How many days will I be in the hospital?
Most patients are hospitalized for five days. Post-operative recovery is individualized but consistent. Usually, the first day is out of bed to the chair, the second day is walking in the hall, the third day is multiple walks, the fourth day more walking, and the fifth day – more walking, independent to bathroom, up and down stairs with minimal assistance.
At Saint Peters Hospital, where we have performed the vast majority of our ASC surgeries, our patients stay in the pediatric ICU (PICU) or adult ICU in a private room their entire stay in a special arrangement with the hospital.
While your level of care is not critical, you are in the ICU for nursing care and for convenience of the patient/ family. In an ICU setting, there is a higher level of care because of a higher medical staff to patient ratio, consisting of ICU doctors and nurses, and this provides consistent caregivers familiar with ASC.
Additionally, Dr. Cuddihy personally oversees your hospital care. A parent can stay in the room 24/7. Patients over the age of 26 will recover in the adult ICU (AICU), which also offers private rooms, specialized care, and consistent caregiving.
After hospital discharge, you are asked to stay local to the hospital area for three to five days depending on how far away you live, until your post operative visit, when the patient and family are ready to travel home.
How long will my surgery take?
Dr Antonacci’s surgical times are consistent due to his meticulous expertise, specialized team support, and his pioneering less invasive techniques. Dr Antonacci has created a dedicated surgical team and does not work surgically with anyone in training such as fellows, residents, or students. Since approximately 2010, Dr. Cuddihy has been his surgical partner. Together this duo has performed all the ASC by Drs. ABC surgeries, assuring elite level care from start to finish.
All curves must be individualized, but generally the correction for single curves takes approximately 2 hours. Double curves take 2 hours each .
With positioning, xrays, anesthesia, closure, and other logistics added, patients are typically asleep in the operating room for 3-5 hours for single thoracic curves and 5-7 hours for double curves.
How much does scoliosis surgery cost?
The cost of scoliosis correction surgery varies for every individual, since no two curves or patients’ needs are exactly the same. For this reason, we don’t provide a single set price—each case is carefully reviewed so that recommendations and costs accurately reflect the patient’s unique situation. It would be irresponsible and inaccurate for us to provide an estimate. If you have scoliosis and are told you need surgery, the first step is to see if you qualify for ASC by Drs ABC. Use this link below to provide your Scoliosis Case, and Dr. Antonacci will personally review it.
How soon will I notice improvement?
Patients typically notice significant improvement of their spine immediately once they are fully standing out of bed (usually post operative day 2).
Because your spine may now be in a dramatically straighter alignment, the muscles, soft tissues and the brain need time to adjust.
Subtle realignment and rebalancing of the body in its new position continues to improve over months. (Also, see “How can I best prepare” below).
This is also why Dr. Antonacci co-designed and strongly recommends our ILAB pre- and post- rehabilitation program uniquely available to patients of Drs. ABC, to optimize recovery.
When can I shower after my surgery?
You can shower once your chest tube is removed, which is typically three (3) to five (5) days after surgery. Your incision will be sealed with a skin “glue” which will gradually fall off over weeks. Your chest tube site will be covered with a gel Band-Aid. Do not scrub over your wound area; just let the soap and water run over your wound as you wash the rest of your body. When done, pat your wound dry.
Will I have to wear a brace after my surgery?
No. We do not routinely recommend or use post operative bracing. However, there are individualized situations where this might be appropriate.
Where will my scar be located? How big will it be?
The surgical incision will be located on the side of the body. It is tucked under (and hidden by) the arm. It is typically about 5 inches long, with some variation depending upon the type of curve and individual anatomy. There are no incisions on the back and no involvement of the all-important back muscles (which in metal rod fusion surgery are permanently functionally eliminated).
When can I go back to school/work and sport/activities?
Many patients feel well enough to attend school as early as 4 to 6 weeks, sometimes starting with half-days.
We do not release patients to anything more than walking and gentle stretching for the first 6 weeks. Your body needs time to heal on the inside after surgery.
During this time, you may go for several walks every day to build up your strength and do certain recommended gentle stretching movements. You may tire easily and need rest periods throughout the day.
You should never force yourself to do something if you don’t feel up to it during this time. After your 6 week x-ray check up, patients are typically given the “green light” to increase their activities including returning to sports.
It is important to recognize that while at 6 weeks, our doctors give patients the go ahead to do sports and other activities, everybody heals differently and on a different time schedule. Additionally, the body needs time to heal, and usually core toning and stretching modalities are recommended during the 6 week to 4 month period to prepare your body for its usual level of preferred sport/activity. Many of our highly competitive athletes return to competition between three and six months. However, Dr. Antonacci is fond of saying that until the incision color returns to your typical skin color, things are still healing on the inside. Listen to your own body.
How is pain managed after surgery?
Our approach to pain management is multimodal and individualized. Dr. Cuddihy, NP Maddie, and the PICU/AICU team work together to find what works best for each patient. Prior to surgery, patients are started on gabapentin one week in advance to set the stage for optimal pain control post operatively.
We use a combination of opioid pain medications, anti-inflammatory medications, muscle relaxers, and other pharmacological modalities. We minimize opioid medication strength and length of use to just enough .
For the first few days after surgery, opioid pain medication is delivered via patient controlled analgesia pump, allowing us to further individualize pain management for each patient. This pump allows the patient to deliver administer an additional medication dose (which is predetermined based on age and size for safety) as needed, based on their pain level.
The use of opioid pain medication is closely supervised, and each patient leaves the hospital with an individualized medication management plan which is managed by Dr. Cuddihy and NP Maddie.
We also use many nonpharmacological methods in conjunction with medications, including a TENS unit, hot and cold therapy, music therapy, meditation and visualization, and virtual reality. We also work closely with the Child Life Team at St. Peter’s to provide fun, age appropriate distractions to our patients. Patients who enrolled in the ILAB program prepare for the month before surgery to become active participants with respect to their mindset and body, and continue the program from week 6 to 3 months.
How can I best prepare for ASC surgery?
Dr Antonacci has long been a strong proponent of more holistic approaches to rehabilitation of surgical spine patients. He was among the earliest (since 2001) to recommend using specialized core neutral toning programs such as a modified spring-based Pilates instead of traditional physical therapy after spine surgery.
In recent years, Dr Antonacci specifically co-designed a pre-surgical and post-surgical program for our ASC by Drs. ABC patients based on the above concepts and applying it to posture and movement of the body before and after ASC. The concept is that with ASC, a life altering postural scoliosis correction occurs in one day, and this transformation may be best optimized by preparing the body both in mindset and through movement from several weeks before surgery to several months after surgery. Much like what is done for professional athletes—It is a combination of specialized coaching, including mindset preparation and core body movement conditioning. Known as ILAB, the program is designed to optimize the body’s spatial awareness, fluidity of movement of the body through space, and posture.
Dr. Antonacci specifically worked with two elite professional former dancers to design this program. The culmination of these years of formulation is our ILAB-ASC program. Participating in ILAB-ASC is not mandatory but is highly recommended. ILAB was designed as a holistic adjunct to ASC surgery and is a voluntary videoconference-based program.
ILAB starts three to four weeks before surgery with patient customized (mindset/movement) pre-hab sessions to prepare the body and mind for ASC surgery. There are very specific muscle imbalances common in scoliosis that are addressed. Then mind-body coaching rehab sessions resume 3-4 weeks after surgery and more specific physical rehab and movement conditioning begins again 6 weeks post-surgery.
Who should consider Anterior Scoliosis Surgery (ASC)?
ASC by Drs. ABC now can treat virtually all types of scoliosis. Our candidates for muscle sparing, less invasive anterior scoliosis surgery correction have a variety of scoliosis types. Most have idiopathic scoliosis (adolescent, juvenile or infantile) or idiopathic “like” (i.e. post-syrinx decompression). But we have also treated those whose scoliosis is associated with a syndrome, a neuromuscular condition or is congenital.
Each case is individually evaluated and carefully considered. Our patients are generally between 4 and 50 years of age, with or without remaining spine growth and have a thoracic, thoracolumbar or lumbar curve(s) of 35 to over 90 degrees.
Patients are seeking correction without permanently sacrificing normal spinal motion as done by metal rod fusion, which fully destroys the spinal discs and function of the back muscles. Adults with advanced degenerative scoliosis or patients who have had prior spinal fusion are NOT candidates for ASC.
How long will I have to wait to get my surgery done?
Once you and your family decide that ASC is the best option and the insurance/financial specifics have been arranged through our office, surgery can most often occur 4-6 weeks later, with slightly longer wait times during the summer months.
Dr Antonacci and staff work diligently to arrange a mutually convenient surgery date to get patients back to living their best lives as quickly as possible, and Dr Antonacci operates 3 days per week to accommodate patients’ needs as much as possible.
Our typical process is that your preoperative evaluation is prepared by our PA Janet C. You then speak to Dr. Betz if it is determined you are a candidate for ASC by Drs. ABC.
If you decide to proceed to surgery, a zoom conference is scheduled for you with Dr. Antonacci to go over your entire case and plan, and you have a definitive preoperative visit in person the week of your surgery. Of course, personal visits prior to this are also always welcome if feasible for you.
We have found the zoom conferences to be particularly effective though, also considering that 75% of our patients are from outside our local region (NJ, NY, PA), and nearly 20% of our patients are international. Our staff are experts at taking you through the process no matter how far away you are coming from.
Why should I trust Drs. ABC for my ASC surgery?
When it comes to Anterior Scoliosis Correction (ASC) surgery, the expertise and experience of your medical team can significantly impact the procedure’s success and your overall recovery. Here’s why you should trust Drs. Antonacci, Betz, and Cuddihy (ABC) for your ASC surgery:
- Experience & Expertise: Dr. M. Darryl Antonacci, a renowned surgeon with extensive experience in scoliosis and complex reconstructive neck and spine surgery, leads the team. Recognized as one of the top spine surgeons in NJ and NY, Dr. Antonacci has been performing ASC surgeries at Saint Peter’s University Hospital since 2015. He is a pioneer in ASC surgery, contributing to its development and advancement.
- Specialized Care: Dr. Randal Betz brings over 30 years of experience in treating children and adults with spinal problems to the team. His expertise in scoliosis is internationally recognized. This specialized care ensures that patients of all ages receive targeted, effective treatment.
- Comprehensive Team Approach: Dr. Laury Cuddihy, a fully trained spine surgeon, completes the team. Having completed her fellowship under Drs. Betz and Antonacci provides a high level of surgical care as a primary surgical assistant to Dr. Antonacci. This comprehensive team approach ensures seamless communication and collaboration, maximizing patient care and outcomes.
- Research & Innovation: The team isn’t just involved in performing surgeries — they’re also pushing the boundaries of what’s possible in spinal care. The team is actively involved in research and contributes to various medical societies and journals, ensuring that the team stays at the forefront of spinal care innovation.
- Personalized Review: Every patient is unique, and so is every case of scoliosis. Dr. Antonacci and his team offer to personally review your case, ensuring that your treatment plan is tailored to your specific needs.
In essence, choosing Drs. ABC for your ASC surgery means choosing a team with a proven track record, extensive experience, and a commitment to personalized, innovative care. Learn more about our team.
What insurance does the practice accept?
For ASC by Drs. ABC, U.S. health insurance plans must include out-of-network benefits. The following plan types generally do not cover this treatment:
- HMO plans
- Medicaid and Medicare
- Most international health plans
Self-pay is also an option. Because coverage varies significantly by plan, we recommend contacting our office directly to discuss your specific insurance situation. You are also welcome to submit a case review form first, and our team will follow up with you regarding next steps, including insurance and financial details.
Can I submit a case review even if I don’t have qualifying insurance?
Yes. You are welcome to fill out the ASC Case Review form regardless of your current insurance status. After our team reviews your case, a staff member will typically contact you within 48 hours to discuss your options, including insurance requirements and self-pay. If your current plan does not qualify, we can explain what type of coverage would be needed so you can explore your options.
Are there non-surgical alternatives to scoliosis treatment?
Non-surgical options typically do not structurally correct a scoliosis curve, particularly if it is moderate to severe. For significant or progressive curves, surgery may still be the most appropriate recommendation. Dr. Antonacci and his team can review your specific case and help determine whether ASC should be considered.
What are the risks of leaving scoliosis untreated?
Untreated scoliosis, particularly when the curve is moderate to severe or continuing to progress, can lead to:
- Worsening spinal curvature over time
- Noticeable postural changes, such as uneven shoulders, a rib prominence, or an asymmetrical waistline
- Chronic back pain and discomfort
- Reduced quality of life and physical function
- In more advanced cases, potential effects on breathing and internal function
Early evaluation is important. If you are concerned about progression, we encourage you to submit your case for review so Dr. Antonacci and his team can assess your current situation.
What is the age range for ASC surgery?
ASC by Drs. ABC is generally offered to patients between the ages of 4 and 50. Adults with advanced degenerative scoliosis — typically those over 55 — are generally not appropriate candidates for ASC. That said, each case is individually reviewed, and adults have been successfully treated. Age alone is not the sole determining factor; overall spinal health, curve flexibility, bone quality, and disc condition all play a role in candidacy.
Do I need to have X-rays done before requesting a consultation?
You do not need to obtain new imaging before reaching out to us. Many patients submit their existing X-rays, reports, and a medical history summary as part of the initial case review. If you do not yet have imaging, our team can guide you on what to obtain and where. For the ASC evaluation, standing full-spine X-rays (front and side views) are typically required, and additional bending or traction films, MRI, or CT scans may be requested depending on your case. The best first step is to submit the case review form, and our team will follow up with specific instructions.
I already have a prior spinal fusion or metal rod… are any treatment options still available?
Patients who have had a prior spinal fusion are not candidates for ASC. Many patients who had metal rod surgery decades ago later develop new symptoms such as leg or hip pain, worsening posture, or flat-back syndrome, which may be treatable with other procedures.
Can scoliosis cause difficulty swallowing or gastrointestinal symptoms?
Scoliosis can affect overall body posture and, in more severe cases, may impact breathing and internal function. Some patients with significant curves report feeling compressed or restricted in the torso. However, difficulty swallowing solids or esophageal symptoms are not a confirmed direct effect of scoliosis based on the information available here. If you are experiencing these symptoms, we recommend discussing them with a medical specialist to determine whether they are related to your spinal condition or another cause.
Are the implants used in scoliosis surgery MRI-compatible?
Most modern scoliosis implants — including those used in ASC — are made of titanium or titanium alloy, which is non-ferromagnetic and considered MRI-safe or MRI-conditional. This means most patients with scoliosis hardware can still have MRI scans after surgery. Some image distortion (artifact) near the implants is expected, but this typically does not prevent imaging from being performed. If you have concerns about MRI compatibility related to a specific surgery or hardware, we recommend contacting the surgical team or the hospital where your procedure was performed for confirmation.
Where is the office located, and where are surgeries performed?
The Institute for Spine & Scoliosis office is located in the United States at:
3100 Princeton Pike, Building 1-D, Lawrenceville, NJ 08648
ASC surgeries by Drs. ABC are performed at Saint Peter’s University Hospital in New Brunswick, NJ, approximately 20 minutes from Newark International Airport. To reach our team, you can call 609-912-1500, or submit the online case review form at spineandscoliosis.com/consultation-appointment/. The office is open Monday through Friday, 9:00 AM to 5:00 PM.