Surgical Treatment for Scoliosis - OrthoInfo - AAOS (2022)

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In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed.

Most scoliosis surgeons agree that children who have very severe curves (45 to 50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.

The operation for scoliosis is a spinal fusion. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone.

With the tools and technology available today, scoliosis surgeons are able to improve curves significantly.

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(Left) This X-ray shows two large curves that require surgery. (Right) The same patient after surgery to correct the curves.

Courtesy of Texas Scottish Rite Hospital for Children

General Questions About Surgery for Scoliosis

Do I need surgery?

If your curve is greater than 45 to 50 degrees, it will very likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. Surgery is recommended.

Curves between 40 and 50 degrees in a growing child fall into a grey area — several factors may influence whether surgery is recommended. These should be discussed with your surgeon.

How successful is surgery for scoliosis?

Spinal fusion is very successful in stopping the curve from growing. Today, doctors are also able to straighten the curve significantly, which improves the patient's appearance.

How straight will my spine be after surgery?

Because your spinal bones protect your spinal cord, your surgeon will straighten the bones only as far as is safe.

The degree of correction from surgery depends on how flexible your scoliosis is before your operation. In general, the more flexible your curve is, the better the correction from surgery. Your doctor can measure your flexibility before surgery with special X-rays called bending or traction films.

Most patients recover from surgery with curves that have been straightened to less than 25 degrees. In many cases, these small curves are hardly noticeable.

I have back pain associated with my scoliosis. Will the surgery relieve it?

Immediately after surgery, there will be more pain than before, but this usually resolves over a period of a few weeks to a few months. Most patients report that their back pain is better at one year after surgery than it was beforehand.

Everyone — whether there is scoliosis or not — has some back discomfort from time to time. Expecting to never have any future back pain is unrealistic.

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What is involved with a spinal fusion surgery?

In a spinal fusion, the curved vertebrae are fused together so that they heal into a single, solid bone. This will stop growth completely in the abnormal segment of the spine and prevent the curve from getting worse.

All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. Generally, small pieces of bone are placed into the spaces between the vertebrae to be fused. The bone grows together — similar to when a broken bone heals.

Metal rods are typically used to hold the spine in place until fusion happens. The rods are attached to the spine by screws, hooks, and/or wires.

Exactly how much of the spine is fused depends upon your curve(s).

What is a bone graft?

A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone.

In the past, a bone graft harvested from the patient's hip was the only option for fusing the vertebrae. This type of graft is called an autograft. Harvesting a bone graft may require an additional incision during the operation. It increases the length of surgery and can cause increased pain after the operation because of an additional region of the pelvis being included in the procedure.

One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank.

Today, several artificial bone graft materials have also been developed.These artificial materials are often used with an autograft or allograft.

How long does the surgery take?

Most fusions last from 4 to 8 hours, depending on the size of the patient's curve and how much of the spine needs to be fused.Some of this time is spent preparing the patient for anesthesia, hooking the patient up to various monitors, and positioning the patient to be as safe and comfortable as possible.

How much pain will I be in after surgery?

The amount of pain people report after surgery varies a great deal from patient to patient. The surgery is a major procedure that involves moving muscles and realigning the skeleton.

The first few days are usually quite uncomfortable, but most people improve rapidly by the third or fourth day, and they can walk around, and get in and out of bed well enough to go home by then. The pain continues to improve gradually and most teenagers can return to school by 4 to 6 weeks after surgery.

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Mild pain may persist, but by 3 to 6 weeks after surgery, pain medication should no longer be necessary.

What type of pain control will there be after the operation?

Pain control varies between different doctors and hospitals. In many cases, a PCA (patient controlled anesthesia machine) is used, which injects a small dose of pain medicine intravenously when you push a button. Some surgeons use an intravenous catheter (small plastic tube placed in a vein) to provide the medication in larger but less frequent doses. The pain relief system that your doctor is accustomed to using is probably the safest and most reliable for you after surgery in that particular institution.

On the second or third day after surgery, your doctor will most likely change your medication to pills or liquid pain relievers taken by mouth. These medications are an opiate (morphine-like medicine).Because these medications are known to be addictive if taken for a long time, you may be encouraged to switch to a different type of pain medication as soon as possible after you go home.

Do the rods and other implants stay in my spine even after it has fused?

If rods are used in a fusion, they usually are not removed. Very few people require rod removal. When it is required, this may be for a variety of reasons, such as an infection or broken rod.

Will fusion make my back stiff and unable to move?

The fused portion of your back will be permanently stiff. Most people have enough motion in the unfused portion of their lower backs to perform all activities of daily living and most sports. If you participate in activities that require a tremendous amount of flexibility, it may take awhile to adapt. Most people find that, within a year or so, their backs begin to feel "normal" when participating in those activities.

Can I have my scoliosis corrected without a fusion?

Several institutions are investigating fusion-less spine surgery in younger patients with moderate curves (45 to 50 degrees) who are still growing. However, more patient follow-up is needed to determine the usefulness of this tethering growth modulation surgery, and its lasting effect. At this time, the gold standard for surgical treatment of scoliosis is still fusion surgery.

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Common Questions About Surgical Recovery

Most patients are in the hospital for 3 to 4 days, out of school for 4 to 6 weeks, and back into activities in 2 to 6 months.

How long do patients need pain medication after being discharged home?

Most surgeons prescribe strong pain medications to patients after scoliosis surgery. Patients who have not used opiate pain killers before usually stop needing them within 2 weeks after surgery. If the patient has used these medicines frequently before surgery, it may take longer to stop needing them.

It is best to stop taking these strong medications as soon as possible because they can be addictive if taken for long periods of time.

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What limitations will I have right after surgery?

Your surgeon will detail any limitations you have after surgery. Most patients will be asked to avoid heavy lifting and to minimize the amount of bending forward for the first 6 weeks.

Does surgery lead to permanent restrictions on activities?

No, most patients are able to return to all of their favorite activities and sports. Most patients return to non-contact sporting activities (running, weightlifting, exercises) within 4 to 6 months after surgery.

Before returning to all activities, including contact sports, the spine must be fully healed. It typically takes 6 to 12 months after surgery to obtain a solid fusion of the spine in order to return to unrestricted activities.

Will I be able to walk after surgery?

Yes. Some patients may need physical therapy after surgery, but they are able to walk when they are discharged from the hospital.

When can I go back to school after the operation?

Most children miss between 4 to 6 weeks of school after surgery. It typically takes about 4 weeks before the spine is healed enough to carry a backpack.

When will I be allowed to drive a car?

You will not be able to drive a car until you have healed well enough from surgery. In addition to being off of your narcotic pain medicines, you need to be moving around well enough to be safe. This typically takes 6 or more weeks.

When can I start hanging out with my friends again?

Your friends can visit you after surgery in the hospital and at home. Going out with your friends — like to school functions or the movies — can occur after you are off all pain medications and are feeling back to normal (this usually happens about 4 to 6 weeks after surgery).

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POSNA (Pediatric Orthopaedic Society of North America)

The Pediatric Orthopaedic Society of North America (POSNA) is a group of board eligible/board certified orthopaedic surgeons who have specialized training in the care of children's musculoskeletal health.

FAQs

What is the surgical procedure for scoliosis? ›

The operation for scoliosis is a spinal fusion. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone. With the tools and technology available today, scoliosis surgeons are able to improve curves significantly.

Is surgery the best option for scoliosis? ›

A scoliosis curve will not get straight on its own. Bracing will help to keep it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight. Surgery will also stiffen the spine and is therefore reserved for more severe deformities.

What is the most common scoliosis surgery? ›

Posterior approach: The most frequently performed surgery for adolescent idiopathic scoliosis involves posterior spinal fusion with instrumentation and bone grafting. This is performed through the back while the patient lies on his or her stomach.

At what degree is scoliosis surgery necessary? ›

If your C-curve becomes severe (i.e., more than 40 degrees), or if you develop an S-shaped curve, you need surgery. As an adult, a scoliosis curve is only considered to be severe if it's more than 50 degrees.

What is the newest treatment for scoliosis? ›

In August 2019, the FDA approved vertebral body tethering (VBT) as a treatment for pediatric scoliosis. It's a nonfusion surgery and is minimally invasive, so it's been getting quite a bit of attention in the scoliosis world.

What age is best for scoliosis surgery? ›

Children with scoliosis between 3-10 years of age is normally the time when the best long term results can be achieved.

Is scoliosis surgery risky? ›

Complications such as infection, nerve damage, blood loss, and bowel and bladder problems are some of the potential risks of any type of spinal surgery, including spinal fusion for the treatment of scoliosis.

Is life better after scoliosis surgery? ›

Patients with scoliosis who receive surgery generally experience better physical health. Though some patients still have complications, most are as healthy as the general population. Life after scoliosis surgery can be productive and pain-free. Advanced methods aim to prevent pain while straightening the spine.

What percentage of scoliosis patients need surgery? ›

“I see a number of patients who automatically assume they will need treatment for their scoliosis, but only a small percentage — about 30 percent — require bracing, and an even smaller percent — about 10 percent — of patients actually require surgery,” Sponseller assures.

How many hours is scoliosis surgery? ›

During scoliosis surgery, the surgeon will sometimes use special equipment to keep an eye on the nerves that come from the spine to make sure they are not damaged. Scoliosis surgery often takes 4 to 6 hours. It can also be much longer if the involved area is larger.

What are the 4 types of scoliosis? ›

There are four types of scoliosis: congenital, idiopathic, neuromuscular, and degenerative2. In congenital scoliosis, the misalignment occurs as a result of deformed vertebrae or ribs present at birth.

What are the 3 types of scoliosis? ›

Most experts feel there are three categories of scoliosis. idiopathic, congenital, and neuromuscular. Idiopathic is the most common type of scoliosis. This means that the cause is unknown or that there is no single factor that contributes to the development of the disease.

What is the minimum curve for scoliosis surgery? ›

Why might my child need minimally invasive scoliosis surgery? Your child might need surgery if his or her spine has a severe curve. This is a curve of at least 40 degrees. Or your child may need surgery in the future if other treatments, such as bracing, don't keep the curve from getting worse.

Does 35 degree scoliosis need surgery? ›

Small curves below twenty degrees or curvatures up to 40 degrees in skeletally mature patients do not require surgery or bracing. If curves progress in the still growing adolescent, bracing is recommended for curvatures between 25-40 degrees.

What happens if you don't get scoliosis surgery? ›

Mild cases of scoliosis may not need treatment. But, moderate to severe scoliosis that is left untreated can lead to pain and increasing deformity, as well as potential heart and lung damage. Scoliosis is a sideways curve of the spine with rotation. It most often develops during the growth spurt just before puberty.

What is the best treatment for severe scoliosis? ›

Surgery. Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse.

Who is the best scoliosis surgeon? ›

Jason E. Lowenstein. Dr. Lowenstein of The Advanced Spine Center is one of the best spine surgeons in the world—especially when it comes to scoliosis treatment.

What is the treatment for the most severe spinal curvature in scoliosis? ›

In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe curves.

How old is too late for scoliosis surgery? ›

Don't worry – no age is 'too late' to start treatment, and the many 20-year-old patients we've treated here at the Scoliosis SOS Clinic have seen fantastic results. A person who is suffering from scoliosis may suffer from pain, stiffness, postural problems, and self-esteem issues.

Can you bend after scoliosis surgery? ›

No Bending, Lifting, or Twisting

The most basic of precautions for the patient during the recovery process will be “no BLTs.” These include: No bending. The patient is allowed to bend at the knees and hips, but not at the back. No lifting.

How successful is scoliosis surgery in adults? ›

The answers were based on a study of nearly 700 patients from around the country two years after surgery to fuse five or more vertebrae. About 70% of patients reported feeling better about their appearance and were about one-half inch taller on average.

Why is scoliosis surgery so painful? ›

Abstract. Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain.

Do people regret getting scoliosis surgery? ›

Why is there a relatively small number of patients who regret having scoliosis surgery, in spite of greater than 50% complication rates AND greater than 27% rate of reoperations after the first surgery has failed (and even sometimes the second one) ?!!

Can you move normally after scoliosis surgery? ›

Patients can start to move around within a day or two after scoliosis surgery. The total hospital stay is typically four to seven days. Patients can return to school or a sedentary/desk job about two to four weeks after surgery, but activity needs to be limited while the bone is fusing.

How often does scoliosis surgery go wrong? ›

During a normal life span, more than 50 percent of spinal fusion patients will suffer from long-term scoliosis surgery complications. These can range from chronic lower back pain to permanent disability. Scoliosis surgery risks include: Implant failure.

Can you live without scoliosis surgery? ›

Many people with scoliosis can manage their symptoms just fine without any type of surgery.” In many cases, treatment for scoliosis is aimed at relieving symptoms rather than fixing the curve in the spine.

How urgent is scoliosis surgery? ›

Most scoliosis surgeons agree that there is rarely a need for emergency or urgent surgery. Most surgeries can be scheduled for a time that works for both the patient and the doctor.

Can you live with severe scoliosis without surgery? ›

Fortunately, most children with scoliosis will not need surgery to correct the condition. In fact, most cases of scoliosis do not require treatment and are simply observed during growth.

How much pain is there after scoliosis surgery? ›

One hundred and five patients out of 122 eligible patients completed the survey. Fifty-two percent had ongoing pain upon hospital discharge either in the primary surgical site and/or in the iliac bone graft site. Approximately 10 and 7% of all patients had back and pelvic pain persisting beyond 12 months, respectively.

How long are you in the hospital after scoliosis surgery? ›

If there are no complications, most scoliosis surgery patients can expect to be discharged from the hospital 3 to 7 days after surgery. During the first few days, patients will need plenty of rest. As early as the first day after surgery, your doctor may have you stand and walk short distances with assistance.

How long does it take to wake up after scoliosis surgery? ›

After scoliosis surgery, the patient will first awaken while lying on the back, facing up. The patient will be groggy while still under the influence of medications used during and after the surgery.

What is the most severe case of scoliosis? ›

Severe Scoliosis (SS)

(SS) is the worst form of the condition and should not be taken lightly. Patients with spinal curves beyond 40 degrees are usually treated surgically with multiple level spinal fusion.

What organs are affected by scoliosis? ›

Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body's hormonal and digestive systems. It can deplete the body's nutritional resources and damage its major organs including the heart and lungs.

Which type of scoliosis is reversible? ›

When mild scoliosis becomes severe, it can even place pressure on the rib cage, restrict the natural movement of the lungs, and cause significant problems with breathing. The good news is that with the right intervention and care, mild scoliosis at the lumbar spine region is reversible.

What exercises are not good for scoliosis? ›

As scoliosis introduces uneven forces and can cause postural deviation related to the body's overall symmetry, sports or exercises that involve overusing one side of the body play into those asymmetrical effects and can exacerbate symptoms: Bowling. Golf.
...
  • Weightlifting.
  • Long-distance running.
  • Long jump.
  • Horseback riding.

What can worsen scoliosis? ›

Repeated extension of your thoracic spine with backbends, gymnastics, high jumps, dance maneuvers (especially in ballet) and certain yoga positions causes vertebrae to rotate further into the scoliosis curve. The force often causes rapid scoliosis progression.

Which exercise is good for scoliosis? ›

Low-impact exercises such as Pilates, yoga,` and tai chi can help improve trunk flexibility and range of motion. Some scoliosis exercise programs, such as the Schroth method, may help teens reduce the magnitude of their spinal curve.

How long does scoliosis surgery usually take? ›

During scoliosis surgery, the surgeon will sometimes use special equipment to keep an eye on the nerves that come from the spine to make sure they are not damaged. Scoliosis surgery often takes 4 to 6 hours. It can also be much longer if the involved area is larger.

How long does it take to recover from scoliosis surgery? ›

Scoliosis surgery recovery is a relatively long process – patients won't be able to go back to their normal activities until 3 to 6 months after the procedure.

How serious is scoliosis surgery? ›

The most concerning risk with scoliosis surgery is paraplegia—loss of movement and feeling in the lower body and legs. It is rare but can be a devastating complication. To help manage this risk, the spinal cord is monitored during surgery through a several simultaneous methods: Somatosensory evoked potential (SSEP).

Do they put you to sleep for scoliosis surgery? ›

General anesthesia is administered for surgical repair of curvature of the spine (scoliosis). There are two types of spinal curvature that require surgical correction. The first, sometimes called idiopathic scoliosis, occurs when the spine curves abnormally for unknown reasons.

How long is bed rest after scoliosis surgery? ›

Full Recovery Takes Up to 12 Months

The total hospital stay is typically four to seven days. Patients can return to school or a sedentary/desk job about two to four weeks after surgery, but activity needs to be limited while the bone is fusing.

Is life better after scoliosis surgery? ›

Patients with scoliosis who receive surgery generally experience better physical health. Though some patients still have complications, most are as healthy as the general population. Life after scoliosis surgery can be productive and pain-free. Advanced methods aim to prevent pain while straightening the spine.

Can you bend over after scoliosis surgery? ›

*DON'T do any heavy lifting and minimize bending forward until 6 to 12 weeks after surgery.

What can you never do after scoliosis surgery? ›

The patient may shower seven days after surgery. No sports, running, or jumping for 3 months after surgery. There are no permanent restrictions after 6 months of the date of surgery.

Can I do everything after scoliosis surgery? ›

After full healing, most patients will not have activity restrictions. However, certain sports activities such as gymnastics may not be practical. Activities that may be prohibited will be discussed by your surgeon and are dependent on the extent of your spinal fusion. Most patients do not feel restricted.

Why is scoliosis surgery so painful? ›

Abstract. Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain.

Who is the best scoliosis surgeon? ›

Jason E. Lowenstein. Dr. Lowenstein of The Advanced Spine Center is one of the best spine surgeons in the world—especially when it comes to scoliosis treatment.

What are the chances of surviving a scoliosis surgery? ›

Conclusions: The 10-year survival rate of primary scoliosis surgery in adult patients is 61%. Risk factors identified for reoperation included patients with higher morbidity, double surgical approach, and preoperative thoracic hyperkyphosis.

How often does scoliosis surgery go wrong? ›

During a normal life span, more than 50 percent of spinal fusion patients will suffer from long-term scoliosis surgery complications. These can range from chronic lower back pain to permanent disability. Scoliosis surgery risks include: Implant failure.

How much pain is there after scoliosis surgery? ›

One hundred and five patients out of 122 eligible patients completed the survey. Fifty-two percent had ongoing pain upon hospital discharge either in the primary surgical site and/or in the iliac bone graft site. Approximately 10 and 7% of all patients had back and pelvic pain persisting beyond 12 months, respectively.

What percentage of scoliosis patients need surgery? ›

“I see a number of patients who automatically assume they will need treatment for their scoliosis, but only a small percentage — about 30 percent — require bracing, and an even smaller percent — about 10 percent — of patients actually require surgery,” Sponseller assures.

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