Spinal Deformity Surgery : It Becomes an Essential Part of Neurosurgery

Abstract

Among the spinal disorders, the treatment approach for spinal deformities has been discussed least among department of neurosurgery. But nowadays, more and more neurosurgeons are interested in spinal deformities as well as complex spinal disorders and are doing not a few surgeries for these kinds of disease. Nevertheless, it is mandatory to understand the course of spinal deformity, principles of treatment, and surgical outcomes and complications. Understanding of the biology, biomechanics and metallurgy of the spine and instrumentation are also required for successful spinal deformity surgery. We need senior mentors and good surgical and neurophysiologic monitoring team. Knowledge of spinal deformity may be augmented with spine fellowships and surgical experience. Step by step training such as basic knowledge, orthopedic as well as neurosurgical disciplines and surgical skills would be mandatory. Neurosurgeons can have several advantages for spinal deformity surgeries. By high-level technical ability of the spinal cord handling to preserve neurological function and familiarity with microscopic surgery, better synergistic effect could be expected. A fundamental understanding of pediatric spinal deformity and growing spine should be needed for spinal deformity surgery.

Keywords: Instrumentation; Neurosurgeon; Outcomes; Scoliosis; Spinal deformity.

Fig. 1.

Learning curve of operative time (A), surgical bleeding (B), and correction rate (C) for adolescent idiopathic scoliosis surgery by a neurosurgeon[14].

Fig. 2.

Intraoperative photographs of revision pedicle subtraction osteotomy. Using a microscope, spine surgeon can perform spinal deformity surgery more safely.

Fig. 3.

Preoperative whole spine plain radiographs (A and C) showing scoliotic curvature with 150 degrees scoliosis due to cerebral palsy. Right : postoperative 6 months’ whole spine plain radiographs (B and D) demonstrating a balanced trunk and pelvis after surgical correction. She underwent selective dorsal rhizotomy for rigidity on her lower exteremities and deformity corrective surgery in a single day by two attending neurosurgeons. Total operative time was about 8 hours.