinal brace. Light activities, such as walking, can be resumed within a few weeks, while strenuous activities require medical clearance.

Long-Term Follow-up and Monitoring

Regular follow-up appointments assess spinal healing and implant stability. X-rays and MRI scans track bone fusion progress. Your doctor provides guidelines for long-term spine care, ensuring sustained recovery and optimal function.

Potential Risks and Complications

As with any major surgical procedure, this surgery carries some risks. However, advanced surgical techniques and careful monitoring minimise potential complications.

• Infection Risk – Despite sterile techniques, infections can occur but are managed with antibiotics and wound care.

• Nerve Injury—Spinal manipulation can cause Temporary nerve irritation or, in rare cases, permanent nerve damage.

• Blood Loss – This procedure involves significant correction, and blood transfusion may be required to maintain stability.

• Implant-Related Issues – Rods or screws may loosen over time, potentially requiring revision surgery.

• Spinal Fusion Failure – In some cases, the bone grafts may not fuse properly, necessitating additional interventions.

• Pulmonary Complications – The anterior approach may temporarily affect lung function, requiring breathing exercises for recovery.

Discussing these risks with your doctor helps you understand preventive measures and ensures optimal surgical outcomes.

Why Choose MIRSS Combined Anterior and Posterior Instrumented Scoliosis Correction?

Choosing the right medical centre is crucial for a successful outcome after spine surgery. MIRSS is the best spine surgery hospital in Bangalore that offers cutting-edge facilities and a team of skilled spine specialists who ensure the highest standards of surgical care.

• At MIRSS, you receive a multidisciplinary approach to scoliosis treatment. The surgical team includes robotic spine surgeons, spine care specialists, anesthesiologists, and physiotherapists who collaborate to provide comprehensive care. 

• Advanced imaging technology ensures precise preoperative planning, while state-of-the-art surgical equipment enhances accuracy and safety.

• The hospital follows internationally recognised surgical protocols to minimise complications and maximise recovery. 

• From preoperative evaluation to postoperative rehabilitation , every stage is meticulously planned to optimise your spinal health. Personalised rehabilitation programs help you regain mobility and strength faster.

• Advanced pain management strategies and 24/7 monitoring prioritise your comfort and well-being. 

MIRSS is committed to delivering superior clinical outcomes and ensuring that you receive expert care every step of the way.