Understanding scoliosis surgery

Surgery for scoliosis is not indicated based solely on the presence of a spinal curve. The decision depends , in particular , on the severity of the curve, its progression, remaining growth potential, the overall balance of the trunk, and the patient’s individual circumstances.

In adolescents, surgery is typically considered for certain severe and progressive cases of scoliosis, particularly when the Cobb angle approaches or exceeds 45 to 50°. These values serve as guidelines and do not automatically constitute an indication for surgery.

The purpose of a surgical consultation is to assess the situation, the potential risks, and the various treatment options. Seeking a surgical opinion does not necessarily mean that surgery will be performed.

The main goal is to correct part of the deformity and provide long-term stabilization of the spine, while achieving a satisfactory balance in the trunk.

The most commonly used technique for severe idiopathic scoliosis involves spinal instrumentation combined with spinal fusion. Screws and rods are used to correct and stabilize the spine while bone fusion takes place.

The desired correction does not necessarily involve achieving a perfectly straight spine. The surgical strategy must take into account, among other things, the three-dimensional shape of the scoliosis, sagittal and frontal balance, and the number of vertebrae that need to be included in the fusion.

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Surgery generally results in significant correction of the deformity and, most importantly, stabilizes the curvature to limit its progression.

Among adolescents who have undergone surgery for idiopathic scoliosis, follow-up studies generally report favorable outcomes in terms of radiographic correction, function, and quality of life. However, outcomes vary depending on the type of scoliosis, the initial severity of the curvature, the surgical technique used, and patient characteristics.

The goal is not necessarily to achieve a perfectly straight spine. The correction should preserve, as much as possible, a satisfactory three-dimensional balance of the spine and trunk.

Scoliosis surgery is a major procedure and requires a personalized discussion of its benefits and risks.

Possible complications include infection, bleeding, certain neurological complications, problems related to the implant or bone fusion, as well as the possibility of a repeat procedure in certain situations.

Spinal fusion also results in a permanent loss of mobility in the fused vertebral segments. The extent of this loss depends, in particular, on the number and location of the vertebrae included in the fusion.

These risks must be weighed against the risks associated with the progression of severe scoliosis. The decision is therefore made in consultation with the surgical team based on the patient’s individual situation.

Once fusion is achieved, the vertebrae included in the arthrodesis no longer move relative to one another. However, the segments not included in the arthrodesis retain their mobility.

Many patients gradually resume their activities after the recovery period, in accordance with their surgical team’s recommendations. The options and timing for returning to sports depend, in particular, on the type of surgery, the extent of the fusion, and the postoperative course.

Long-term follow-up remains important to assess clinical progression, spinal alignment, and any potential problems related to the instrumentation or non-fused segments.

Severe scoliosis does not automatically require surgery. The decision depends, among other factors , on the Cobb angle, the progression of the curvature, remaining growth potential, trunk balance, symptoms, and the patient’s individual circumstances.

In children and adolescents who are still growing, when scoliosis is at risk of progressing, conservative management may include specific exercises and bracing, when indicated. The primary goal is to limit the progression of the deformity during growth.

When scoliosis reaches a severity level at which surgery is being considered, the situation becomes more complex. It is then important to seek a consultation with a spine surgeon. Depending on the case, conservative treatment may still be discussed, but it should not be presented as a guarantee that surgery can be avoided.

In adults, the goals of conservative management are different. They may include, in particular, symptoms, function, postural balance, and quality of life. Significant structural scoliosis in an adult obviously no longer has the same potential for correction as scoliosis in a growing child.

When an important surgical decision needs to be made, seeking a second specialist opinion can also allow the patient and their family to better understand the benefits, risks, and different options available.

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When surgery is being considered, it is important that the patient and their family understand precisely why the procedure is being proposed, what its objectives are, and what the possible alternatives are .

Useful questions to ask include:

Why are you recommending intervention now?
What is the risk of development if we do not operate?
What correction can reasonably be expected?
Which vertebrae will be included in the arthrodesis?
What level of mobility will remain after the procedure?
What are the main risks in this particular case?
Is there still a reasonable conservative option?
What will be the recovery and resumption timeframe for school, activities, and sports?

When the decision is difficult, a second opinion from a surgeon specializing in scoliosis can help the family make an informed decision.

Surgery is an important option in the management of some severe or progressive scoliosis, but it is not suitable for all scoliosis cases.

The decision must take into account the extent and progression of the curvature, remaining growth, overall spinal balance, symptoms, and patient goals .

When growth is not complete, identifying progressive scoliosis early enough also allows for discussion of various conservative options before the deformity becomes more significant.

Do you wish to have a scoliosis assessed or discuss the different treatment options before making a therapeutic decision?