Scoliosis Surgery (Spinal Fusion)

— Factually accurate and verified by Dr. Clayton J. Stitzel. Last updated on April 22, 2020.

Scoliosis Surgery Risks May Outweigh Benefits

"Posture Memory" Re-Training is a Better Alternative with Lifelong Results

Scoliosis surgery is not medically necessary 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). Most scoliosis surgeons agree that after age five, only a very severe scoliosis spine curve would be dangerous to your child's heart and lungs. In fact, many studies find there is little-to-no change in pulmonary and cardiac output from scoliosis before and after surgery for a period of six months to two years.

Yet, scoliosis spinal fusion surgery is often prematurely recommended when a teenager's 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," and the doctor may say that spine surgeries are much less invasive than they used to be, but all spine surgery is invasive — and recovery from scoliosis surgery can be a long and difficult process, especially if it fuses many of the 24 vertebrae.

If you can avoid scoliosis surgery, you should. Here is how.

Effective Non-Surgical Scoliosis Treatment Does Exist!

Part of the dilemma is that non-surgical scoliosis treatment information is not readily available to most patients and 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 — without the high risk of complications from corrective surgery.

Related: Can You Work Together with My Orthopedic Specialist?

We use "posture memory" retraining to treat the entire scoliosis condition, not just 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 10 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 10.

It is important to mention that most doctors will use the outdated 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 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." Just imagine the spine if it was a rubber band being twisted from the top and bottom until it created a coil in the middle.

Exercises Target the Root of Scoliosis

Although we don't know the exact causes of idiopathic scoliosis, research does show that miscommunication between the brain and spine causes its curve progression. The postural control centers in the brain should create automatic responses and send out a signal that the body is not balanced, but they don't. 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) so it tells the body to correct its imbalance and begin to remember it as 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 30 degrees, you will likely never have to discuss surgery with a doctor. Keeping the curve from getting worse — that our first goal for every patient.

Studies Show the Many Risks of Scoliosis Surgery

Various studies show that spine surgery is riddled with complications. These risks seem inordinate since spinal surgery does not "cure scoliosis," stop its progression (long-term), or improve functions of the heart and lungs. The following excerpts from various studies fuel our passion for non-surgical spine treatment.

• Surgery doesn't improve breathing function.
  "Scoliosis approaches that violate the chest wall demonstrate 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)

• Back pain is not eliminated.
  In a study of 118 patients ages 10-17 who underwent spinal deformity correction a minimum of 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)

• Your child may look better (discounting the scar down the entire back) but at huge risks.
  "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)

• Quality of life is not improved.
  "Spinal fusion has an isolated negative effect on AIS patients' quality of life . . . The overall 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 magnitude on quality of life in patients with adolescent idiopathic scoliosis," (2009)

• Surgery damages psychological health.
  "The psychological health status is significantly impaired." "Quality of Life and Back Pain: Outcome 16.7 Years after Harrington Instrumentation," (2002)

• Many adults with untreated scoliosis are highly functioning.
  "For social function, childbearing, and marriage, no apparent disadvantageous effects were reported 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 in terms of work and family. Some patients with larger curves have pulmonary problems, but not to the extent that this affects the life span. 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)

Additional Risks of Scoliosis Fusion Surgery

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 Failures

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 fairly routine by 1941. The Harrington rod surgery, in which a stainless steel rod is implanted 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.

Only Rare, Life-threatening Scoliosis Justifies Surgery

Scoliosis is serious. It affects you and/or your child both physiologically and psychologically; however, it is rarely life-threatening (unlike the surgeries performed to correct spine curve deformity). At ScoliSMART Clinics, we don't offer a cure or a quick fix, but we do offer realistic hope and non-surgical treatment that works. We can stop scoliosis progression, reduce curves, and reduce pain. With early stage scoliosis intervention treatment, your child may never experience an obvious curve, brace, or pain.

The Most Common Questions Parents & Patients Have About Scoliosis Surgery

Is the Scoliosis Surgery Dangerous?

All surgical intervention is inherently "dangerous" and contains risks that include internal hemorrhage, stroke, blood transplants, paralysis, infection, and even death. While modern medicine has mitigated and minimized all of these risks, the risk is never zero and should be carefully considered and thoroughly discussed with one's orthopedic surgeon before committing to surgical intervention for scoliosis.

What Is the Best Age for Scoliosis Surgery?

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

Is Scoliosis Surgery a Major Surgery?

Yes. The spine has 24 movable segments that work together in a lever arm fashion to produce 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 and severely limits the natural torque-producing ability of the spine.

What Is the Success Rate for Scoliosis Surgery?

The current "hooks and screws" double steel rod surgical implants can produce excellent curve reduction in curves even as high as 90–100 degrees; however, 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, who reported only mild-to-moderate pain the majority of the time.

Is Scoliosis Surgery Worth It?

Surgery is primarily indicated for cosmetic improvement of spinal deformity and potentially halting further progression. It has not been shown to consistently reduce or eliminate pain, improve cardiac (heart) 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 regarding their quality of life, suggesting a "cognitive dissonance" effect associated with their data reporting. The decision to undergo surgical intervention is a deeply personal one, and short- and long-term considerations should be taken into account before a decision is made.

Can Scoliosis Come Back After Surgery?

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 overall "scoliosis condition" — thus surgical intervention is only treating the condition's primary symptom and not the underlying condition itself. As Dr. Paul Harrington (inventor of the Harrington rod surgery technique used through out the 1960s through the mid 1980s) said, "Metal does not cure the disease of scoliosis, which involves far more than just the spinal column."

After Scoliosis Surgery, Can You Bend Your Back?

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, thereby forcing more stress, wear and tear, and premature degeneration — especially on the segments below the area of fusion, as they carry more body weight.

What Degree of Curvature Requires Surgery?

The Scoliosis Research Society (SRS) currently recommends surgical intervention for patients with curves 50 degrees or more (this is a 10-degree increase from the previous recommendation for patients with curves over 40 degrees); however, current research suggests significant lung restriction does not begin until a curve reaches 80–90 degrees.

Is Scoliosis Surgery Painful?

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, and insertion of a vast system of surgical hardware. The blood loss is extensive enough to require blood transfusions, bone grafts, and a 4–6-week hospital stay in many cases. Long-term complications include chronic back spasms and potential metal implant toxicity from hardware breakdown (leading to permanent inflammation).