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Scoliosis Surgery (Spinal Fusion): Risks vs. Benefits


Dr. Aatif Siddiqui


May 21, 2024

Table of Contents

What is idiopathic 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 activities or carrying heavy backpacks or bags on one shoulder can help reduce the risk of a child developing a mild curve in their spine. In cases of mild curves, no treatment may be needed, but regular checkups are important to monitor any changes as the child grows.

idiopathic scoliosis and how can I prevent it

Causes of Scoliosis and Who is at Risk

Scoliosis can be caused by various factors, including genetics, neuromuscular conditions, or birth defects. While it can develop at any age, it commonly occurs during growth spurts before puberty. Girls are more prone to progressive curves than boys. In most cases, the cause remains unknown, termed idiopathic scoliosis. Individuals with a family history of scoliosis are at a higher risk. Other risk factors include age, as scoliosis tends to progress in younger individuals or those with severe curves.

Scoliosis surgery for a spinal curvature

Most scoliosis surgeons agree a very severe scoliosis spine curve (more than 80 degrees as seen on x rays) 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, children and patients are choosing to avoid scoliosis surgery entirely due to the risks involved, such as bleeding, blood clots, infection, and the potential need for a transfusion.

Idiopathic scoliosis is only life-threatening if a child younger than five years old has a severe spine deformity. Before the lungs are fully developed, there is a rare possibility that a scoliosis curvature could cause the child’s 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.

Spine fusion is often recommended when a curve measures over 50 degrees as seen on x ray and there signs of possible progression. It also gets recommended before children are done growing. Scoliosis fusion operations may seem like the only option if a doctor says your child “needs it immediately”. The spine surgeon makes it seem that back surgeries performed are not invasive, but all back surgery is invasive, including spine surgery. The recovery from surgery performed to fix a scoliotic curvature can be as long as several months and difficult process, especially if many of the 24 vertebrae are fused. The basic idea of the operation is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone. Some patients may be candidates to have a surgical fusion using minimally invasive spine surgery. 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 non-surgical healthcare professional before making any decisions about surgery or treatment options, depending on the particular case.

Surgery Should always be the last option

Types of Spine Surgeries

With the first operation for scoliosis taking or may take place in 1865 (France), there certainly has been a lot of innovation in the field of surgical correction over the decades. The most notable types of surgeries include the Harrington rod surgery beginning in the late 1950’s and early 1960’s, which was a partial fusion surgery with a single rod attached to the vertebrae, at the top and bottom of the curve. Another type is the use of pedicle screw and double rod hardware (CD instrumentation) which began in the mid 1980’s and introduced full back surgery with much better curvature deformity correction and improved efficacy, including lumbar 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. For children with rapidly progressing scoliosis at a young age, surgeons may also opt for an expanding rod surgery, where one or two expandable rods are attached along the spine that can adjust in length as the child grows.

Types of Spine Surgeries

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 and may in fact get worse.

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

The 2 Best Reasons For Scoliosis Surgery

What is involved with a spinal fusion surgery?

In spinal fusions, the vertebra are fused to form an unbreakable bone. It stops all abnormal spine growth and prevents the curve from worsening. In back operations there is a bone graft which promotes the bones growing together, typically obtained from the patient’s pelvis. This autogenous bone graft has advantages such as more rapid incorporation with the rest of the vertebrae and safety. In the vertebral spaces, smaller bones are placed to form fused structures using the bone graft. The bones grow in tandem, as broken bones heal themselves. Metal wire/rods are usually used for holding the vertebral column together while the healing occurs in the back. The rod is secured to the backbone with screws. How many spines fuse depends on your curve.

How straight will my spine be after surgery?

Since the spine protects the cord, surgeons can only straighten the spine to a point that the cord and soft tissue allow. A correction can vary depending on whether the scoliosis has a stiff or flexible structure before undergoing surgery. Generally, the more flexible your curve, the better your procedure can reduce your curve. During surgery your physician will assess your flexibility via a specially designed lateral bending or fulcrum bending films. Many patients recover after surgery, with their contours straightened to 25 degrees. In some situations these curves can still be seen in your posture by the average person.

How can I get my child ready for minimally invasive scoliosis surgery?

Talk with your pediatric doctor about a safe surgical procedure. Tell them the medications the child is taking, including any potential interactions with general anesthesia. Your child might be required to stop taking medication right away. During surgery, a child will undergo an imaging examination. Typically, this involves X-ray and magnetic resonance imaging (MRI). Do not give your child anything before midnight as it may cause a lot of stress. Tell your doctor if your child is suffering from an illness or fever. Keep all other directions given by your doctor before surgery.

How long does the scoliosis surgery take?

A majority of fusions take around eight hours depending on the size of the patient, shape and amount of spine to be fused. A portion of the time is spent putting the patient under anesthesia and connecting the patient to several monitoring devices and positioning it in a safe place as possible.

How long does the scoliosis surgery take

What type of pain control will there be after scoliosis surgery?

Pain management differs between physicians and hospitals. Occasionally a machine applies an anesthetic that can be used for injection of small doses to the patient. Surgical specialists usually employ intravenous catheters to give medications in large quantities. The pain relief system you use from a physician can be the best for you after an operation, such as receiving pain medicine through a special catheter or pump. Your doctor can also prescribe pain pills or administer shots for pain control.

Do the rods and other implants stay in my spine even after it has fused?

The use of rods for fusion is not usually eliminated once the spine has fused. The need may occur due to various factors like infection, damaged rods or broken parts.

Will fusion make my back stiff and unable to move?

You have a fused portion that is immobile. Many individuals may not have enough movement in their lower backs for everyday activities as well as sports. Adapting is sometimes difficult for individuals if they’re involved in incredibly flexible activities. Most people find their backs feel somewhat stiff or sore after completing their social or work related activities.

What are the scoliosis surgery risks?

Occasionally scoliosis can result in medical procedure complications caused by infection or nerve damage. Nonetheless, it also causes some inflexibility in the spine, this can vary depending on how many vertebra are fused.

What is the recovery time for scoliosis surgery?

Most fusion patients have been in a hospital for at least 3-5 days. Children and teens generally start low-impact exercise at 3 months and complete activities at 6 to 7 months. It takes between six and twelve months of healing to recover. Patients with a combination spine procedure will have a longer hospital stay. Despite these limitations, modern operation recovery time has been much shorter than it has been decades ago. On the fourth day, the patient begins climbing stairs, marking a significant milestone in their recovery process.

We Help Kids Avoid Scoliosis Surgery

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 four to six years, new scoliosis rehabilitation concepts have been developed as an effective non-surgical treatment option for adolescent idiopathic scoliosis, including minimally invasive surgery using small incisions.

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 side benefit of growth modulation by balancing hormones levels naturally.

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 spine and 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.

Identical Twins Scoliosis Success Story

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, spinal cord and spine which causes 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 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 stay in the hospital because while surgery may be, 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 a 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. 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 patients may be candidates for surgical procedures if physical therapy and back bracing are ineffective in correcting the curve with this treatment. The choice of when to have surgery will vary, but it is important to consider the age of the patient and the growth of their spinal bones. After the vertebral bones of the skeleton stop growing, the curve should not worsen rapidly. 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 getting worse quickly despite any non invasive treatment.

What Is the Best Age for Scoliosis Surgery

What Is the Success Rate of Surgery for Scoliosis?

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 back 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 this type of surgical treatment. Each year, nearly 40,000 scoliosis patients choose to endure this invasive procedure.

But just because a doctor usually recommends, a brace, or 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 the bone and a column of 3-inch screws and hooks inserted into the bone along the outside edge of the spinal curve. It’s a highly invasive surgery that usually 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.

Is Surgical Treatment 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 major risks of spinal fusion, however, success rates for surgery may 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. 

Is Surgical Treatment Worth the Risk

How Old is the Patient?

How Old is the Patient?

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