Scoliosis is an abnormal sideways curvature of the spine. It is most frequently diagnosed in childhood or early adolescence. For individuals with severe and progressive spinal curves, scoliosis surgery corrects the deformity and prevents further worsening.
When Surgery Becomes an Option
Scoliosis surgery is considered when spinal curvature progresses despite non-surgical treatments. A common indicator for surgery is a curve exceeding 45-50 degrees in adolescents who are still growing. For adults, surgery may be recommended for curves over 50 degrees, especially if accompanied by nerve damage or severe pain.
Curve progression is another reason for surgical intervention. Skeletal immaturity in adolescents is also a factor, as curves can worsen rapidly during growth spurts. Beyond the Cobb angle, the decision for surgery also considers the impact on quality of life, including issues like pain, uneven posture, or potential compromise of lung function.
Types of Surgical Procedures
The most prevalent surgical approach for scoliosis is spinal fusion. This procedure involves joining two or more vertebrae into a single, solid bone. The goal of spinal fusion is to stop curve progression and correct the deformity. Metal rods and screws hold the spine in a straighter position while the fusion occurs.
Newer, motion-sparing techniques offer alternatives to traditional fusion, especially for growing children. Vertebral Body Tethering (VBT), also known as Anterior Scoliosis Correction (ASC), involves placing screws on the convex side of the curve and connecting them with a flexible cord or tether. This tether is tightened to partially straighten the spine, and it uses the child’s continued growth to further correct the curve without fusing the vertebrae. ASC is considered a less invasive option than spinal fusion, often involving smaller incisions and allowing for faster recovery and preserved spinal mobility.
The Surgical Process Itself
Scoliosis surgery, particularly spinal fusion, is a complex procedure lasting four to eight hours. Before the operation, the patient receives anesthesia. An incision is then made to expose the spine.
Once the spine is exposed, the surgeon moves muscles aside to access the vertebrae. To prepare for fusion, the joints between the vertebrae may be removed and the bone surfaces roughened to encourage new bone growth. Metal implants are then inserted into the vertebrae and connected by one or two rods. These instruments realign and stabilize the spine, holding it in the corrected position while the bone heals.
Bone graft material is applied to facilitate the fusion process. This graft, sourced from the patient’s own body or a donor, is placed between the vertebrae to encourage them to grow together. Throughout the procedure, intraoperative neurological monitoring is employed to continuously check the health of the spinal cord and nerves, helping to reduce the risk of neurological injury. Finally, once the instrumentation is secured and the bone graft is in place, the incision is closed.
Recovery and Rehabilitation
Recovery after scoliosis surgery begins immediately following the procedure, involving a hospital stay of three to six days. During this initial period, pain management is a focus, involving medications, including opioids for acute pain, which are gradually tapered as healing progresses. Early mobilization is encouraged, with patients getting out of bed and walking short distances the day after surgery to aid recovery.
Upon returning home, recovery continues with specific activity restrictions to protect the healing spine. Patients are advised to avoid heavy lifting, typically anything more than a few pounds, and to minimize bending or twisting movements for several weeks to months. Physical therapy plays a role in rehabilitation, guiding patients through exercises that promote healing, improve mobility, and strengthen the muscles supporting the spine.
Full recovery can take six to twelve months, during which patients gradually return to their normal activities, including school or work, usually starting part-time around four weeks post-surgery. Long-term follow-up appointments are necessary to monitor the fusion process, with regular X-rays to check the stability of the implants. While some permanent activity limitations may remain, most individuals experience improved quality of life, better posture, and increased confidence after surgery.