What Are the Surgical Options for Adult Spinal Deformity?

In the case of adult spinal deformity, surgeons may perform fusion surgery, osteotomies, decompression, and other minimally invasive spine surgeries. They select one or more techniques based on spinal alignment, nerve compression, instability, deformity severity, symptoms, and overall health to restore proper alignment and improve function.

At Total Orthopedics and Sports Medicine, Dr. Karen Avanesov, our board-certified orthopedic spine surgeon, evaluates your symptoms, medical history, posture, spinal alignment, and neurological function using advanced imaging. After reviewing the results, he creates a treatment plan according to your condition, symptoms, and goals. He may perform fusion surgery, decompression, osteotomies, and complex corrective procedures to stabilize the spine. Contact us at 855-321-6784 to discuss the most appropriate treatment options for your spinal deformity.

Which Surgeries Are Used to Correct Adult Spinal Deformity?

Spinal fusion, decompression, osteotomy, or vertebral column resection are spinal deformity surgeries used to improve posture in adults. These innovative treatment options relieve nerve root pressure, realign the abnormal curvature, and prevent age-related changes in the spine.

Here’s how surgeons typically perform different types of adult spinal deformity surgeries:

1. Spinal Fusion

Spinal fusion is commonly used when the lumbar spine is unstable, severely misaligned, or affected by conditions such as degenerative scoliosis or spondylolisthesis. It may also be recommended when abnormal movement between vertebrae contributes to persistent pain, or when correction requires permanent stabilization of the affected segments.

During this spinal surgery, the surgeon first exposes the affected portion of the spine through an appropriate surgical approach. Depending on the patient’s deformity and treatment plan, the surgeon may remove damaged discs or other structures that are contributing to the problem. Bone graft material is then placed between selected vertebrae to fuse the vertebrae.

After this, the surgeon positions screws, rods, cages, or other spinal implants to hold the vertebrae in the desired alignment. These implants provide immediate stability while the bone graft gradually forms a solid connection between the vertebrae. Over time, the fused segments help maintain normal alignment and reduce mechanical pain.

2. Spinal Decompression

Decompression is a minimally invasive surgery that is performed when a spinal deformity causes narrowing around the spinal cord or nerve root. It may occur due to degenerative changes, spinal stenosis, herniated discs, or other age-related changes. These spinal conditions cause leg pain, numbness, weakness, or other symptoms due to nerve compression.

Therefore, surgeons carefully remove the structures responsible for the pressure. Depending on the location and cause of compression, they may remove part of the lamina, thickened ligament, bone spurs, or disc material. Besides that, they work around the nerves with precision to create additional space within the spinal canal or neural foramen. This can reduce radiating pain, numbness, tingling, and weakness, and improve walking or daily function.

3. Osteotomy

An osteotomy is considered when the spinal deformity is too rigid or severe to be corrected through simpler procedures. It may be particularly useful for adults with substantial sagittal imbalance, excessive inward curvature, or a forward-stooping posture that cannot be corrected by spinal positioning.

During an osteotomy, the surgeon removes or cuts a carefully planned portion of bone from one or more vertebrae. The amount and location of bone removed depend on the degree and direction of the required correction. After the bone has been prepared, the surgeon carefully adjusts the vertebral segments to improve the spine’s overall alignment. Spinal screws and rods are then placed to hold the corrected position. Here are the most common osteotomy techniques that most surgeons use:

• Smith-Petersen Osteotomy (SPO): Removes the posterior spinal elements while preserving the anterior disc space. It is typically used for flexible deformities and can provide modest correction at each treated level.
• Pedicle Subtraction Osteotomy (PSO): Creates a three-column wedge correction at a single vertebral level. This technique is considered for excessive forward curvature.
• Vertebral Column Resection (VCR): Addresses highly rigid or sharply angulated deformities by removing a vertebral segment and reconstructing the spinal column.

4. Vertebral Column Resection

Vertebral column resection (VCR) is reserved for complex and severe spinal deformities that cannot be adequately corrected with less extensive techniques. It may be considered for sharply angulated deformities, three-dimensional spinal abnormalities, or severe adult scoliosis that requires greater correction.

During this procedure, the surgeon first exposes and stabilizes the spine with carefully positioned instrumentation. A severely deformed vertebral segment, including the vertebral body and associated spinal structures, is then removed under controlled conditions. Because this creates a significant gap in the spinal column, surgeons protect the spinal cord and surrounding neural structures throughout the procedure.

After the abnormal vertebra has been removed, the surgeon gradually fuses the remaining spinal segments into a more appropriate position. A structural implant or cage is also placed to reconstruct the anterior portion of the spinal column. In addition, the medical team places screws and rods to stabilize the corrected spine from the posterior side.

Who Is Eligible for Adult Spinal Deformity Surgery?

Adults experiencing symptoms of persistent pain, disability, nerve compression, or progressive deformity that does not improve with non-surgical treatment are eligible for spinal deformity surgery. Surgical eligibility may also depend on imaging-confirmed structural abnormalities and the patient’s overall health.

Besides that, according to NCBI research, patients with degenerative spinal deformity causing lower thoracic kyphosis may require surgery. Here are the criteria that most surgeons follow before choosing the right candidate for spinal deformity surgery:

• Kyphosis Angle: Measured via standing full-spine X-rays using the Cobb method. Angles more than 75 degrees show severe structural deformity.
• Chin-Brow Vertical Angle (CBVA): Evaluates a patient’s horizontal gaze by measuring the angle between the chin and the brow. Values greater than 35 degrees signify a severe downward gaze.
• Coronal/Sagittal Imbalance: Assesses global spinal alignment via vertical axis offsets (such as C2-C7 or T1 sagittal vertical offsets) and lateral trunk deviations on long-cassette radiographs.

Because adult spinal deformity surgery can involve complex reconstruction, surgeons determine eligibility through an individualized evaluation rather than a single curvature measurement. They carefully review bone quality, fitness, and the ability to tolerate anesthesia. Similarly, they evaluate potential benefits and risks, as well as the individual’s functional goals, before recommending the surgical procedure.

What Factors Affect the Success of Spinal Deformity Surgery?

Severity of the deformity, achieving proper spinal balance, careful patient selection, and bone health may affect the success of surgery. Similarly, surgical team expertise, minimizing modifiable risks, and following the postoperative care plan can also improve outcomes and reduce potential complications.

Here is how these factors can restore function and significantly improve spinal pain after surgery:

1. Severity of the Deformity

The degree of spinal curvature, sagittal imbalance, vertebral degeneration, and structural changes can impact the complexity of surgery and the extent of correction required. More advanced deformities may require extensive fusion, osteotomies, or other corrective procedures, which can increase surgical complexity and recovery time. According to the NIH review, 95% of patients with increased baseline deformity severity require sagittal correction to achieve good outcomes.

2. Achieving Proper Spinal Balance

Before performing a surgical procedure, the surgeon considers parameters such as pelvic incidence, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. This is because appropriate alignment can improve posture, reduce compensatory strain on the hips and knees, and support better long-term function

3. Careful Patient Selection

Selecting suitable candidates leads to pain relief, functional improvement, successful recovery, and long-term spinal stability. Therefore, before performing the procedure, surgeons carefully select patients based on the following factors:

• Symptoms
• Functional limitations
• Deformity progression
• Imaging findings
• Previous treatments
• Medical conditions
• Activity level
• Treatment goals

4. Bone Health

Good bone health is essential for maintaining stable spinal implants and achieving successful fusion. Osteoporosis and low bone density can increase the risk of screw loosening, vertebral fractures, implant failure, and unsuccessful fusion. For this reason, surgeons assess bone health before surgery. PMC research also found that spinal deformity patients with osteoporosis have an increased risk of undergoing revision for a surgery-related complication.

5. Surgical Team Expertise

Adult spinal deformity surgery can involve complex correction and reconstruction. Therefore, choosing an experienced surgical team improves surgical outcomes through detailed imaging assessment. They also implement individualized surgical planning and select corrective techniques to carefully manage surgical risks.

6. Minimizing Risks

Addressing risk factors before surgery can improve the patient’s ability to heal and reduce the chances of postoperative complications. For instance, surgeons may recommend quitting smoking as nicotine can impair blood flow and bone healing. It also increases the risk of failed spinal fusion and revision surgeries. In fact, a PubMed review found that a history of smoking significantly increased the risk of excessive intraoperative bleeding and implant failure rate.

Preoperative optimization may also involve reducing or managing opioid use, particularly when long-term use could complicate postoperative pain management. Moreover, nutritional deficiencies should be identified and corrected because adequate protein, vitamins, and minerals are important for tissue repair and bone healing. Similarly, doctors may recommend maintaining a healthy weight because obesity can increase the stress on the surgical site.

7. Following the Postoperative Care Plan

Patients should follow instructions regarding activity, lifting, wound care, medications, and rehabilitation. Regular follow-up allows the surgical team to monitor healing, spinal alignment, and fusion while identifying complications early. Gradually rebuilding strength and mobility can also improve surgical outcomes and help patients return to daily activities safely.

What Are the Causes of Spinal Deformity?

Spinal deformity can result from aging, congenital abnormalities, trauma, degenerative changes, neuromuscular conditions, or previous spinal surgery. Other factors that cause spinal deformity may include scoliosis, kyphosis, and excessive lordosis.

In adults, weakened spinal structures and vertebral fractures can also alter spinal alignment and cause progressive deformity. Here is how these factors can impact spinal health and cause deformities:

• Degenerative changes: Wear and tear in the discs and facet joints can cause the spine to lose its normal alignment, particularly in older adults.
• Congenital conditions: Some people are born with vertebral abnormalities that affect how the spine develops and aligns.
• Scoliosis: Abnormal sideways curvature can develop during childhood or adulthood and may progress over time.
• Kyphosis: Excessive forward curvature of the upper or middle spine can result from aging, osteoporosis, vertebral fractures, or structural abnormalities.
• Trauma: Spinal fractures or significant injuries can change vertebral shape and disrupt normal alignment.
• Neuromuscular disorders: Conditions affecting muscles or nerves can interfere with the body’s ability to maintain proper spinal alignment.
• Osteoporosis: Reduced bone strength can lead to vertebral compression fractures, which may gradually increase spinal curvature.

What Are the Symptoms of Adult Spinal Deformity?

Adults with spinal deformity may experience persistent upper back pain, noticeable changes in posture, difficulty standing upright, and reduced mobility. Other signs may include uneven shoulders or hips, forward stooping, fatigue while standing or walking, and difficulty performing everyday activities.

According to PMC research, greater pelvic incidence–lumbar lordosis mismatch was associated with greater back and leg pain. Besides that, many patients may experience the following symptoms:

• Height Loss: Gradual shrinking over time due to collapsing discs or worsening spinal curves.
• Radiculopathy: Sharp, shooting pain traveling down the legs or arms if the deformity pinches a nerve root.
• Numbness and Weakness: Tingling sensations or a “pins and needles” effect, along with leg heaviness or cramping during activity.
• Breathing Difficulties: Reduced lung capacity in severe thoracic curves.

In fact, the NCBI clinical review found that thoracolumbar kyphotic curvature was associated with restrictive ventilatory impairment. Researchers also found that rigid thoracic deformity can contribute to reduced pulmonary function.

How Do Doctors Diagnose Adult Spinal Deformity?

Dr. Karen Avanesov, our spine specialist, performs a physical examination, reviews medical history, and orders standing full-spine X-rays. He may also perform bending X-rays to assess spinal flexibility and determine whether a curve is rigid or correctable. These tests help identify abnormal spinal curves, imbalance, vertebral changes, and nerve-related problems.

In some cases, he may perform an MRI or order CT scans to assess nerves, discs, bone structures, and other underlying abnormalities. Moreover, Dr. Karen Avanesov performs posture and gait assessment to identify abnormal alignment, forward stooping, uneven shoulders or hips, and walking difficulties. If you have osteoporosis or reduced bone strength, he also orders a bone density test (DEXA) to improve surgical outcomes. Besides that, if symptoms suggest nerve dysfunction, radiculopathy, or peripheral nerve problems, he may order Electromyography (EMG) and nerve conduction studies. Reach out today for a proper diagnosis of your spinal deformity.

Can Non-Surgical Treatments Treat Spinal Deformity?

Yes, non-surgical treatments such as targeted exercises, pain medications, injections, and lifestyle changes may alleviate pain, improve mobility, strengthen supporting muscles, and support healing. However, it can only prevent further progression of mild-to-moderate curves.

Here’s how these treatment approaches can treat spinal deformity and provide relief:

• Targeted Exercises: Strengthens the core and back muscles while improving posture, flexibility, balance, and movement patterns.
• Pain Management: Medications such as anti-inflammatory drugs may help control pain and inflammation.
• Epidural or facet injections: Targeted injections can provide temporary relief when nerve irritation or inflamed spinal joints contribute to symptoms.
• Activity modification: Adjusting activities that worsen pain and using proper body mechanics can reduce spinal stress.
• Weight management and conditioning: Maintaining a healthy weight and improving overall physical fitness can reduce mechanical strain and support daily function.

What Complications Can Occur After the Surgery?

Infection, blood clots, nerve damage, spinal fluid leaks, hardware failure, nonunion, or persistent pain can occur after spinal deformity surgery. Most patients may also develop adjacent segment problems or loss of spinal alignment, particularly after complex or extensive spinal reconstruction.

However, the risk of complications depends on factors such as age, overall health, bone quality, smoking status, deformity severity, and procedural complexity. According to PMC research, complications that may occur after deformity surgery include implant-related, radiographic, neurological, operative, cardiopulmonary, and infection. Researchers also found that higher complication rates were associated with older age and greater body mass index.

Therefore, careful surgical planning, preoperative medical optimization, appropriate implant selection, and close postoperative monitoring are essential to reduce these risks. Additionally, you should promptly report worsening pain, fever, wound drainage, new weakness or numbness, difficulty walking, or changes in bladder or bowel control. These symptoms may indicate nerve compression or injury, spinal cord involvement, blood loss, or other postoperative complications.

How Long Does It Take to Recover From Spinal Deformity?

Recovering from spinal deformity surgery (such as correction for scoliosis or kyphosis) generally takes 6 to 12 months for complete bone healing and stabilization. In contrast, acute recovery and a return to light daily activities or desk work require 2 to 6 weeks, while strenuous exercise and heavy lifting remain restricted for several months.

Moreover, patients may have to stay in the hospital for 4 to 7 days. They may also need extra help at home during recovery. However, if you have undergone minimally invasive techniques, recovery times and tissue damage are reduced. In both cases, you must focus on wound care and pain management initially. After several weeks (4 to 6 weeks), you can increase your tolerance for walking. At 6 to 8 weeks, you can drive without restrictions. Within 3 to 6 months, you can begin core-strengthening exercises to improve stability.

Can Adult Spinal Deformity Return After Surgery?

Yes, spinal deformity can recur after surgery due to pseudarthrosis (failed bone healing) or adjacent segment breakdown. Recurrent curvature or spinal imbalance may also develop due to age-related degeneration, implant complications, or poor bone quality.

However, the risk of recurrence depends on the severity of the original deformity, surgical technique, spinal alignment achieved, bone strength, and the patient’s overall health. Therefore, most doctors recommend maintaining good bone health, following recovery guidelines, and avoiding smoking to support better posture and long-term spinal stability.

Consult Dr. Karen Avanesov for Spinal Deformity Treatments in Syosset

Spinal deformity may cause chronic back pain, muscle fatigue, stiffness, difficulty walking or standing for long periods, and nerve compression pain. When conservative treatments no longer provide enough relief, choosing between decompression, spinal fusion, osteotomy, or minimally invasive correction may become difficult for you.

At Total Orthopedics and Sports Medicine, Dr. Karen Avanesov, our fellowship-trained pediatric spine surgeon, evaluates sagittal alignment and assesses spinal flexibility, nerve compression, and bone quality. Based on these findings, he determines whether you need decompression, minimally invasive stabilization, spinal fusion, osteotomy-based correction, or a combination of techniques. Visit us at 115 Eileen Way, Syosset, NY 11791, or call 855-321-6784 to restore your spinal balance.

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