Should I (or my child) have surgery for scoliosis?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Surgery for scoliosis is only done to correct severe spinal curves. Most cases of scoliosis are not severe and do not require surgery. Consider the following when making your decision on whether you or your child should have surgery for scoliosis:

• If your spinal curve is less than 25 degrees, have it examined by a doctor every 4 to 6 months to see whether the curve is getting worse. Treatment is not necessary.
• If your spinal curve is between 25 and 45 degrees, treatment may be necessary and may involve bracing. Bracing is usually effective in preventing a spinal curve from getting worse, but it cannot correct a curve. Bracing will not help an adult's scoliosis.
• If your child has a spinal curve greater than 45 degrees, or if you have a spinal curve greater than 50 degrees, and the curve is getting worse, surgery may be considered.

Medical Information

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What is scoliosis?

Scoliosis is a condition in which the spine curves abnormally from side to side, rather than being straight. The spine may also be twisted (rotated). Scoliosis involves spinal curves, greater than 10 degrees, that are usually S-shaped or C-shaped.

Scoliosis occurs most often in girls who are 10 to 16 years old. In the general population, about 1 in 100 people (1%) have some type of scoliosis.¹

See an illustration of scoliosis .

What kind of surgery is done for scoliosis?

The main type of surgery for scoliosis is a spinal fusion. In this procedure, the curved part of the backbone is straightened with rods, wires, hooks, or screws. Then small pieces of bone are put over the spine. These pieces of bone will grow together with the spine, fusing it into proper position.

Instrumentation without fusion is a technique in which metal rods are attached to the spine to stabilize a spinal curve without fusing the vertebrae together. This is only done in small children when fusion of the spine, which stops growth in that area of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.

What are the risks of surgery for scoliosis?

New problems that could develop from surgery for scoliosis include the following:

• Problems associated with back surgery, such as nerve damage, lung problems, or spinal cord damage.
• In a child, spinal fusion will stop growth in the area of the spine that is fused.
• General complications from surgery, such as blood clots or infection or complications from anesthesia. The risk of these complications is higher in older adults.

Talk to your doctor about your or your child's chances of developing problems from surgery.

Other problems include lost time at work or school for recovery and the possible need to wear a body cast or brace for a few months after surgery.

What are the risks of not having surgery for scoliosis?

A severe spinal curve that is progressing and is not treated with surgery is likely to get worse.

As scoliosis gets worse, the bones of the spine rotate toward the inner part of the curve. If the upper part of the spine is affected (thoracic curve), the ribs may crowd together on one side of the body and become widely separated on the other side. The curve may force the space between the spinal bones to narrow. The spinal bones may also become thicker on the outer edge of the curve.

In severe curves, the misshapen ribs may reduce the amount of air the lungs can hold and may cause the heart to work harder to pump blood through the compressed lung tissue. Over time, this may lead to heart failure.

Scoliosis that is present at birth or that develops in infants may be worse in the long run than scoliosis that develops later in life. If an infant or young child with a severe spinal curve does not have surgery, it is likely that the spinal curve will get worse. This is because the more growing the skeleton has to do, the worse the curve may become.

How effective is surgery for scoliosis?

Surgery for scoliosis effectively prevents further curvature of the spine and usually can make the curvature less severe. Surgery may also help decrease pain and allow people with scoliosis to do more daily activities than they would otherwise.

Each person who has scoliosis is different. Talk to your doctor about what impact surgery for scoliosis is likely to have on you.

If you need more information, see the topic Scoliosis.

Your Information

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Your choices are:

• Wait to see if your spinal curve gets worse.
• Use a brace to control scoliosis. This is an option for children only.
• Have surgery to treat scoliosis.

The decision about whether to have surgery for scoliosis takes into account your personal feelings and the medical facts.

Deciding about surgery for scoliosis

Reasons to have surgery for scoliosis

Reasons not to have surgery for scoliosis

You (or your child) have severe scoliosis that is irreversible and caused by a disease or an unknown factor. Your child has a spinal curve greater than 45 degrees that is progressing or expected to progress. You have a spinal curve greater than 50 degrees that is progressing or expected to progress. You (or your child) have severe scoliosis, and other treatment, such as bracing, cannot be used or has failed. Are there other reasons you might want to have surgery for scoliosis?

Your scoliosis is caused by an underlying factor that can be treated. You (or your child) have a spinal curve that is less than 25 degrees and will have examinations by a doctor every 4 to 6 months to watch for curve progression. You have moderate scoliosis but suffer from back pain, which may not be relieved by surgery for scoliosis. Your general health places you at significant risk from undergoing any kind of surgery. Are there other reasons you might not want to have surgery for scoliosis?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for scoliosis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Does scoliosis have a major impact on your life?	Yes	No	Unsure
Do you (or your child) have scoliosis caused by an underlying factor that can be treated?	Yes	No	Unsure
If you (or your child) have a severe spinal curve, do you want to wait to see if it progresses?	Yes	No	Unsure
Do you have a spinal curve greater than 50 degrees that is progressing?	Yes	No	NA*
Does your child have a spinal curve greater than 45 degrees that is progressing?	Yes	No	NA
Do you (or your child) have a spinal curve less than 25 degrees?	Yes	No	NA
Are you comfortable with having surgery?	Yes	No	Unsure
Does your home or work situation allow you to take the time necessary to recover after surgery?	Yes	No	Unsure
Has bracing or another treatment for scoliosis been effective?	Yes	No	NA
Do you (or your child) have severe scoliosis that is irreversible and caused by a disease or an unknown factor?	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for scoliosis.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Return to the topic Scoliosis.

References

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Citations

1. Hu SS, et al. (2006). Scoliosis section of Disorders, diseases and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., chap. 5, pp. 255–269. New York: Lange Medical/McGraw-Hill.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Thomas S. Renshaw, MD - Orthopedics
Last Updated	August 30, 2007