Scoliosis is an abnormal, sideways curvature of the spine, forming an “S” or “C” shape when viewed from the back. This spinal distortion often develops during the growth spurt just before puberty, and the cause remains unknown in most cases. Surgery aims to significantly correct the abnormal curve and halt its progression. For severe, progressive cases, surgical intervention is highly effective, offering a definitive treatment when other methods have proven insufficient.
Criteria for Surgical Intervention
The decision to pursue an operation is based on the measurement of the spinal curve and the patient’s remaining growth potential. Doctors use the Cobb angle, which quantifies the degree of the curve on an X-ray image of the spine. While mild curves (less than 25 degrees) are monitored, surgery is considered when the curve progresses to 40 to 50 degrees or more.
This threshold is not absolute, but a curve of this size in a still-growing patient carries a significant risk of worsening even after skeletal maturity. For adolescents, remaining growth is a key factor, as curves progress most rapidly during growth spurts. If a patient is near the end of their growth period, a curve exceeding 50 degrees is a strong indication for surgery to prevent future health issues, such as compromised lung function.
The procedure is reserved for those whose curves have continued to worsen despite attempts at non-surgical management, such as bracing. The goal is to intervene before the spinal deformity compromises the function of internal organs or causes intractable pain. The surgery is a treatment of last resort, selected when the spinal angle and physical maturity indicate a substantial risk of further progression.
The Surgical Procedure and Goal
The primary surgical method for addressing significant spinal curvature is spinal fusion, which aims to create a single, solid bone column from the affected vertebrae. This is accomplished by exposing the spine through an incision and preparing the vertebrae for fusion. The surgeon removes the joints between the curved vertebrae and roughens the bone surfaces to encourage new bone growth across the gaps.
To hold the spine in a straighter position, metal instrumentation—rods, screws, and hooks—is attached to the vertebrae. These implants provide immediate mechanical support and alignment while the biological fusion process takes place. Bone graft material, which can be harvested from the patient’s own body (autograft) or sourced from a donor (allograft), is packed around the prepared bones to stimulate the final, permanent bond.
The immediate goal of the operation is to reduce the curve magnitude by 50 percent or more and permanently stop its progression. By locking the bones together, the procedure prevents the spine from bending or twisting in the fused section, stabilizing the correction. Vertebral Body Tethering (VBT) may be considered for younger patients with substantial growth remaining, as it uses a flexible cord to correct the curve while preserving some spinal movement.
Recovery and Long-Term Outcomes
The recovery period following spinal fusion is substantial. Patients typically spend three to seven days in the hospital, where initial pain management involves pumps or catheters before transitioning to oral medication. Physical therapists begin working immediately, encouraging patients to sit up and walk as early as the first day following the operation.
Once discharged, the initial recovery phase lasts two to four weeks, focusing on basic activities like walking and self-care. Patients must strictly avoid three major restrictions for several months to protect the instrumentation and developing fusion: bending, lifting objects heavier than a few pounds, and twisting the torso. Most adolescents can return to school within three to four weeks, but with modified schedules.
The long-term outcome hinges on the successful fusion of the vertebrae, which takes six months to a full year to complete. X-rays confirm the solid bone bridge has formed, and the patient is typically cleared to resume all normal activities, including sports. While the corrected section of the spine will no longer bend, the surrounding unfused segments generally compensate, maintaining sufficient flexibility for most daily activities.
Non-Surgical Management
For the majority of patients, initial management involves careful monitoring and intervention rather than surgery. A small curve, generally less than 25 degrees, in a growing patient is addressed with observation, involving regular checkups and X-rays to track changes. Many small curves never worsen enough to require active treatment.
If a curve progresses or is moderate (25 to 40 degrees) in a growing individual, a custom-fitted brace is often prescribed. The brace is worn for many hours a day, applying pressure to prevent the curve from increasing while the bones mature. Physical therapy, including specialized programs like the Schroth method, is used alongside bracing to strengthen supporting muscles and improve postural awareness.