Scoliosis is defined as an abnormal lateral curvature of the spine, often appearing as an “S” or “C” shape when viewed from the back. For many individuals and families facing this diagnosis, the immediate question is whether surgery can offer a true “fix” for the condition. While modern surgical techniques provide substantial and lasting correction, it is more accurate to view the procedure as a powerful method of correction and management rather than a complete cure that restores the spine to a perfectly normal state. The goal of intervention is to prevent the curve from worsening, improve spinal alignment, and address any related physical symptoms.
Determining the Need for Surgery
The decision to pursue surgery is not made lightly and follows a progression of non-surgical management options. Initial treatment for curves between 25 and 40 degrees in growing adolescents often involves a rigid brace to prevent further curve progression. Observation is the standard approach for milder curves, especially if the patient is nearing skeletal maturity.
The consideration for surgery typically begins when the spinal curve magnitude, measured by the Cobb angle on an X-ray, reaches 40 to 50 degrees or greater. Curves of this severity have a high probability of continuing to worsen even after a patient stops growing. The patient’s remaining growth potential is assessed using the Risser sign, a grading system from 0 to 5 that measures the ossification of the pelvic bone. A low Risser grade (0 to 2) indicates significant growth remaining, which increases the risk of rapid curve progression and strengthens the argument for surgical intervention at a lower Cobb angle.
Surgery may also be considered for curves slightly less than 40 degrees if they show rapid progression, or if the curve is causing significant pain or compromising lung function. The presence of associated symptoms, or progression despite consistent bracing, helps inform the surgical recommendation.
Overview of Surgical Procedures
The long-standing standard of care for severe scoliosis is Posterior Spinal Fusion (PSF), performed through an incision along the back. This procedure involves attaching metal instrumentation, such as rods and screws, to the vertebrae along the curve. The surgeon manipulates the rods to gently pull the spine into a straighter alignment.
Once the spine is realigned, bone grafts are placed around the exposed vertebrae to encourage them to grow together, or “fuse,” into one solid bone mass. This fusion process, which takes many months, locks the corrected section of the spine in place. PSF is highly effective at correcting the deformity and is the most common approach for adolescents with severe curves.
For some growing patients, newer motion-preserving techniques offer an alternative to fusion. Vertebral Body Tethering (VBT) is a procedure where metal screws are placed on the convex (outer) side of the curve and connected by a flexible cord or “tether”. By tensioning this cord, the surgeon achieves an immediate partial correction. Over time, the tether restricts growth on the outer side of the curve, allowing the inner side to catch up and gradually straighten the spine through a process called guided growth. VBT is generally reserved for patients who still have significant skeletal growth remaining and have flexible curves, often between 40 and 65 degrees.
Post-Surgical Expectations and Outcomes
A realistic expectation for scoliosis surgery is significant correction, not total elimination of the curve, with typical outcomes showing a 50 to 70% reduction in the Cobb angle. The primary success of the procedure is measured by halting the progression of the curve and improving the patient’s overall spinal alignment and posture.
Initial recovery involves a hospital stay of approximately three to seven days for pain management and mobilization. Patients are typically encouraged to stand and walk with assistance very soon after the operation. The long-term recovery phase requires patience, with return to school or light activities often possible within four to six weeks.
Full recovery, which means the fused bone has become solid and the patient is cleared for all activities, including contact sports, usually takes between six months and a full year. Potential long-term considerations include a loss of flexibility in the fused segment, which is generally well-tolerated, and a low risk of complications like hardware failure or pseudoarthrosis, where the bone fails to fuse properly.