Scoliosis Surgery by DVR

1. What is it? Any common name for this procedure?

Direct Vertebral Rotation (DVR) is an advanced surgical technique used during scoliosis correction surgery. While traditional scoliosis surgery primarily focused on pulling the spine "sideways" to make it straight, DVR addresses the rotational component of the deformity.

Think of scoliosis not just as a side-to-side curve, but as a "spiral" staircase. DVR involves the surgeon applying force through pedicle screws to physically rotate individual vertebrae back into their natural, front-facing alignment. This un-twists the spine, which significantly improves the appearance of the "rib hump" often seen in scoliosis patients.

Common Names:

• True 3D Correction
• Rotational Deformity Correction
• Pedicle Screw Deformity Correction

2. Common Indications: When is it Recommended?

• DVR is a maneuver performed during a posterior spinal fusion for scoliosis.
• Adolescent Idiopathic Scoliosis (AIS): The most common form of scoliosis in teenagers where the spine has both a curve and a twist.
• Severe Rib Hump: When the rotation of the spine has caused the ribs to push outward on one side, creating a significant cosmetic deformity.
• Large Curves: Generally used for curves greater than 40 to 50 degrees that are likely to progress.
• Adult Degenerative Scoliosis: Where rotation causes significant nerve impingement or "leaning" to one side.

3. List of Associated Risks and Conditions

• Rib Hump (Gibbus): The protrusion caused by the rotated spine pushing the thoracic cage.
• Trunk Shift: When the torso is not centered over the pelvis.
• Screw Malposition: Because DVR involves applying torque (twisting force) to the screws, the bone must be strong enough to hold the hardware without breaking.

4. List of Screening Tests and Assessment Tools

5. Am I Eligible for This Evaluation?

• Curve Severity: Your curve is typically over 45 degrees or is rapidly progressing.
• Skeletal Maturity: Surgeons often use the Risser Scale (seen on X-rays) to determine how much growth you have left, which influences the timing of the surgery.
• Flexible vs. Stiff Curve: Surgeons use "side-bending" X-rays to see how much of the rotation is "fixed" and how much can be corrected by DVR.
• Bone Strength: The vertebrae must be healthy enough to anchor the pedicle screws used for the rotation.

6. Pre and Post Care

Pre-Care:

• Autologous Blood Donation: Some patients donate their own blood weeks before surgery in case a transfusion is needed.
• Neuromonitoring Prep: You will be told about the sensors placed on your limbs to monitor nerve health during the rotation maneuver.

Post-Care:

• "No BLT": For the first 6 months, you must avoid Bending, Lifting, or Twisting to allow the fusion to solidify.
• Height Change: Be prepared—straightening and un-twisting the spine often results in an immediate increase in height (typically 1–2 inches).
• Pain Management: Walking is usually started by day 2, but internal muscle soreness is common for several weeks.

7. Days Required for Hospitalization

• Surgical Time: 4 to 8 hours, depending on the length of the curve.
• In-Hospital Stay: 3 to 5 Days. This ensures pain is managed and the patient can walk independently.
• Full Recovery: 6 to 12 months for a solid bone fusion, though students usually return to school in 4 to 6 weeks.
• Hospitalization: 3–5 Days.

8. Benefits of the DVR Technique

• Superior Cosmetic Result: DVR is the best way to flatten a rib hump without needing to remove pieces of the ribs (thoracoplasty).
• Better "Balance": By un-twisting the spine, the shoulders and hips are more likely to be perfectly level.
• Maximum Correction: It allows for a higher percentage of "Cobb Angle" correction compared to older methods that only pulled the spine sideways.
• Lung Function: By normalizing the shape of the chest cavity, it can potentially improve long-term respiratory health.