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Penn Adult Spine Deformity Program Heals with Expertise and Advanced Care

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Dr. Vincent Arlet of Penn Medicine

Spinal deformity (scoliosis and kyphosis) can have a significant impact on quality of life, and patients with these spinal deformities know the struggle well, as many manage cosmetic issues, functional limitations, and occasionally, severe curvatures that can be painful or dangerous. Patients who once were told that nothing could be done for their severe spinal deformity now can gain significant improvement in function and quality of life at the Penn Adult Spine Deformity Program.

“We take on challenging cases that lots of other places would not take on,” said Vincent Arlet, MD, Chief of Orthopaedic Spine Surgery.

Depending on the patient’s age, severity and shape of the spine curvature − in addition to mobility issues and the extent of the patient’s pain − there are several different treatment options for spinal deformity. Initially, the first treatments are conservative, such as bracing, cortisone injections, physical therapy or pain medication. If those treatments are not effective, surgery may be recommended.

Benefits of Minimally Invasive Surgery

These ‘front’ or ‘side’ surgical approaches help avoid complications which can come from cutting muscles and nerves when operating from the back. The patient benefits immensely − typically receiving smaller incisions and reduced blood loss during surgery, having shorter hospital stays, following, and possibly less need for post-surgery medications.

Different Approaches for Better Outcomes

At Penn, we use several minimally-invasive techniques that utilize muscle sparing technologies. Compared to other approaches, these techniques result in both better outcomes and less pain for patients.

These procedures are performed by a surgeon specifically trained in these approaches, and both the spine team and the approach team have experience from more than 1,000 cases. In each approach, disc material is removed from between two lumbar vertebrae, creating a space. A bone graft or implant is inserted into this space, supported by rods and screws. The most common options include:

  • Anterior Lumbar Interbody Fusion (ALIF) – approaching the spine from the front
  • Direct Lateral Interbody Fusion (DLIF) – approaching the spine from the side
  • Oblique Lumbar Interbody Fusion (OLIF) – approaching the spine from the flank

Whole Spine Imaging Technology

“Focusing precisely on every aspect of treating adult spine deformity is of greatest importance to the program,” Dr. Arlet noted. “We want to get the most perfect result we possibly can, so we are careful in every single detail.”

Understanding the benefits of optimal imaging, Penn’s Adult Spine Deformity Program also stands out for its use of new technologies to support careful diagnosis and complex treatments: The EOS imaging system allows for 3D x-rays of the whole body, from head to toe, producing better imaging for surgery planning, and providing fewer complications and improved surgical outcomes. Penn is able to correct the spine deformity to the patient’s precise anatomy.

Penn Medicine is the only adult Pennsylvania center with this type of detailed imaging system, which uses five times less radiation than a conventional x-ray. In addition, Penn utilizes an MRI machine which is safe for patients who have pacemakers or other implants, who typically can’t go for imaging procedures.

Multidisciplinary Care with Penn Spine Center

The Penn Spine Center specialists work alongside the Adult Spine Deformity Program to plan the best treatment plan for each patient with other experts, including orthopaedic surgeons and physicians, neurosurgeons, cardiologists, anesthesiologists, physiatrists and physical therapists.

We offer patients safety and expertise in all of these domains. This collaboration between spine specialists from all of these disciplines is what makes the Penn Spine Center one of the most sophisticated and comprehensive programs in the nation.” said Dr. Arlet.

Treating Adult Patients of All Ages

Penn’s comprehensive program treats spine deformities in all adult patients, ranging from teenagers to senior citizens. Experts in the Adult Spine Deformity Program assess which patients may need conservative treatment such as physical therapy, cortisone injections or − in some cases − geriatric rehabilitation, and who could best benefit from surgery.

For teens with scoliosis, the Penn Spine Center physicians understand when bracing is appropriate or if surgery is needed. They also offer solutions for young adults who were previously treated with adolescent idiopathic scoliosis. And because scoliosis worsens and causes more problems over time, middle-aged patients in their 40s and 50s may suffer great pain from spine deformity and our program provides treatment to slow further progression. Penn’s spine specialists successfully treat many geriatric patients, as well − including those who have increased back and nerve pain from severe scoliosis, or who suffer leg pain from spinal stenosis.

Spine deformity surgery is customized to each patient” says Dr. Arlet. “It is no longer acceptable to perform only one type of surgery. For each patient, we have to review and discuss the different surgical options with our patient and choose the best treatment plan with the best outcomes for the patient. At Penn, the correction of scoliosis, kyphosis, flat back or spondylolisthesis is tailored to each patient’s specific anatomy and needs. This approach allows for safer surgery - in many instances maximizing results.”

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