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Vertebral fusion surgery for scoliosis should be the absolutely last resort in terms of a scoliosis treatment option and even then, it's continued use is controversial due to high complication rates and poor long term outcomes.

Given the conclusions of a pair of large, long-term follow-up of scoliosis surgery patients studies (“40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons” and “The psychological health status is significantly impaired.”) it makes one wonder if idiopathic scoliosis patient would be better of taking a different course of action.

Let's take a step back and examine the failed treatment process that leads idiopathic scoliosis patients to this point of "desperate measures" in terms of scoliosis treatment.  Let's face it, no body goes to bed with a straight spine and wakes up with a 40 degree cobb angle scoliosis.

Approximately 80-85% of all scoliosis cases begin between the ages of 9-12 years old, and unfortunately, are rarely diagnosed and/or rendered appropriate early stage scoliosis intervention treatment while the curvature is still small and hasn't gained any bio-mechanical momentum.  The defense for this "hands off" approach to observation of the spinal curvature was due to the uncertain nature of scoliosis progression, however the advent of genetic testing for idiopathic scoliosis (Scoliscore) can now identify which patients are at increase risk of progression and should be utilized in every applicable case.

The second mis-handling of a adolescent idiopathic scoliosis case that leads to vertebral fusion surgery for scoliosis occurs once the Scoliscore test indicates an increase genetic pre-disposition for severe progression and the scoliosis specialists STILL waits for proven progression or even worse just skipped the genetic testing all together and just gambled with the child spinal health and hoped for the best.

Hoping doesn't fix scoliosis; action fixes scoliosis.  This leads us to the 3rd phase of case mis-management that leads to scoliosis surgery.  Scoliosis Brace Treatment.  The spine is a dynamic organ that requires movement and the freedom to orient itself to gravity on a continual basis.  Scoliosis brace treatment does just the opposite and recent research out of the University of Vermont now finds that a scoliosis brace will actually increase the spinal deformity of the discs (causing even more risk for progression in adolescence and adulthood).  Active rehabilitation that targets the automatic postural control centers in the brain can and will halt the progression of the spinal curvature and can even achieve significant scoliosis reduction in most cases.  The patients brain can be "re-trained" over a period of time (minimum 4-6 months) to learn the how to hold the spine in the new "straighter" position and thus becomes a permanent solution to the scoliosis condition.

As painfully obviouse as all of this is, scoliosis brace treatment failure is still the standard of care and the #1 reason over 20,000 adolscent idiopathic scoliosis surgeries are performed every year.

As you can see, the road to scoliosis surgery is a long and twisted one (no pun intended) fill with mis-handling of the condition, lack of certainty, and the continued usage of obsolete treatment procedures (scoliosis brace treatment).  The proper intervention at any stage of the scoliosis treatment process can prevent the "need" for scoliosis surgery.

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Approximately 4% of Adolescent Idiopathic Scoliosis patients choose to have scoliosis surgery......And that 4% doesn't even include the untold number of scoliosis patient whose curvatures reach the ever changing surgical threshold and chose not to trade deformity for dysfunction via the spinal fusion surgery.

These numbers are despite the fact we know only 1% of AIS patients have a genetic high risk for being "pre-disposed" to develop a "surgical threshold" level curvature (40*)...... is an ever changing definition.

There is a general assertion that non-surgical scoliosis treatment's only goal is to keep the spinal curvature from reaching the "surgical threshold". This notion is absolutely naive and absurd since it implies that only severe curvatures affect one's quality of life. This perspective could not be anymore wrong as demonstrated in this article published in SPINE 2003; 28(6): 602-606 entitled: "Adult Scoliosis: A health assessment analysis by SF-36".

The researchers found that "adult scoliosis patients with spinal curves 10 degree or greater scored significantly lower in 7 out of 8 categories including physical functioning, general health, social functioning, and body pain when compared to the general population. In fact the researchers concluded "It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing segment of our society to a previously unrecognized degree."

The goal for all non-surgical scoliosis treatments should be focused on the reduction/elimination of the environmental risk factors (bio-mechanical, bio-chemical, and activity related) that play a huge roll in driving curve progression.....not just an adjunct shot in the dark of avoiding surgical intervention.

Treat the cause(s), not just the curve.

We need a better way (which by it's very definition is a non-surgical solution) we need to create higher expectations and standards than "just avoiding surgery".

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Up to 4% (4 in 100) chose to have scoliosis surgery for their spinal curvatures? And that 4% doesn't even include the untold number of scoliosis patient whose curvatures reach the ever changing surgical threshold and chose not to trade deformity for dysfunction via the spinal fusion surgery.

These numbers are despite the fact we know only 1% of AIS patients are genetically "pre-disposed" to develop a "surgical threshold" level curvature......which again, is an ever changing definition.

The assertion that scoliosis doesn't require treatment unless it reaches the "surgical threshold" is absolutely naive as demonstrated in this article published in SPINE 2003; 28(6): 602-606 entitled: "Adult Scoliosis: A health assessment analysis by SF-36".

The researchers found that adult scoliosis patients with spinal curves 10 degree or greater scored significantly lower in 7 out of 8 categories including physical functioning, general health, social functioning, and body pain when compared to the general population. In fact the researchers concluded "It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing segment of our society to a previously unrecognized degree."

Apparently, some people need to be reminded that all larger spinal curves started out as small ones and that just because something doesn't kill you, doesn't mean it can significantly impact one's quality of life in adulthood.

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(Authors: Weinstein, Dolan et al....Published in Lancet 2008)

As a father with a daughter I couldn't imagine having to make the decision whether or not to subject my daughter to a massively invasive scoliosis surgery that has a high risk for crippling long term chronic pain syndromes.  However, I would have taken piece in the mind set that I made the best decision for her after reading the introduction of the article.....

"primary objectives of surgical treatment with instrumentation are to (1) arrest progression, (2) achieve maximum permanent correction of the deformity in three dimensions, (3) improve appearance by balancing the trunk, and (4) keep short-term and long-term complications to a minimum."

BUT, then on the next page they write this:

"At present time, no conclusive evidence exists about improved radiographic outcomes in patients with AIS correlate with enhanced function, self-image, or health."

Are they really saying that we need surgery to make the spine straighter, but there isn't really evidence to say that surgical correction provides enhanced function, self-image, or improved health?

Scoliosis surgery is a permanent decision that should not be entered into lightly and all patients and parents should be well informed that the primary indication for scoliosis surgery is improvement of the cosmetic deformity, not medical necessity.