Canadian first: new scoliosis correction technique at CHUM

Two patients at the University of Montreal Hospital Centre (CHUM) recently became the very first in Canada to benefit from a scoliosis correction technique that only recently arrived in the country.

The technique involves applying custom-made guides to each of the patient’s vertebrae before drilling into the bone, in order to allow the most effective and safest correction possible.

The Canadian Press was granted exclusive access to the second surgery, including a lengthy discussion with orthopedic surgeons Jesse Shen and Zhi Wang, and a tour of the operating room on the day of the procedure.

“It’s possible to perform this surgery without the need for technology, but now we have technology to help us perform a safer procedure,” summarized Dr. Shen.

“You can drive a car and get to point B without GPS, but now we all have a camera in the car and there are better ways to get from point A to point B.”

Scoliosis is a three-dimensional deformity of the spine. This means that the spine is potentially deformed in all directions, not just on one side or the other.

In a traditional procedure, multiple images are taken of the patient’s anatomy, and on the day of surgery, the doctor relies on these images, his expertise, and his experience to make the correction.

The procedure recently introduced at the CHUM involves creating a three-dimensional model of the patient’s spine. Guides are then custom-made and their fit is checked on the 3D model both before and during surgery.

If the fit on the model is correct, the surgeon positions the guide directly on the patient’s corresponding vertebra, allowing him to install the screws necessary for the correction with minimal risk and maximum precision ― a crucial advantage when we know that sometimes he only has a margin of about one millimeter to avoid damaging the spinal cord, with all the catastrophic consequences that this could have.

“The more severe the scoliosis, the greater the difficulty and the greater the risk,” said Dr. Wang. “But if we can reduce the risk to 0.1 per cent, instead of 2 or 5 per cent, why wouldn’t we do it?”

Even the most experienced surgeon may have to forgo installing two or three screws during a freehand procedure, which could affect the quality of the correction, he added.

“The last case we did (with the new technique), we missed zero screws, everything was successful,” he rejoiced.

In the operating room

Dr. Shen became familiar with this technique during his training in the United States, where it has long been used, and it will come as no surprise that he and his colleagues had to overcome multiple regulatory, bureaucratic, and budgetary hurdles to import it to Canada.

However, it has clear advantages for both the patient and the surgeon, he argued.

“I feel like my body is slowing down, I’m not as stressed (during the procedure),” Dr. Shen said. “I feel 100 per cent more confident.”

This comfort, if we can use that term, is palpable during The Canadian Press’ visit to the operating room. 

Dr. Wang, who is waiting to take over from his colleague, is inexhaustible when it comes to explaining everything we see. Dr. Shen, despite holding his patient’s life in his hands, seems as at ease as if he were grilling hamburgers by the pool.

We were even surprised to hear him greet us and welcome us shortly after our arrival, when we assumed he was completely absorbed ― rightly ― in his task.

“It reduces my stress and it helps everyone else on the team because all the screws are pre-planned,” he explained during our meeting. “It increases safety, it reduces stress, and it can just help everyone.”

He’s clearly right. None of the surgical team members seem particularly stressed by the procedure during our visit. We even see one nurse dividing her attention between the screens in front of her and her cell phone.

However, we must not fall into the trap of letting technology take over, warned Dr. Wang.

“It doesn’t replace the surgeon’s expertise,” he said. “As they say in English, ‘a fool with a tool is still a fool.'”

Paradigm shift

The introduction of this new technique reflects the changes that have taken place in scoliosis correction in recent years, said Dr. Wang, who began practicing in 2008.

“It’s a whole different world,” he said. “At that time (in 2008), if the patient came out of the operating room without pain and able to move their legs, that was already a ‘winner’. Today, it’s not enough for the patient to move their legs, they have to get better. The battle is not won just because they move their legs.”

Patients undergoing scoliosis correction are often young adults, which comes with its own set of challenges because there is no “right time” for this procedure, only “less wrong times,” Wang said.

Going under the knife can thus interfere with pursuing studies, starting a career, or starting a family. Dr. Shen had to gently bring his patient back to reality, as she was hoping to go on a trip at the end of July.

However, surgery can’t be delayed constantly, as scoliosis worsens with each passing year. And since these patients often still have 50 or 60 years of life ahead of them, it’s critical to restore their quality of life as quickly as possible, Dr. Wang said, “because we’re not the ones living with the pain, they are.”

“(The pain) affects their mental health,” he recalled. “They can’t exercise, they gain weight, they can’t watch a movie without getting up two or three times because their back is in the wrong position…”

Drs. Shen and Wang agree on one point: it is very “frustrating” not to be able to offer the best possible option to the patient when you know it exists.

Patients don’t know everything, Dr. Shen said, “but we do, we know there’s something faster, safer, and easier.”

And even if there are budgetary constraints, Canada cannot always live in the 1990s and we cannot run a crowdfunding campaign every time, added Dr. Wang.

“Why would I do hand-to-hand cases if there is something more reliable, better for me and for the patient?” he asked in conclusion. “Why would I jump into the ocean without a life jacket?”

–This report by La Presse Canadienne was translated by CityNews