Anterior (frontal) surgery for reduction of scoliosis may be offered for curves that are mainly at the thoracolumbar junction (T12-L1). This approach requires an open incision and the removal of a rib (usually on the left side). The diaphragm can then be released from the chest wall and spine, giving clear exposure of thoracic and lumbar spinal vertebral bodies for removal of discs to loosen up the spine. Screws can then be placed in the vertebral bodies and a reduction of the curvature obtained and held with a rod. Bone is added to the disc space (usually the patient’s own or bone morphogenic protein, a bone substitute, may be used), to allow the spine to fuse together. This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.
The anterior approach to scoliosis surgery means fewer lumbar vertebral bodies will need to be fused and some additional motion segments can be preserved, particularly important for lower back curves (lumbar spine). Another advantage is that the anterior approach to scoliosis surgery can sometimes allow for a better reduction of the curve and a more favourable cosmetic result.