Chapter 26 Spinal Fusion in Adolescent Idiopathic Scoliosis
Surgical Overview
• The curve fused and levels of fusion are determined by the identification of the primary and secondary curves as well as the severity of the curve.
1 The first and the last vertebra of the major curve(s) are identified and all included vertebras are fused.
2 To achieve a neutrally rotated spine, the fusion must often extend one level above the scoliotic curve.
• The possible surgical approaches for correction of scoliosis include a posterior spinal fusion (PSF), an anterior spinal fusion (ASF), or a combination of both.
• The most common surgical procedure performed for correction of AIS is a posterior spinal fusion in conjunction with posterior instrumentation.
1 In a PSF, a subperiosteal exposure is made followed by facet excision, and fusion is achieved with bone obtained from the iliac crest or ribs.
• An anterior approach is often chosen when there is a single lumbar curve or for a thoracolumbar curve.
1 For this surgical approach, the segments included in the fusion are those central to the structural central area of the curve.
• A combined anterior/posterior spinal fusion for AIS is indicated for large, stiff curves and/or a progressing curve that demonstrates a rotational deformity, especially in a skeletally immature patient.
Rehabilitation Overview
• At HSS, physical therapy plays a primary role in the post-surgical rehabilitation of AIS. The rehabilitation program following ASF and/or PSF surgery is designed to progressively return patients to their prior level of function.
• The focus of physical therapy is to restore trunk and core abdominal strength, upper and lower extremity flexibility and strength, as well as educate the patient in proper posture and body mechanics.
• Both the anatomy and biomechanics of the spine pre- and post-surgery must be considered throughout the course of treatment. The biomechanics of the fused levels are altered post-surgically as well as those levels just above and below the fusion.
• Continuous communication between the surgeon, therapist, and patient is key for a successful outcome.
• Throughout the rehabilitation course, the patient should play an active role in his or her recovery by setting and working toward functional goals. The patient must be compliant with all spine precautions to protect the healing fusion and be diligent in performing his or her home exercise program (HEP) to ensure carryover and success in the rehabilitative process.
