Spinal Surgery for Scoliosis

 While it’s difficult to determine the exact causes of scoliosis, this medical condition is linked to various genes. As it affects 3 percent of the population in the United States, scoliosis impacts an individual's spinal curvature that can cause musculoskeletal problems. Different treatment modalities target varying degrees of scoliosis severity.

Scoliosis refers to the lateral curvature of the spine. A minimum curvature of 10 degrees is often indicative of the condition. While early-stage scoliosis patients rarely report symptoms, more severe curvatures with increased degrees result in noticeable pain, muscle spasms, and balance issues.

Before deciding which treatment method is most suitable for a scoliosis patient, orthopedic specialists conduct serial x-ray imaging to monitor the patient’s progress. X-ray imaging allows a doctor to determine the exact degree of curvature, which dictates the severity of the condition and corresponding treatment plans.

Curvatures under 25 degrees require regular observation with x-ray tests held every four to six months. The test results demonstrate whether the spinal curvature is increasing or not, thus guiding the doctor’s decision regarding treatment.

Adolescents with scoliosis reaching 20 to 25 degrees or more may require back bracing. Bracing supports the patient’s spine and halts any further curvature. Successful bracing reduces the need for surgery.

However, if spinal curvature continues to worsen, reaching 40 or more degrees, or if bracing is not ideal for the patient, surgery becomes the recommended treatment. Spinal surgery for scoliosis treatment targets three functions: preventing the progression of the curvature, fixing deformity, and restoring trunk balance.

Multiple surgical procedures can alleviate the symptoms of severe scoliosis. Spinal fusion surgery (SFS) is the most common method. SFS entails the fusion of several vertebrae into a single immobile bone. The procedure can take from four to six hours. SFS decreases the spinal curvature and prevents it from getting worse.

The success of SFS varies based on the patient’s initial curvature. Typically, the surgery can reduce curvature to 25 degrees or less. However, fusing vertebrae into a single bone decreases their mobility. Therefore, the surgery outcomes depend on the severity of scoliosis. The surgery rarely causes complications. Risks such as infection, bleeding, and nerve injury rarely occur.

Unfortunately, SFS is not optimal in young patients. Doctors deem girls under 10 and boys under the age of 12 unsuitable for SFS because the procedure may interfere with the growth of the trunk, which may also affect the development of the lungs.

Alternative surgical solutions for such patients include growing rods and fusion-less tethering systems. Growing rods is an intermediate modality that can delay SFS. Usually, doctors utilize growing rods in children with severe scoliosis. The anchored rods keep the spine in place to limit its curvature. The doctor lengthens the rods every six to 12 months to accommodate the child’s spinal growth. Upon reaching skeletal maturity, patients can undergo SFS.

The fusion-less tethering system is a more recent surgical approach. Doctors straighten the spine by pulling a cord attached to screws on the spine. While this promising approach can be safer than SFS, it’s still in its early phases.