Scoliosis Surgery (Spinal Fusion): Risks vs. Benefits

"Posture Memory" Therapy is a Better Alternative with Lifelong Results 

Believe it or not, scoliosis surgery is not a necessary procedure to save the patient’s life in the vast majority of cases. Please, let us explain… 

Scoliosis is only life-threatening if a child younger than five years old has severe spinal deformation. When the lungs are not fully developed, there is a rare possibility that a scoliosis curve could cause the heart to stop (cor pulmonale).  

Yet, scoliosis spinal fusion surgery is often recommended when a  scoliosis curve measures over 50 degrees. It also gets recommended before children are done growing — as young as age 14. A scoliosis operation may seem like the only option if a doctor says your child "needs it immediately". The doctor may say that spine surgeries are much less invasive than they used to be, but all spine surgery is invasive. The recovery from scoliosis surgery can be a long and difficult process, especially if it fuses many of the 24 vertebrae. Receive free recommendations about avoiding scoliosis surgery sent directly to your email.

Clayton J. Stitzel DC
CEO, ScoliSMART 

With the first spinal surgery for scoliosis taking place in 1865 (France), there certainly has been a lot of innovation in the field of surgery for scoliosis over the decades.  The most notable was the Harrington rod surgery beginning in the late 1950’s and early 1960’s.  This was a partial fusion surgery with a single rod attached to the top and bottom of the spinal curve.  The use of  pedicle screw and double rod hardware (CD instrumentation) began in the mid 1980’s and introduced full spinal fusion with much better scoliosis curve reduction.  Unfortunately, this also increases the risk of complications both short and long-term.  Scoliosis tethering ( non fusion scoliosis surgery) procedures (VBT and ASC) started to be utilized in the mid 2000’s and continue in their development.

The recommended restrictions following surgery for scoliosis are going to vary from patient to patient and doctor to doctor a great deal.  Some of the factors that may influence these post surgery recommendations are:

• The type of scoliosis surgery
• The number of and location of the spinal levels involved
• Age of the patient
• Overall health status
• Specific activities requested by the patient
• Levels of pain after scoliosis surgery
• If the patient experiences scoliosis surgery pain years after

Part of the problem is non-surgical scoliosis treatment information is not always available to patients or parents. As a result, many often feel spine 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 scoliosis surgery before and after, scoliosis surgery recovery, and life after scoliosis surgery.

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 corrective surgery.

Don’t know where to start?  Take our FREE “ScoliQuiz.”  (No x-ray required) 

We use "posture memory" retraining to treat the entire scoliosis condition, not only the spinal curve. Most cases of scoliosis are idiopathic, meaning they have no known cause. Over 80 percent of children with scoliosis have idiopathic scoliosis that occurs between ages 9 and 18. Some children are born with congenital scoliosis, which develops while they are in the womb. It is often difficult to see at birth and not detected until they are older. A few children develop infantile scoliosis between birth and age three (which may correct itself). Others develop juvenile scoliosis between ages 3 and 8. 

It is important to mention that most doctors will use a Cobb angle to measure your child's spinal curve. The Cobb angle is the amount of lateral bending visible on an x-ray. This is only a two-dimensional measurement whereas the scoliosis curve is a three-dimensional problem. It is a twist and bend that creates torque, causing more twisting, bending, and buckling of the spine. We call this self-feeding loop a "coil down effect." Imagine the spine if it was a rubber band twisted from the top and bottom until it creates a coil in the middle.

We don't know the exact causes of idiopathic scoliosis. But, research does show that miscommunication between the brain and spine causes its curve progression. This creates a faulty "postural memory" your brain uses to (incorrectly) align the spine to gravity. 

We use patented scoliosis 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 unlock the spine. Your child's brain and body actually learn how to hold the spine straighter. This treatment can reduce a curve, halt progression, and reduce pain for a child or an adult. It stops the progressive coil down effect. If we start this rehabilitation before your child's curve measures 25 degrees, you will likely never have to discuss surgery with a doctor. Keeping the curve from getting worse — that is our first goal for every patient.

Various studies show that spine surgery has many complications. These risks seem inordinate since spinal surgery does not:

• "cure scoliosis,"
• stop its progression (long-term),
• improve functions of the heart and lungs.
• does not improve quality of life after scoliosis surgery

The following excerpts from various studies fuel our passion for non-surgical spine treatment.

"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)

In a study of 118 patients ages 10-17 who underwent spinal deformity correction at least five years prior, "common symptoms included:

• occasional back pain (90, 76%),
• limited range of motion (52, 44%),
• activity limitations (54, 46%),
• waistline imbalance (41, 35%),
• rib prominence (28, 24%),
• wound/scar problems (18, 15%),
• and shortness of breath (18, 15%).

There was a high incidence of occasional back pain and activity complaints after surgery for AIS . . ." 

"Health-related quality-of-life scores, spine-related symptoms, and reoperations in young adults 7 to 17 years after surgical treatment of adolescent idiopathic scoliosis," American Journal of Orthopedics (2015)

"Combined anterior and posterior instrumentation and fusion has double the complication rate of either anterior or posterior instrumentation and fusion alone. Combined anterior and posterior instrumentation and fusion also has a significantly higher rate of neurologic complications than anterior or posterior instrumentation and fusion alone." 

"Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium," (2006) 

"In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups." 

"Complications in the surgical treatment of 19,360 cases of pediatric scoliosis," (2011)

"Spinal fusion has an isolated negative effect on AIS patients' quality of life . . . The  positive effect of surgery depends on the individual effects of spinal fusion (slight reduction in quality of life) and deformity reduction (modest improvement in quality of life)." 

"Dissecting the effects of spinal fusion and deformity size on quality of life in patients with adolescent idiopathic scoliosis," (2009)

"The psychological health status is very impaired." 

"Quality of Life and Back Pain: Outcome 16.7 Years after Harrington Instrumentation," (2002)

"For social function, childbearing, and marriage, no apparent disadvantageous effects  compared to the healthy population. The conclusion is that most individuals with AIS and moderate curve size around maturity function well and lead an acceptable life (work and family). Some patients with larger curves have pulmonary problems, but not to the extent that this affects the lifespan. This needs to be taken into account when discussing surgery . . ." 

"Natural history of adolescent idiopathic scoliosis: a tool for guidance in decision of surgery of curves above 50°," Journal of Children's Orthopaedics (2013)

During a normal life span, an estimated 40-55 percent of spinal fusion patients will suffer from long-term scoliosis surgery complications. These can range from chronic lower back pain to permanent disability.

Surgery risks include:

• Implant failure
• Nerve damage
• Chronic pain
• Infection
• Bone graft procedures
• Spinal cord injury

The history of scoliosis surgery is full of failure. The first scoliosis surgery in 1865 — the year the civil war ended — had terrible results and ended in a lawsuit, Guerin vs. Malgaigne. 

American doctors first performed scoliosis surgery in 1914. Surgery was becoming  routine by 1941. The Harrington rod surgery, in which a stainless steel rod attached along the spinal column, was created in 1953. It is estimated that a million people will have this type of spine surgery over the next 40 years. 

The Harrington rod spine surgery has been replaced by other spine surgeries such the eXtreme Lateral Interbody Fusion (XLIF).  Which may be done alone or with Posterior Lumbar Interbody Fusion (PLIF). The XLIF is called less invasive because the surgeon makes an incision through the patient's side instead of a long incision down the spine. The PLIF adds a bone graft fusion in the spine. 

Still, a 2010 study says these spine surgeries continue to pose significant risks. 

Pedicle screw systems, first developed by Cotrel & Dubousset, can correct the rotation of the vertebrae and balance the body. This system of screws is said to withstand wear and tear much better than the old spinal rods. Complications during and after spine surgery are still a huge threat, though. Serious complications include fluid in or around the lungs, spinal cord injuries, and death. Lower limb pain, a wound rupture, or infection and pneumonia are among the minor complications and side effects of surgery.

Scoliosis is serious. It affects you and/or your child both physiologically and psychologically.  Yet, it is rarely life-threatening. All surgical intervention is "dangerous" and contains risks that include:

• internal hemorrhage
• stroke
• blood transplants
• paralysis
• infection
• even 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 surgical intervention for scoliosis.

Like all conditions that may need surgical intervention, there are many individual variables patients (and their parents) should consider before committing to spine surgery. Most orthopedic surgeons prefer to wait until patients are done (or almost done) growing. Spine surgery procedures disrupt the growth plates and prevent any further growth of the spine. But, most younger children do not have enough bone density to keep the surgical hardware from pulling out of the bones. They may need a bone graft before the age of 10 years old.

Yes. The spine has 24 movable segments that work together in a lever arm fashion.  This produces the torque for driving the pelvic and shoulder girdles for:

• walking/running
• the flexibility for bending and lifting
• and the strength for core stabilization

Multiple level spine fusion surgery used for treating scoliosis massively disrupts this normal bio-mechanical process. It also severely limits the natural torque-producing ability of the spine.

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. The 15–20 year follow-up studies of post-scoliosis-fusion patients with moderate-to-severe pain ranges from 40–55 percent.  Contrasted with a 50-year follow-up study of completely untreated patients with scoliosis.  They reported only mild-to-moderate pain the majority of the time.

Surgery is  indicated for cosmetic improvement of spinal deformity and  halting further progression. It has not been shown to consistently:

• reduce or relieve pain
• improve cardiac (heart) function
• or pulmonary (lung) function
• or improve the patient's psychological well-being

While the majority of post-fusion patients do report satisfaction with their decision to undergo surgery, many of those respondents also report conflicting answers when answering more specific questions about their quality of life. This suggests a "cognitive dissonance" effect associated with their data reporting. The decision to undergo surgical intervention is a very personal one. Short- and long-term considerations should be taken into account before a decision is made.

The scoliosis condition appears to be primarily a neurohormonal condition with genomic variant predispositions. The spinal curve seen on x-ray is only the most obvious and visible symptom of the complete "scoliosis condition". Thus surgical intervention is only treating the condition's primary symptom. Not the underlying scoliosis condition itself. As Dr. Paul Harrington (inventor of the Harrington rod surgery technique used throughout the 1960s through the mid 1980s) said:  "Metal does not cure the disease of scoliosis, which involves far more than only the spinal column."

Patients with fused spines have a limited range of motion in general and no motion in the areas of fusion. While it may appear most post-fusion surgery patients can and do have a normal range of motion, the motion is actually coming from the unfused segments. This  forces more stress, wear and tear, and premature degeneration on the segments below the area of fusion, as they carry more body weight.

The Scoliosis Research Society (SRS) currently recommends surgical intervention for patients with curves 50 degrees or more. But, current research suggests significant lung restriction does not begin until a curve reaches 80–90 degrees.

Yes. It is one of the most extensive and invasive orthopedic procedures performed on children or adults. It involves:

• the dissection of five layers of spinal muscles,
• removal of the vertebral posterior joints,
• insertion of a vast system of surgical hardware
• blood loss is extensive enough to require blood transfusions
• bone grafts
• 4–6-week recovery in many cases.

Long-term complications include chronic back spasms and potential metal implant toxicity from hardware breakdown (leading to permanent inflammation).

Scoliosis comes in many forms, each with its own set of diagnostic criteria and specific age of onset, yet surgery is not the only option. Non-surgical treatment solutions - that reduce pain and halt curve progression - are available for both children and adults with scoliosis.

Don’t know where to start?  Take our FREE “ScoliQuiz.”  (No x-ray required)

Non-fusion scoliosis surgery or scoliosis tethering (otherwise known as vertebral body tethering or VBT) is a less invasive surgical procedure that has been used for the past 7 years by a select number of Orthopedic surgeons. While still a highly invasive surgical procedure, as all spinal surgeries are, it does offer some significant advantages over the more widely used spinal fusion for scoliosis procedures.

Don’t know where to start?  Take our FREE “ScoliQuiz.”  (No x-ray required)

Please note, as with all surgical procedures, there are risks and complications associated with a certain percentage of cases and scoliosis tethering procedures should only be considered as an alternative to fusion surgery for scoliosis.

Many of the scoliosis tethering procedures are done endoscopically, meaning the actual surgery is performed via an endoscope, and do not require an open back incision. This means a 4-6 inch scar under one of the arm pits (usually the right side), rather than a full spine incision down the middle of the back. Cosmetically, this is obviously desirable, but clinically it means a lot less blood loss (and little or no blood transfusions), less risk for infection, and a much faster recovery time since less muscle, bone, tendon, tissues are damaged during the procedure. Clearly these advantages are significant to clinical outcomes, but can and do have a positive effect on the financial burden of surgical intervention for scoliosis

Scoliosis curve progression is typically seen during periods of rapid growth, particularly in female patients, and unbalanced pressure on the vertebrae may cause uneven growth of the spinal bones. For centuries, yes centuries, doctors have attempted to “guide spinal growth” in scoliosis patients with rigid braces. While it sounds good in theory, practical application of applying pressure to the spine through the muscles, organs, lungs, ect with a brace have proven rather ineffective and psychologically traumatizing for patients. The end results indicate widespread use of braces for scoliosis do not reduce the number of patients for whom surgical fusion is recommended.

The pressure placed on the convexity (outside part) of the spinal curvature by the scoliosis tethering procedure works to re-balance the pressure being placed on the vertebrae during growth and can effectively guide spinal growth during growth spurts. Some concerns and complications have arisen leading to unintended spinal compensation patterns, but innovative new rehabilitation programs are being developed to address these issues.

Unlike multiple level spinal fusion, tethering for scoliosis does not create intersegmental fusion and has very little negative impact on spinal biomechanics. The spine is composed of 24 individual segments that work together in a lever arm fashion to produce the torque force that drives the pelvis and shoulder girdles to provide human locomotion (walking/running). Fusion surgeries in scoliosis patients often involved 6-8 segments and essentially meld them all together into one long bar of bone. This has a profound impact on the spinal biomechanics and often leads to many pain syndromes as a result of dis-coordinated spinal muscle firing patterns leading to inflammation and muscle spasms.

Vertebral Body Tethering (VBT) is a relatively spinal motion sparing procedure that still allows for almost all normal spinal biomechanics and an almost full range of spinal motion as well. Although long term data isn’t yet available, it is likely the long term pain syndromes associated with tethering for scoliosis should be much lower than those found in long term post fusion treated scoliosis patients.

Spinal fusion procedures being utilized in the treatment of scoliosis require a lot of surgical hardware. Very long screws, hooks, long rods, and dissection of the entire posterior spinal joint system in order to install the hardware. As everyone knows, the more hardware, pieces, and parts, the more likely the chance for complications and breakage in the future, which is also supported by the published long term data on traditional scoliosis fusion procedures.

Scoliosis tethering requires much less hardware and no destruction of any spinal joint systems. In fact, the only “moving parts” are a nylon cord that is secured at each and every spinal level making systemic failure of the tether virtually impossible. As stated earlier in this article, long term data on vertebral body tethering (VBT) isn’t yet available, but the minimal used of hardware, lack of invasive spinal joint dissection, and stress being place on a nylon cord, rather than metal rods, is widely expected to outperform the long term complication rates seen in post fusion treated patients.

The treatment of adolescent idiopathic scoliosis has and continues to be a challenge for all healthcare providers who seek to help patients overcome it. Passive approaches implemented via braces and fusion surgeries have not proved an effective treatment model given the unpredictability of results and reality of long term complication rates. Less invasive, spinal motion sparing approaches like tethering surgery for scoliosis are a welcome and necessary step forward in an effort to convert the current scoliosis treatment model into an active approach which may prove more effective with less risk of unintended long term complications. It is the hope and expectation that more Orthopedic surgeons will begin to offer and recommend vertebral body tethering as the primary recommendation as an alternative to spinal fusion surgery as long term data becomes available.

As many as one in 10 scoliosis patients will ultimately get a referral for spinal fusion surgery. Each year, nearly 40,000 choose to endure this invasive procedure.

But just because a doctor recommends spinal fusion 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 scoliosis surgery. To reach the spine, a surgeon must cut through five layers of spinal muscles, including surrounding ligaments, tendons and the spine’s entire posterior joint system. Stabilizing the curve involves running a solid metal rod through a column of 3-inch screws and hooks inserted into the bone along the entire length of the curve. It’s a highly invasive surgery that requires months of recovery time.

At best, the procedure results in a 20 to 60 percent loss in side flexibility.

But is scoliosis surgery dangerous? Explore the facts and decide for yourself.

Click to view full infographic.

During a normal life span, more than 50 percent of spinal fusion patients will suffer from long-term scoliosis surgery complications. These can range from chronic lower back pain to permanent disability.

Scoliosis surgery risks include:

Implant failure. Spinal fusion implants fail in more than half of all patients who receive them. They can break, become dislodged, pierce the spinal canal and compress nerve roots, causing pain or disability. In one study, one in five patients with fused spines had to have their implants removed, and 22 percent of patients required a total of 28 additional operations.

Nerve damage. Damage to the spinal nerves can leave patients with a variety of neurologic complications such as loss of skin sensation, weakness in the feet or legs, or loss of bowel and bladder control. One study found that 40 percent of spinal fusion patients were considered severely disabled after surgery. In more serious cases, patients can develop paraplegia or quadriplegia, although the risk is less than 1 percent.

Chronic pain. Even patients whose spinal fusion surgeries are considered successful can experience lower back pain down the road. Up to a third of patients suffer from back pain within 5 to 7 years of their surgery.

Infection. Every surgery carries the risk of infection. With a procedure as invasive as spinal fusion, the risk is elevated. Around 5 to 10 percent of surgical patients develop deep infections a year or more after surgery. The threat of infection doesn’t disappear with time, either — some can develop as long as 8 years afterward.

Don’t know where to start? Take our FREE “ScoliQuiz.” (No x-ray required)

ScoliSMART Clinics is committed to treating the WHOLE scoliosis condition, not only the curve. Genetic & clinical testing with targeted nutrient therapies, expert in-office treatment programs, and the world’s only ScoliSMART Activity Suit provides patients of all ages with the most comprehensive, most effective, and least invasive treatment options available worldwide.