Sometimes bracing is not enough to stop a scoliosis curve from progressing. That could be because the brace wasn't worn properly—for example, it wasn't worn tightly enough or for the right amount of time.
However, in some cases, even a child who has been a good brace wearer and has followed the doctor's recommendations exactly can have a curve that progresses. This is not the child's fault. If the curve does keep progressing, your doctor may recommend spine surgery.
The goal of spine surgery for scoliosis is to stop the curve from getting worse, restore the spine to a more normal alignment and appearance, and also to address any back pain or heart or lung function problems caused by the scoliosis.
When Scoliosis Surgery May Be Recommended
Children may be surgically treated for progressive scoliotic curves greater than 40°.
How the Surgeon Plans the Surgery
To prepare for and plan the scoliosis surgery, the surgeon will consider:
The surgeon may also order more x-rays or magentic resonance imaging (MRI) scans to help him or her decide where and how to operate.
Additionally, if your child has congenital scoliosis, the surgeon may order 2 more tests: a renal sonogram to test the kidneys and an echocardiogram to test the heart. Because congenital scoliosis comes from a developmental problem in utero, there are often problems with other major organ systems that develop at the same time (third to sixth week of the pregnancy). By ordering a renal sonogram and an echocardiogram, the surgeon is trying to make sure that your child's body is strong enough to undergo surgery.
Spine Surgery Procedures for Scoliosis
For scoliosis, spinal fusion using spinal instrumentation is the most common surgical procedure.
Here's how it works: Using a combination of rods, hooks, cables, screws, and cages, the surgeon very carefully moves the spine back into a more normal alignment. Then the surgeon puts in a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth) to help the bones in your spine fuse together over time.
The goal of the fusion is to stop movement between the vertebrae, providing long-term stability. The spinal instrumentation will help the spine stay straight while the fusion heals, which usually takes at least 6 to 9 months.
The whole operation can take anywhere from 2 to 10 hours. It can be performed through the back of the spine (posterior), from the front (anterior), or in a combination front and back approach (anterior-posterior).
In very particular cases of scoliosis, minimally invasive surgery can be done, which means that the surgery is done through relatively small incisions. Minimally invasive surgery leads to less scarring and a shorter recovery time, but surgeons are just in the very beginning stages of using minimally invasive surgery for scoliosis.
Your surgeon will decide which surgical approach (posterior, anterior, anterior-posterior, or minimally invasive) is best based on several factors, including the curve severity and the spinal instrumentation needed.
Risks with Surgery
As with any operation, there are risks involved with scoliosis surgery. Your surgeon will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:
Recovery from Scoliosis Surgery
After scoliosis surgery, your child won't instantly be better and your curve won't instantly look better. He or she will most likely be out of bed within 24 hours on pain medications for 2 to 4 weeks. The incision should heal in at least 7 to 14 days, and the fusion should completely heal in at least 6 to 9 months.
In the meantime, the curve may even get slightly worse as the fusion settles in and the spine readjusts. Around 6 months, though, you should see improvement. As the fusion takes place, your child should avoid any heavy lifting, bending, or twisting. Exercise is all right as long as the spine is kept stable; that means no contact sports until the fusion is completely healed. After your child has healed and the surgeon says it's okay, he or she will most likely be able to play again.
Adults may undergo surgery for scoliosis for different reasons, especially pain. Unlike scoliosis surgery for children, correcting the curve isn't the most important goal of surgery. Instead, trying to stop the curve from getting worse later is the main goal.
We have an article just on scoliosis in adults: read it to learn more about your surgery options.
However, the older you are, the riskier the surgery is. Compared to children, adults are more at risk for post-surgical complications, such as infection and pneumonia. Regardless, if you and your surgeon feel surgery is the best option, you should go ahead with it.
A spine surgeon put together a list of the most common questions he hears about scoliosis surgery. Review the list.
Baron S. Lonner, MD, a spine surgeon, has provided details on surgical procedures and approaches used for scoliosis. Read his scoliosis surgery details article.
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