Your Guide to Scoliosis Treatment...Follo s bswhealth 1 Scolio reatmen uide 4708 Alliance Blvd. #800, Plano, TX 75093 | 469.814.2464 | BSWScoliosisCenters.com Your Guide to Scoliosis

Follow Us: @bswhealth

1Scoliosis Treatment Guide4708 Alliance Blvd. #800, Plano, TX 75093 | 469.814.2464 | BSWScoliosisCenters.com

Your Guide to Scoliosis TreatmentAs your partner in care, we are dedicated to helping you get better. We developed this guide to answer common questions about scoliosis, including risk factors, symptoms and treatment options. If you have any specific questions about your care after reading this, please discuss them with your physician. We hope this is a valuable resource for you on your journey to better.

The spine is the backbone of your body, consisting of a series of vertebrae that provide support for the body and protect the spinal cord. Scoliosis is an irregular curvature of the spine. Instead of being a straight line, the spine twists to the right or left, presenting as a “C” or “S” shape. When the abnormality begins to cause both physical and cosmetic issues and interferes with daily life, it may be time to start researching viable treatment options.

Why Choose Baylor Scott & White Scoliosis CenterBaylor Scott & White Scoliosis Center specializes in treating advanced scoliosis. Since January 2005, the Center has focused on the care of adult scoliosis patients. We offer scoliosis screening, bracing and conservative care for patients from all over the United States and throughout the world.

There are only a handful of facilities in the nation that are equipped to offer spinal reconstructive surgery for scoliosis and revision surgery, and Baylor Scott & White Scoliosis Center is proud to be among this elite group. The medical staff features fellowship-trained scoliosis surgeons who specialize in scoliosis care and offer advanced treatment options to help reduce pain and significantly improve the quality of life for each patient.

Treatment OptionsThere are several treatment options for patients with scoliosis. The majority of cases can see success through conservative, non-surgical treatments. The type of treatment plan depends on the severity of your scoliosis and your level of pain.

https://www.bswscoliosiscenters.com/?utm_source=treatment-guide&utm_medium=offline&utm_campaign= 16-ALL-0013-Scoliosis&utm_content=footer-link



Surgical Treatments

If non-surgical treatments for scoliosis have failed, your doctor may recommend surgery. There are two types of surgery to correct your scoliosis: anterior and posterior spinal fusion.

• Anterior Lumbar Interbody Fusion (ALIF) is a type of spinal fusion that utilizes an anterior (front – through the abdominal region) approach to fuse the lumbar spine bones together. Interbody fusion means the inter-vertebral disc is removed and replaced with a bone or metal spacer; in this case, using an anterior approach.

The anterior technique is often favored when multiple spinal levels are being fused and multiple discs need to be removed. ALIF may be performed for the correction of spinal deformity. ALIF is also commonly performed for a variety of spinal conditions, such as spondylolisthesis and degenerative disc disease among others. ALIF is generally done on levels *L3- S1. A general/vascular surgeon will be present to perform the anterior approach and assist during the procedure. DLIF Direct Lateral Interbody Fusion (DLIF) and Extreme Lateral Interbody Fusion (XLIF) are spinal fusion techniques to stabilize the spine. Discs are removed from the mid to upper lumbar spine through a small tube and spacers are placed for fusion.

• Posterior Fusion with Spinal Instrumentation is the most common procedure for the correction of spinal deformity. An incision is made in the middle of the back. The muscles are moved to the side to expose the spine. The joints between the vertebrae are removed to loosen them up. If there is a severe deformity, a cut is made in the bone called an osteotomy, in order to realign the spine into a more normal orientation. The body responds by producing new bone which eventually bridges the gaps between the vertebrae and makes them fuse together. Metal implants – rods, screws, hooks or wires made of titanium and/or cobalt chromium – are

Non-surgical Treatment Options

Before surgery is considered to manage scoliosis, non-surgical options are first explored. This can include a combination of any of the following, over the course of several weeks or months:

• Observation – Many individuals do not require surgery to correct their condition. Pediatric patients in particular need to be observed closely before and during their adolescent growth spurt to identify curves that are progressing rapidly and those that remain stable over time.

• Spinal Rehabilitation – Physical therapy is often needed to stabilize the spine. While physical therapy has not been shown to alter the rate of curvature progression in adults, core strengthening and conditioning programs often help improve back pain. If surgery should ultimately be required, physically fit patients often have an easier time recovering.

• Pain Management – Anti-inflammatory medications and mild narcotics can be administered via injections to help relieve back pain.

• Epidural Steroid Injections – These types of injections can be helpful in relieving the leg pain that occurs as a result of scoliosis.




Smoking and other forms of nicotine impair wound healing and the spinal fusion process. Stopping smoking will improve your overall outcome. This also includes dip, chewing tobacco, nicotine patches and gum, since these contain nicotine. If you need medications to help you quit, please consult with your primary care physician. After all necessary tests and evaluations have been concluded, the selection committee will review all results to determine eligibility. The team must determine whether the liver disease is advanced enough to necessitate transplantation, and whether you are otherwise healthy enough to tolerate surgery.

As with any surgery, there are risks. Before deciding to move forward with surgery, it’s important to discuss with your surgeon and weigh the benefits and risks of your procedure in order to make an educated decision.

Once you have decided to have surgery, there are many things to do to make sure that you’re healthy enough for a complex surgery and to evaluate your spine in order to plan your surgery in detail. For medical clearance you will need a chest X-ray, EKG and blood work, and in some cases a cardiac stress test and/or pulmonary function tests. Most surgical patients will have one or more of the pre-operative spine tests listed.

Planning ahead for surgery can help make the process easier by reducing stress, minimizing risk and making you more successful long-term. Some considerations before surgery include:

anchored to the vertebra in order to straighten and hold the spine still while the vertebrae fuse.

• Revision Surgery is for patients whose original scoliosis surgery proves unsuccessful. The most common reason for spine revision surgeries is pseudoarthrosis, a condition in which the spine does not heal correctly. Surgical revision may also be needed for junctional scoliosis or kyphosis that occurs when the discs above or below the initial fused area of the spine become worn, shrink or lose their shape. In some cases, individuals require revision surgery because they’ve developed a new deformity that is a secondary outcome of their primary surgery.

Revision surgery is essential to help identify the underlying problem. Because every patient is different, Baylor Scott & White Scoliosis Center goes through a rigorous preoperative regimen to pinpoint the underlying problem, determine the best course of action and identify potential complications.

The board-certified, fellowship-trained spine surgeons on our medical staff are nationally renowned leaders in their field and have developed a number of successful strategies to reverse the consequences of failed initial surgeries. At our Center, we help patients realize positive outcomes and long-lasting, pain-free results – even those who were told nothing could be done.

Considerations

Lifestyle Changes Before Surgery

Complications, Risks and Side Effects

Before Your Surgery




A medical examination is required to determine whether you’re healthy enough for surgery. Medical clearance prior to surgery is completed by an internal medicine physician, along with a cardiologist, hematologist, or pulmonologist if necessary. Please remember to bring your medication list to all appointments.

You will be required to have cardiac clearance prior to surgery if you are currently under the care of a cardiologist, have a history of cardiac issues, or have risk factors for heart disease. You will be asked to provide the care coordinator with the name and telephone number of your cardiologist. This will allow us to obtain any cardiac studies such as an EKG, stress test or echocardiogram if you have had any of these tests performed in the last year for our surgical chart.

Blood work will be needed two weeks prior to surgery. This may be completed at a lab near your homeif timing allows for us to get results back; otherwise they will need to be done near our center. Theselabs will check the basic blood work and possibly some additional lab work depending on your medicaland surgical history. A urine sample will also be taken to rule out urinary tract infection.

Blood work must be completed. You may have it done at a lab near your home. These labs will check basic blood work and possibly some additional labs depending on your medical and surgical history. Fasting is not required for this test. We will confirm the location and date with you.

Pre-testing/pre-registration will be done at the hospital. During this appointment you will be pre-registered for surgery, and have a platelet test (to show how your blood clots), a chest x-ray and an EKG if not done recently.

If your hospital pre-operative/pre-registration appointment is not the day prior to surgery, you will need to visit the hospital for one last blood test. This is to determine your blood type and provide additional information for the blood bank. This test must be done by the hospital the day prior to surgery.

Your schedule with dates and times will be sent to you by a care coordinator. The following may be required before surgery.

Medical Examination

Cardiac Clearance

Blood Work

Two Weeks Before Surgery

One week Before Surgery (To be done within 1-7 days prior to surgery depending on dates and needs).

Day Prior to Surgery

Pre-Surgical Schedule

These tests are completed pre-operatively (before surgery), and our care coordinators will help make arrangements. When your schedule is finalized a letter with your preoperative testing schedule and appointments will be sent to you.




Studies have demonstrated that the rate of non-fusion in smokers is as much as twice that found innon-smokers. It is thought that this is related to the negative effect nicotine has on bone growth (which is essential for achieving a spinal fusion). One of the most negative effects of nicotine is decreased revascularization of the bone graft. In essence, the bone graft does not get enough nutrients due to a lack of blood supply and, therefore, does not grow and cannot form a fusion. Another recently discovered effect of nicotine is that it may have anti-inflammatory effects, which also interfere with fusion healing.

Because of this, we require that patients undergoing a spinal fusion be nicotine free prior to receiving a surgical date. Once you are 100% nicotine free for two weeks, a nicotine test will be given. This test will show the nicotine (current in your system) and cotinine. The cotinine is a biomarker for exposure to nicotine, and it is stored in your fat cells. This will take about six weeks to show negative, but this level is not of concern on the first test. We will do another nicotine test with your pre-operative blood work. Your nicotine should still be negative. If your cotinine is higher than the previous test, that will tell us that you did smoke at some point and this could lead to your surgery being postponed or temporarily canceled.

Smoking and Nicotine

It is important to avoid certain medications prior to surgery. The medications listed below can affect bleeding and swelling, increase the risk of blood clots, and cause other problems if taken. Medications may have been prescribed to you by one or more of your physicians to treat the condition for which you are having surgery, or perhaps they may have been prescribed to treat another condition unrelated to your surgical diagnosis. In either case, if they are listed below they must be discontinued at the appropriate time prior to surgery or there is a chance that your surgery will be canceled or rescheduled for your safety.

Please note that there are many over the counter medications, herbals, vitamins and supplements that may negatively affect your surgery and recovery. It is crucial that you provide us with an accurate list of all medications you currently take when you schedule your surgery. Also, if there are any changes in medications from the time you schedule surgery to your date of surgery please notify us so we can update your medication list.

If you are taking Coumadin (warfarin), aspirin, or anti-platelet medication, for heart or blood clotting conditions, please discuss this with our office prior to discontinuing. We may need to speak with your physician so we can determine how this should be managed before and after surgery.

Remember to check the labels of all your medications, even those you purchase over the counter, to be sure you are not taking aspirin or anti-inflammatory drugs. Tylenol® does not promote bleeding and is generally fine to use in place of aspirin or other anti-inflammatory medications. If you are unsure about any medication, please contact our office. We will review the medication in question and advise you whether or not to discontinue.

Medications to Stop Prior to Surgery

Risks to the Donor




Guidelines for Stopping Medications

Medication Type Discontinue May Resume

Herbs and Supplements 3 Months Prior 2 Weeks After

Hormones, Birth Control 4 Weeks Prior 3 Months After

NSAIDs/Anti-Inflammatory 2 Weeks Prior 6 Months After

Prescriptions with Blood Thinners Consult Physician Up to 1 Month After

OTC with Blood Thinners 2 Weeks Prior Up to 6 Months After

Bone Density Medications Consult Physician Up to 6 Months After

MAOI 2 Weeks Prior Up to 6 Months After

• Herbs and Supplements - Alfalfa, Aloe Vera, Bilberry, Bromelain, Cayenne, Danshen, Dong Quai, Echinacea, Ephedra, Ephedrine, Feverfew, Fish Oil, Garlic, Ginger, Ginkgo, Ginseng, Goldenseal, Hawthorn, Kava Kava, Krill Oil, Licorice, Ma Huang, Omega-3 Fatty Acids, Red Clover, Saw Palmetto, St. John’s Wort, Vitamin E, Valerian, Yohimbe, Daily Multivitamins

• Hormones (HRI) - Activella, Aygestin, Estrogen, Estradiol, Levonorgestrel, Mirena, Micronor, Nor Q, Premphase, Prempro, Prometrium, Provera, Birth Control Pills/Patches/Shots

• NSAIDs/ Anti-Inflammatory - Celecoxib/Celebrex, Diclofenac/Voltaren, Ibuprofen/Motrin, Etodolac/Lodine, Ketoralac/Toradal, Indomethacin/Indocin, Naproxen/Aleve & Naprosyn, Mobic, Oxaprozin/Daypro, Vicoprofen, Piroxicam/Feldene

• Prescribed Medications with Blood Thinning Agent - Stop Any/All Blood Thinning Medications Aggrenox, Aspirin, Arixtra, Brilinta, Carisoprodol w/ASA, Coumadin, Endodan, Fiorinal, Effient, Prasugrel Magan, Plavix, Pletal, Percodan, Persantine, Pradaxia, Soma, Compound, Xarelto, Rivaroxaban, Ticlid

• Over the Counter (OTC) with Blood Thinning Agent - Alka Seltzer, Anacin, Ascriptin, BC Powder, Bayer, Doan’s, Dristan, Ecotrin, Excedrin, Kaopectate, Midol, Pamprin, Pepto Bismol, Sine-Off, St. Josephs, Vanquish (Check the labels of all your medications, even those you purchase over-the-counter, to be sure you are not taking any aspirin or anti-inflammatory drugs.)

• Bone Density Medications - Actonel, Boniva, Fosamax, Evista, Miacalcin

• Monoamine Oxidose Inhibitors - Isocarboxazid (Marplan), Phenelzine (Nardil), Pirlindole (Pirazidol), Moclobemide (Aurorix, Manerix), Selegiline [L-Deprenyl] (Eldepryl, Zelapar, Emsam), Tranylcypromine (Parnate)




Day of Surgery

What to Expect Following Surgery

• Anesthesia will call you the night before to review your medical history and medications. Please have a list of medications available including herbs and supplements.

• Wear loose fitting comfortable clothing. If your surgery requires hospital stay, pack a small bag of personal items.

• Do not wear any make-up, creams or lotions. Deodorant is OK.

• Please remove all jewelry before surgery and leave it at home to prevent loss.

• Do not wear contact lenses. You may wear eyeglasses and dentures.

• You may brush your teeth the morning of surgery, but do not drink anything.

• Remove all fingernail polish.

• Be sure you have your insurance card and ID / Driver’s license with you.

You will wake up in the post-operative recovery area, called the PACU. Your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. Once awake, you will be moved to a room where you’ll increase your activity level (sitting in a chair, walking). If you’ve had a fusion, a brace may need to be worn.

You will be given pain medications by IV and mouth for pain relief to make sure you are comfortable and to help you move. However, the soreness and stiffness in your back and/or limbs will continue for some time. Please take regular pain relief.

A degree of tingling and/or numbness in your limbs may be experienced after surgery and may take some time to subside.

Some patients will have a drain tube near the surgical site to help prevent any collection of fluid at the operation site. The drain is usually removed in 24 to 48 hours.

Pain

Tingling/Numbness

Drains




You will have a IV in your arm to receive fluids and antibiotics during and after surgery. The fluids will be stopped when you are drinking sufficient fluids and after the doctor has stopped the prescribed antibiotics.

A catheter may be inserted into your bladder under anesthesia to drain your bladder during and immediately after surgery. The catheter is removed the day after surgery.

Following your surgery, you will have inflatable compressors on your calves to reduce the risk of deep vein thrombosis (DVT). You may also be given a pair of anti-thrombotic stockings.

Initially, you will be allowed only sips of fluid and crushed ice. Once bowel sounds are present, you will start on a post-operative diet and gradually increase to a full diet.

It is common not to have bowel movements for the first few days. Once you have started on afull diet, you will be given medications to help with bowel movements.

You may have difficulty sleeping for the first few nights.

Physical therapy personnel will see you the day after surgery and get you out of bed and walking.

Drips

Catheter

Calf Compressors

Diet

Bowels

Sleeping

Activity


If you’ve been living with the pain associated with scoliosis and your physician has been unable to provide relief, we can help. More than half our patients come from 100+ miles away for treatment.

While many centers are reluctant to try to correct a failed first procedure, we specialize in complex or challenging deformities—particularly those resulting from unsuccessful surgeries. Trust the experts at Baylor Scott & White Scoliosis Center to successfully treat your curve.

Looking for a Second Opinion?

You will be able to go home one to three days after your operation. How long you have to spend in hospital depends on the type of surgery you had and your state of health.

You can be discharged when:

• Your vital signs are stable

• You can ambulate with or without use of a walker

• You can eat without having nausea

• You can take pain medications by mouth

• You have resumed normal bladder activity

• Your drains are removed and your wound is healing

Guidelines for Stopping Medications



Photography may include models or actors and may not represent actual patients.

Physicians provide clinical services as members of the medical staff at one of Baylor Scott & White Health’s subsidiary, community or affiliated medical centers and do not provide clinical services as employees or agents of those medical centers or Baylor Scott & White Health.


Documents

Your Guide to Scoliosis Treatment...Follo s bswhealth 1 Scolio reatmen uide 4708 Alliance Blvd. #800, Plano, TX 75093 | 469.814.2464 | BSWScoliosisCenters.com Your Guide to Scoliosis