Scoliosis Surgery (Spinal Fusion): Risks vs. Benefits
FACTUALLY ACCURATE & VERIFIED BY
Dr. Aatif Siddiqui
LAST UPDATED ON
May 20, 2023
Most scoliosis surgeons agree a very severe scoliosis spine curve (more than 80 degrees) would be life-threatening to a child’s heart and lungs. Unfortunately, many studies find there is little-to-no improvement in breathing or heart function before and after surgery, so many parents and patients are choosing to avoid scoliosis surgery entirely.
Table of Contents
Scoliosis is only life-threatening if a child younger than five years old has severe spinal deformity. Before the lungs are fully developed, there is a rare possibility that a scoliosis curvature could cause the heart to stop (cor pulmonale). Believe it or not, surgery is not a medically necessary procedure to save the patient’s life in the vast majority of cases.
Yet, spinal fusion surgery is often recommended when a curve measures over 50 degrees and there are signs of progression. It also gets recommended before children are done growing — as young as age 14. A scoliosis operation may seem like the only option if a doctor says your child “needs it immediately”. The spine surgeons may say that back surgeries are than they used to be, but all back surgery is invasive. The recovery from surgery can be a long and difficult process, especially if it fuses many of the 24 vertebrae. The basic idea of the operation is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone. Receive free recommendations about avoiding surgery sent directly to your email. It is important to note that curvature of the spine is a common symptom of the condition, and it is crucial to consult with a healthcare professional before making any decisions about surgery or treatment options, depending on the particular case.
Types of Surgeries
With the first spinal surgery for scoliosis taking place in 1865 (France), there certainly has been a lot of innovation in the field of surgical correction over the decades. The most notable was the Harrington rod surgery beginning in the late 1950’s and early 1960’s. This was a partial fusion surgery with a single rod attached to the vertebra at the top and bottom of the spinal curve. The use of pedicle screw and double rod hardware (CD instrumentation) began in the mid 1980’s and introduced full back surgery with much better curvature deformity correction and improved efficacy, including lumbar spinal fusion surgery. Unfortunately, this also increases the risk of many problems both short and long-term. Scoliosis vertebra tethering (fusionless surgery) procedures (VBT and ASC) started to be utilized in the mid 2000’s and continue in their development as an internal brace.
Studies Show the Many Risks of Scoliosis Surgery
Various studies show that back surgery has many problems. These risks seem inordinate since back surgery does not:
- “cure scoliosis,”
- stop its progression (long-term),
- improve functions of the heart and lungs.
- does not improve quality of life after surgery
- “Scoliosis approaches that violate the chest wall show a significant decline in postoperative pulmonary function.” (The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis) Journal of Spinal Disorders & Techniques (2009)
- Back pain is not eliminated.
During a normal life span, an estimated 40-55 percent of post operative patients will suffer from long-term surgery issues. These can range from chronic lower back pain to permanent disability according to research conducted by MD’s.
Surgical treatment risks include:
- Implant failure
- Nerve damage
- Chronic pain
- Infection
- Bone graft procedures
- Spinal cord injury
Effective Non-Surgical Scoliosis Treatment Does Exist!
Part of the problem is non-surgical scoliosis treatment information is not always available to patients or parents. As a result, many often feel back surgery is a bad idea, yet think there are no other options. Parents and patients end up doing their own online research for terms like type of scoliosis, scoliosis surgery before and after, scoliosis surgery recovery, curvature correction, and life after scoliosis surgery. In recent years, new scoliosis rehabilitation concepts have been developed as an effective non-surgical treatment option for adolescent idiopathic scoliosis.
The ScoliSMART doctors want you to know that both children and adults have non-invasive scoliosis treatment options that can help them/you live their/your best life with scoliosis. All without the high risk of complications from surgery and with the added benefit of growth modulation by balancing hormones levels naturally.
Online consultation scheduling is available!
Now it’s even easier to connect with ScoliSMART. Schedule your no-cost, no-obligation phone or Zoom consultation online with a ScoliSMART physician. Visit the ScoliSMART BootCamp page and click the “Schedule Online” button at the top of the page. Then select the best date and time to connect with a physician. Schedule your consultation right here!
Exercises That Create a New (and Straighter) Scoliosis Posture Memory
Combinations of genetic variant patterns are the cause of idiopathic scoliosis. Further research on neurotransmitters and hormone imbalances strongly suggests the true cause of adolescent idiopathic scoliosis is a miscommunication between the brain and spine causes its curve progression. This creates a faulty “postural memory” your brain uses to (incorrectly) align the spine to gravity. Because it is rooted in a genetic predisposition, the patient’s brain doesn’t even realize that something is wrong! Understanding the the cause and “backbone” of this condition, especially in adolescence, is crucial to developing effective treatment plans.
The Most Common Questions Parents & Patients Have About Surgery
Is Surgery Dangerous?
It affects you and/or your child both physiologically and psychologically. Yet, it is rarely life-threatening. All surgery is “dangerous” and contains risks that include type of surgery.
- internal hemorrhage
- stroke
- blood transplants
- paralysis
- infection
- death
While modern medicine has mitigated and minimized these risks, the risk is never zero. This should be carefully considered and discussed with one’s orthopedic surgeon before committing to posterior spinal fusion.
What Is the Best Age for Scoliosis Surgery?
Like all conditions that may need spinal fusion, there are many individual variables patients (and their parents) should consider before committing to it. Most orthopedic surgeons prefer to wait until patients are done (or almost done) growing. Spinal procedures disrupt the growth plates and prevent any further growth of the spine curves. But, most young people, especially those whose skeletons have not matured, do not have enough bone density to keep the surgical hardware from pulling out of the bones (similar to osteoporosis). They may need a bone graft before the age of 10 years old or wait until they reach skeletal maturity. Adult scoliosis or degenerative scoliosis may be candidates for surgical procedures if physical therapy and a back brace are ineffective in the treatment. The choice of when to have surgery will vary. After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may wait until your child’s bones stop growing. Your child may need surgery before this if the curve in the spine is severe or is getting worse quickly.
What Is the Success Rate for Scoliosis Surgery?
The current “hooks and screws” double steel rod surgical implants can produce excellent curve reduction in curves even as high as 90–100 degrees. But, this amount of forced “correction” comes with a cost including loss of kyphosis resulting in “flat back syndrome“. The 15–20 year follow-up studies of post fusion patients with moderate-to-severe pain ranges from 40–55 percent. Contrasted with a 50-year follow-up study of completely untreated patients with the condition. They reported only mild-to-moderate pain the majority of the time.
What Are the Risks of Scoliosis Fusion Surgery?
As many as one in 10 patients will ultimately get a referral for surgical treatment. Each year, nearly 40,000 choose to endure this invasive procedure.
But just because a doctor recommends surgical procedure doesn’t mean it’s your only — or even best — option.
Before you commit to having your spine fused, it’s important to fully consider the risks of surgical intervention, especially if you participate in contact sports. To reach the spine, a surgeon must make an incision through five layers of spinal muscles, surrounding ligaments, tendons, and the spine’s entire posterior joint system. Stabilizing the curve involves running a solid metal rod through a column of 3-inch screws and hooks inserted into the bone along the entire length of the curve. It’s a highly invasive surgery that requires months of recovery time. At best, the procedure results in a 20 to 60 percent loss in side flexibility. Additionally, during and after the operation, an epidural catheter may be inserted into the back to help control pain.
Before you commit to having your spine fused, it’s important to fully consider the risks of surgical intervention. To reach the spine, a surgeon must make an incision through five layers of spinal muscles, including surrounding ligaments, tendons and the spine’s entire posterior joint system. Stabilizing the curve involves running a solid metal rod through a column of 3-inch screws and hooks inserted into the bone along the entire length of the curve. It’s a highly invasive surgery that requires months of recovery time. At best, the procedure results in a 20 to 60 percent loss in side flexibility.
What is scoliosis and how can I prevent it?
Scoliosis is a condition where the spine curves sideways, often in an “S” or “C” shape. While there is no guaranteed way to prevent it, maintaining proper posture, exercising regularly, and avoiding carrying heavy backpacks or bags on one shoulder can help reduce the risk of developing the condition.
We use patented rehabilitation equipment and exercises to retrain the brain (and spine) to learn a new “posture memory” over time. Our treatments also decrease soft tissue resistance to improve spinal flexibility and elongate the trunk. Your child’s brain and body actually learn how to hold the spine straighter by developing the inner muscles of the rib cage. This treatment can reduce a curve, halt progression, and reduce pain for a child or an adult. It stops the progressive twisting effect. If we start this rehabilitation before your child’s curve measures 25 degrees, you will likely never have to discuss surgical intervention or vertebral body tethering with a doctor. Keeping the curve from getting worse — that is our first goal for every patient.
Is It Worth the Risk?
The goal of surgical intervention is to stop the curvature from progressing while reducing the spinal deformities as much as possible. Given the heavy risks of spinal fusion, however, success rates remain low. In some cases, the spine fails to fuse or the curves continue to progress even after the procedure. In fact, “there is no evidence that health-related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term,” one study concluded.
In other words, even if the surgery does achieve some correction in patients, a full third will lose it all within 10 years. One in five will eventually need more surgery. Ask 100 post op patients if their surgery was a success, and nearly half will tell you they felt no reduction in pain, while more than a quarter will express unhappiness with the outcome.
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