Dear reader, Medacta International is pleased to provide you with these basic guidelines to help you and your family gain the best possible understanding of this pathology. Please treat this booklet as a guide only. If you require additional information, please consult your doctor. Always follow your surgeon’s instructions, even when they differ from those outlined in this booklet.

Anatomy of the spine What is scoliosis What are the causes of adolescent scoliosis? What are the symptoms of adolescent scoliosis? Surgical treatment What happens during the surgery? Why would my doctor choose a MySpine surgery The MySpine advantage What to do before surgery Prepare your home What to bring to the hospital In the hospital 16 After the surgery 17 Frequently asked questions 18 This brochure has been produced to help you to feel comfortable and safe about your operation. It addresses questions you may have about the surgery and post-operative recovery.

IN T R OD U CT ION The Spine, also known as the backbone or vertebral column, consists of 33 interlocking bones positioned on top of each other. It is made up of 24 separate bones interspaced with the “intervertebral discs”, with the sacrum (5 fused bones) and the coccyx (4 fused bones) at the base. The spine is a complex combination of interconnected bones, tendons, muscles, ligaments and nerves, any of which can become injured, misaligned or damaged leading to dysfunction. The spine provides the main structural support of the body allowing mobility, the ability to walk upright, and it gives...

1. A N ATO M Y O F T H E S PIN E The spine is one of the most important structures in the human body. It supports much of the body weight, provides points of attachment for muscles and ligaments, and protects the spinal cord, which carries information from the brain to the rest of the body. A healthy spine is strong yet flexible, allowing for a wide range of movements. It appears straight if viewed from behind and curved from the side. To understand scoliosis, you must first understand what a healthy spine looks like. The spine is made up of vertebrae and is divided into five distinct regions:...

LATERAL VIEW (SIDE) POSTERIOR POSTERIOR VIEW (BACK) CERVICAL CURVE (LORDOTIC) TRANSVERSE PROCESS SPINOUS PROCESS THORACIC CURVE (KYPHOTIC) VERTEBRAL BODY INTERVERTEBRAL DISC LUMBAR CURVE (LORDOTIC) SACRAL CURVE INTERVERTEBRAL DISC VERTEBRA

2 . W H AT I S S C O L I O S I S Everyone’s spine has natural curves. Scoliosis is an abnormal rotation in addition to a lateral curvature in the normally straight vertical line of the spine. Patients with scoliosis could have curves that look more like a “C” (one curve) or an “S” (two curves). NORMAL CONDITION C-SHAPED CURVE

2 .1 W hat are the c auses of adolesc e n t sc oliosis? Scoliosis affects less than 1 percent of the world population[1], mostly children between the ages of 10-16 years. The most common form of scoliosis is called Idiopathic Scoliosis. “Idiopathic” means that the cause is unknown. The condition can be hereditary, so a child with a family history of scoliosis may be susceptible. Females are more disposed to the development of severe spinal curvatures than boys are. Less common forms of adolescent scoliosis[2] are: ■ Congenital Scoliosis: A fairly rare spine abnormality detected at birth ■ Neuromuscular...

3. T R E AT M E N T O P T I O N S In 90 percent of cases, scoliotic curves are mild and do not require active treatment[3]. Non-operative treatment is preferred, including periodic observation, pain relievers and physical therapy. The most important factors to determine the treatment are: ■ Severity and the location of the curve ■ Age, gender and physical maturity ■ Associated symptoms It is very important to monitor curves in an adolescent patient, to prevent the progression of the pathology. In an adolescent with moderate curves, bracing could be an appropriate treatment option to prevent an...

APPROACH The patient is positioned on the operating table in a comfortable prone position. A midline incision is made and the soft tissue is gently moved laterally to expose the bony structures that need to be treated. IMPLANT The pedicle screws are implanted into the vertebrae. The appropriate rods are selected and contoured in order to match the patient’s deformity. The rods are securely locked over the screws. Hooks may also be used in conjunction with screws for enhanced stability, and are placed around the pedicle or around the part of the bone called the lamina. CORRECTION Using dedicated...

3.3 W hy woul d my d o c to r c h oose a M y S pi ne su rge r y MySpine is a patient-matched, 3D printed technology tailored to the patient’s anatomy and simplifying the placement of pedicle screws. MySpine is a validated technology supported by scientific data.[4,5,6,7,8,9] The main patient benefits of MySpine are: ■ Accuracy of pedicle screw position[5] ■ Patient-matched technology allowing for surgical technique customisation ■ Low dose radiation protocol benefits the patients in comparison to C-Arm or O-Arm navigational technologies: up to 30 times less irradiation![4] ■ Potential reduction...

3.4 T he M y S pi ne ad van t age MySpine is a surgical instrument designed to accurately fit your vertebrae. How does it work? OBTAIN AN IMAGE OF YOUR SPINE The surgeon will ask you to have a CT scan of your vertebral column. Medacta have developed a specific “Low Dose CT Protocol” to ensure the safe acquisition of your image. In fact, you will receive a very similar amount of irradiation to one single spine x-ray! REPLICATION OF YOUR SPINE Using images of your spine, Medacta will create a plastic 3D model for each of the vertebra to be treated, in order to allow the physician to select the...

4. P R E PA R AT I O N Depending on your condition, your recovery will be tailored to meet your needs. Your physician will determine the appropriate length of your hospital stay. Your recovery will continue at home or in a rehabilitation centre. It is important for you to make a commitment to follow your doctor’s instructions so you can get the most benefit from your surgery. Plan for assistance in your home after surgery. Consider your need for assistance in meal preparation, cleaning and other home activities. 4.1 W hat to do b efo re su r ge r y Ten days before surgery According to your conditions,...