Surgical Collaboration Treats Complex Spinal Deformities


A unique collaboration at Brigham and Women’s Hospital is helping patients with scoliosis and other complex spinal problems reclaim their quality of life. The Adult Spinal Deformity and Scoliosis Program, led by co-directors Hasan A. Zaidi, MD, Melvin C. Makhni, MD, MBA, and Yi Lu, MD, PhD, is one of the very few in the country to bring together specialists in neurosurgery and orthopaedic surgery to treat patients through the entire continuum of care.

“The vast majority of spinal surgeries around the world are conducted by a surgeon and a trainee,” said Dr. Zaidi, a neurosurgeon. “I recently studied this phenomenon and found that having dual-attending surgeons reduces operative time, shortens hospital stays and lowers the risk of complications. This approach also brings different perspectives to bear in the surgical treatment of spine deformities and helps improve patient outcomes.”

Complex Deformities Require Complex Surgery

Physicians and surgeons at the Adult Spinal Deformity and Scoliosis Program treat conditions including degenerative scoliosis and spinal deformities, tumors and trauma. They also treat patients with thoracic deformities and tumors as well as those who have had multiple spine surgeries that have resulted in fractures or misalignment.

“Scoliosis and spinal deformities can have detrimental effects on patient quality of life,” said Dr. Makhni, an orthopaedic surgeon. “These abnormal curvatures don’t always require surgery, but when they progress, pain and overall functional disability can become quite profound and require complex surgical intervention. These complex surgeries can benefit from having the perspectives of both neurosurgeons and orthopaedic surgeons.”

Drs. Makhni and Zaidi, along with Dr. Lu, a neurosurgeon, apply a variety of spinal decompression and fusion techniques in extensive, multi-level procedures. Surgical techniques range from open, complex osteotomies, which provide robust deformity correction, to minimally-invasive anterior lateral-approach surgery, which results in reduced surgical trauma and morbidity.

Depending on the patient’s anatomical condition, the team may apply a novel surgical technique pioneered at the Brigham: a single-position prone lateral approach in which the surgeon can access the patient’s spine from both the lateral and posterior angles from a single position. This solution minimizes the need for the patient to be repositioned during surgery and still allows the patient to realize the full benefit from both approaches. According to Dr. Lu, this technique shortens surgery length, reduces morbidity and allows the surgeons to more easily access the spine.

“We also use a game-changing neuronavigation system that allows us to see exactly where to place spinal screws with pinpoint accuracy,” Dr. Lu said.

The team has also presented and published about other novel surgical techniques. These include a procedure called the “kickstand rod” technique to correct coronal imbalance in spinal deformity patients as well as use of novel medications to reduce surgical blood loss.

A Balanced Approach for a Balanced Spine

The total care team extends beyond surgeons to include specialists in rehabilitation and pain management.

“We all work together and jointly follow the patient from the time they walk into one of our offices through postsurgical follow-up, providing a true multidisciplinary workup,” Dr. Zaidi said. “The care process starts with a detailed biomechanical diagnosis, which allows us to develop the right treatment plan. Our ultimate goal is to restore the patient’s natural curvature and create a balanced spine so the patient has less pain, improved function and a better quality of life.”

Dr. Makhni and his complex spine colleagues meet weekly to discuss the best approach for patients and to improve collaborative care. They also review previous cases to determine how to make surgeries even safer and outcomes even better.

“The Brigham has built a novel infrastructure to provide collaborative, multidisciplinary surgical and nonsurgical care,” Dr. Makhni said.

Drs. Makhni, Zaidi and Lu agreed that having specialists with different perspectives ultimately results in safer, more effective care and improved patient outcomes.