Sept. 05, 2019
All three Mayo Clinic campuses have neurosurgeons who specialize in the treatment of spinal deformity. Working with colleagues in related specialties, Mayo's highly trained neurosurgeons provide comprehensive care for the full range of spinal deformities in children and adults.
Best upright posture and corrected alignment
A. Lateral X-rays show the best upright posture of a 70-year-old man with Parkinson's disease and severe kyphotic and scoliotic deformities above and below a previous fusion, including a cervical kyphosis. Obtaining this view required piecing together several X-rays. In addition to the severely abnormal posture, the patient experienced significant leg pain from a pinched nerve in the low back. B. Postoperative X-rays show corrected alignment. Surgery was performed in a single-stage operation through the posterior approach, stabilizing and fusing much of the spine. The surgery greatly improved the patient's ability to perform daily activities.
"We treat all spinal deformities — both severe and more-typical cases, in younger as well as older patients," says Jeremy L. Fogelson, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota. The outcomes can be striking.
Following Mayo Clinic's team approach, specialists in neurology, physical medicine and rehabilitation, and pain medicine work with neurosurgeons on the initial evaluations of people with spinal deformities. For small deformities associated with mild back pain, physical therapy and injections are generally the initial treatment recommendations. When surgery is indicated, Mayo Clinic uses minimally invasive surgery when appropriate, as well as robotic guidance, intraoperative monitoring and navigation to minimize the risk of complications.
"Our technology helps us to optimize treatment outcomes. The precise placement of instrumentation results in more-effective stabilization of the spine, which minimizes the need to return to the operating room for corrective surgery," says Eric W. Nottmeier, M.D., medical director of the spine center at Mayo Clinic in Jacksonville, Florida.
As a high-volume center for spinal deformity, Mayo Clinic has experience with the range of treatment options. "The surgeons at all three of our campuses have the training and insight to utilize technology appropriately, in ways tailored to the needs of the patient. We decipher who is going to do best with a particular technology," says Jamal McClendon Jr., M.D., a neurosurgeon at Mayo Clinic in Phoenix/Scottsdale, Arizona. "That training allows us to deliver a consistent quality of care, irrespective of region."
Options for all types of care
The wide range of spinal deformity treated at Mayo Clinic encompasses all forms of scoliosis and kyphosis, high-grade spondylolisthesis, and cervical spine and post-laminectomy deformity, as well as revision surgeries. Intraoperative monitoring to measure neural function and integrity is performed by highly trained technicians and monitored by a neurophysiologist on-site. Three-dimensional spinal navigation is used to guide the placement of spinal hardware, and intraoperative CT to check screw placement.
All members of the patient care team have spinal deformity expertise, including nurses and anesthesiologists dedicated to caring for patients during complex spinal procedures. Postoperative care and rehabilitation are provided by physical medicine and rehabilitation specialists, pain specialists, and physical and occupational therapists who routinely work with people who have spinal deformity surgery.
Before or after surgery, Mayo Clinic can provide additional care to improve bone health. "A large proportion of patients with spinal deformities have osteopenia or osteoporosis. We partner with our endocrinologists in these cases because we believe that optimal management requires working with specialists dedicated to bone metabolism and bone health," Dr. Fogelson says.
Misalignment and nearly normal alignment of grade 5 spondylolisthesis of L5 on the sacrum
A. X-ray, CT and MRI demonstrate grade 5 spondylolisthesis of L5 on the sacrum in a 12-year-old girl. B. On the left, a preoperative X-ray shows misalignment. On the right, a postoperative X-ray shows nearly normal alignment.
Mayo Clinic's expertise facilitates optimal outcomes even in the most challenging cases. Dr. Fogelson cites a healthy 12-year-old girl who experienced progressive difficulty maintaining upright posture, as well as leg pain, weakness and numbness. The pain worsened with standing and walking, forcing the girl to stop playing sports. After a diagnosis of spondylolisthesis, nonoperative treatments failed to resolve the patient's pain. Surgery performed by a combined neurosurgical and pediatric orthopedic team utilized a single-stage posterior approach.
"The patient is three years out from surgery, and her symptoms have completely resolved," Dr. Fogelson says.
X-rays show spinal curvature, pre- and post-spinal fusion
On the left, preoperative X-rays show spinal curvature in a 53-year-old woman who presented at Mayo Clinic with pain in her right leg, low back and ribs. As a child, the patient developed scoliosis, which progressed slowly over the years. After confirming that nonsurgical management wouldn't adequately treat her pain, Mayo Clinic neurosurgeons performed a spinal fusion in a single surgery through a posterior approach. On the right, postoperative X-rays show the result.
Mayo Clinic also has extensive experience with severe curvature in younger adults. Many of these patients had scoliosis as children. "Although these patients are relatively young and otherwise healthy, they can experience a lot of pain, and benefit from surgery," Dr. Fogelson says.
For physicians considering referral to Mayo Clinic, Mayo's neurosurgeons are able to discuss cases by telephone or electronically. "At Mayo Clinic, we have the breadth and depth of expertise to utilize multiple strategies for spinal deformity, irrespective of the complexity," Dr. McClendon says. "Our care is always individualized to the patient."