Specialized expertise for spinal deformity surgery

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.

"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.

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.

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."