What Is Scoliosis Surgery and When Is It Necessary?

Scoliosis surgery corrects severe spinal curvature, improves alignment, and helps prevent further progression. Doctors typically recommend this surgery when the curve progression causes significant pain or breathing problems, or does not respond to conservative treatments.

At Total Orthopedics and Sports Medicine, Dr. Karen Avanesov, our fellowship-trained spine surgeon in adult and pediatric spine surgery, uses advanced scoliosis techniques, including spinal fusion surgery, minimally invasive approaches, and intraoperative imaging to stabilize the spine. He also offers advanced non-surgical spine treatments and coordinated follow-up care to support every stage of recovery. Call us at 855-321-6784 to schedule a consultation and explore effective scoliosis treatment options.

When Is Scoliosis Surgery Needed?

Most doctors recommend scoliosis surgery when non-surgical treatments fail, and the curve reaches about 45–50 degrees or causes visible spinal deformity. In fact, the NCBI study found that the surgeons perform posterior spinal fusion when the median magnitude is 55° for thoracic curves and 51° for lumbar curves.

Additionally, surgery is needed when the twist of the spine presses on the spinal cord or makes it difficult to breathe and causes other neurological symptoms. In such cases, surgery prevents curve progression and improves posture. It can also reduce spinal curves from 50 or 60 degrees to 20 degrees.

Can Scoliosis Get Worse Without Surgery?

Yes, scoliosis can worsen without surgery, particularly when the spinal curve is severe, continues progressing during growth, or develops in adulthood. However, the progression of curves depends on factors such as the spinal curvature, age, skeletal maturity, curve location, and underlying condition.

Here’s how these factors can impact the progression of the thoracic and lumbar spine curves:

Spinal Curvature

Larger curves have a greater risk of worsening over time, especially when younger patients are still growing. In contrast, mild curves may remain stable, while severe or moderate curves require closer monitoring. For scoliosis monitoring, doctors use the Cobb angle measured on standing X-rays to track changes in curve severity and identify whether scoliosis is worsening over time.

Age and Growth

Scoliosis is more likely to progress during periods of continued growth. In children and adolescents, spinal curvature can change quickly as the skeleton develops. A curve that appears mild at one age may become significantly larger during a growth spurt. However, after skeletal maturity, progression is usually slower, but it does not stop. Larger curves still gradually worsen in adulthood due to changes in the curvature of the spine, discs, and supporting structures.

Curve Location

The location of the curve can affect the way scoliosis progresses. For instance, curves may primarily affect the thoracic spine, lumbar spine, or both. Thoracic curves can affect the alignment of the chest and rib cage when they become severe. On the other hand, mumbar curves may contribute to uneven hips, lower-back discomfort, and changes in spinal balance.

Underlying Cause of Scoliosis

The underlying cause of scoliosis plays an important role in determining how the spinal curve develops and whether it is likely to progress. Moreover, different types of scoliosis have distinct patterns of progression, such as:

• Adolescent Idiopathic Scoliosis: Its progression is mainly affected by the severity of the curve and the remaining skeletal growth.
• Congenital scoliosis: Develops from vertebral body abnormalities present at birth. Progression depends on the type and severity of the spinal malformation and may increase as the child grows.
• Neuromuscular scoliosis: Occurs when muscle or nervous system disorders affect spinal support and alignment. These curves may progress as the underlying condition changes.
• Degenerative scoliosis: Usually develops or worsens in adulthood because of age-related disc and joint degeneration. Uneven spinal wear can also increase curvature and contribute to pain.

Identifying the specific type of scoliosis helps doctors estimate the risk of progression. If progression becomes significant despite observation or non-surgical treatment, a spine specialist may recommend surgical correction.

Symptoms and Their Impact on Daily Life

Most patients with significant scoliosis may experience little discomfort. On the other hand, many patients can develop persistent back pain, fatigue, reduced mobility, or difficulty performing everyday activities. In more severe cases, spinal deformity can affect the chest wall and may cause lung problems. Nerve compression may also cause symptoms such as numbness, weakness, or radiating pain. When these symptoms affect your quality of life and cannot be controlled with conservative treatment, you may require surgery to improve lung capacity.

What Types of Surgery Do Doctors Perform for Scoliosis?

Doctors perform spinal fusion surgery, vertebral body tethering, osteotomy, and growth-friendly surgeries to treat severe scoliosis. However, the choice of surgery depends on factors such as the severity of the curve, the patient’s age and growth stage, and the underlying cause of the spinal deformity.

Here is how surgeons perform these surgical procedures to align severe curves:

1. Spinal Fusion Surgery

Spinal fusion is the most common scoliosis surgery in which doctors use screws, rods, and bone grafts to correct the spinal curvature and fuse selected vertebrae. As the vertebral bones fuse, they form a solid bone that helps prevent the curve from progressing. However, the number of vertebrae fused depends on the patient’s curve pattern, spinal balance, and the goal of preserving the spine’s normal anatomy.

2. Vertebral Body Tethering

Vertebral body tethering (VBT) is a growth-friendly procedure used for scoliosis treatment in growing children and adolescents. In this procedure, instead of permanently fusing the vertebrae, the surgeon places a flexible tether along the convex side of the curve. As the child grows, the tether can gradually guide the spine toward a straighter position through growth modulation.

Moreover, because the spine is not fused, this approach may preserve more spinal motion. In fact, the NCBI systematic review found that vertebral body tethering (VBT) significantly improved scoliosis curves. The average Cobb angle decreased from 47.8° before surgery to 22.2° after at least two years.

3. Osteotomy

An osteotomy is used when a scoliosis curve is particularly rigid, severe, or difficult to correct with standard techniques. During this technique, the surgeon carefully removes or reshapes part of one or more vertebrae to increase spinal flexibility and allow greater correction. However, different types of osteotomy provide different degrees of correction, such as:

• Smith-Petersen Osteotomy (SPO): Improves spinal flexibility by trimming the posterior vertebral elements. It provides moderate correction when the discs are stable.
• Pedicle Subtraction Osteotomy (PSO): Creates a wedge-shaped opening through the vertebra. It allows doctors to correct for severe, rigid curves and spinal imbalance.
• Vertebral Column Resection (VCR): Involves resecting a vertebral segment to address highly complex, rigid, three-dimensional deformities requiring major correction.
• Multiple-Level Osteotomies: Combines smaller corrections across several vertebral levels to improve overall alignment while distributing the correction throughout the spine.

4. Growth-Friendly Scoliosis Surgery

Growth-friendly procedures are primarily used for young children with early-onset scoliosis, when spinal fusion could restrict normal growth of the spine and chest. These techniques use expandable implants to control the spinal curve while allowing continued growth.

Depending on the child’s condition, options may include magnetically controlled growing metal rods or other growth-preserving systems. According to the PMC study, magnetically controlled growing rods significantly improved scoliosis. The average curve decreased from 71° before surgery to 41° after surgery and remained around 43° at two years. Kyphosis also improved initially, from 49° to 36°, but increased to 42° after 2 years.

How Do Doctors Diagnose Scoliosis?

Dr. Karen Avanesov, our orthopedic surgeon, may review your family history to determine when symptoms or posture changes began and to check for pain or nerve issues. He also assesses posture, shoulder and hip alignment, spinal rotation, and reviews the Cobb angle.

In addition, he may order further imaging, such as MRI, when neurological symptoms, unusual spinal curvature patterns, or underlying spinal abnormalities are suspected. Similarly, he may perform full-spine X-rays to confirm the presence and location of the curve.

Besides that, he evaluates reflexes, muscle strength, sensation, and coordination to identify signs of nerve or spinal cord involvement. He also performs the Adams forward bend test, in which the patient bends forward at a 90-degree angle from the waist. This helps Dr. Karen Avanesov evaluate whether one side of the rib cage or back appears higher than the other. If you are experiencing symptoms of scoliosis or noticing changes in your posture, book an appointment with our doctor.

What Are the Causes of Scoliosis?

Scoliosis may occur due to abnormal spinal development, neuromuscular conditions, or degenerative changes. For instance, idiopathic scoliosis may result from genetic and growth-related factors. On the other hand, congenital scoliosis develops when the vertebrae do not form or separate properly before birth.

Similarly, neuromuscular scoliosis results from conditions affecting muscles or nerves, such as cerebral palsy or muscular dystrophy. Moreover, degenerative scoliosis is an age-related wear of spinal discs and joints that can gradually create or worsen a curve in adults. Here are other factors that may also cause scoliosis:

1. Spinal injuries: Trauma that damages vertebrae or alters spinal alignment may contribute to a secondary curvature.
2. Tumors: Spinal tumors can sometimes alter vertebral structure or produce neurological changes associated with scoliosis.
3. Infections: Certain spinal infections can damage vertebral structures and potentially result in abnormal spinal alignment.
4. Connective-tissue disorders: Conditions affecting connective tissue can compromise the spine’s structural support and may be associated with scoliosis.

Additionally, NIH research has reported that environmental factors, vitamin deficiencies, chemicals, and drugs may cause vertebral abnormalities that may lead to scoliosis.

Are There Any Non-Surgical Options to Treat Mild Scoliosis?

Yes, non-surgical treatments such as pain medications, observation, curve-specific exercises, and bracing can help manage mild scoliosis. For growing children and adolescents at higher risk of curve progression, bracing may help prevent the curve from worsening.

Similarly, specific exercises can improve core strength, posture, flexibility, and functional movement. Moreover, techniques such as the Schroth method may help improve posture, muscular balance, and body awareness. In fact, PubMed research reported that Schroth exercises significantly reduced the Cobb angle compared with non-surgical management (p < 0.05). They also produced significant improvements in quality of life (QOL) at 12 weeks (p < 0.002) and 24 weeks (p < 0.0004).

What Complications Can Occur After Scoliosis Surgery?

Nerve damage, incision site infections, hardware failure like loose screws, excessive blood loss, and failure of the bone to fuse properly (pseudarthrosis) may occur after the surgery. Other potential risks may include digestive obstructions such as an ileus or superior mesenteric artery (SMA) syndrome, dural tears, and reduced spinal flexibility.

According to the NIH review, 24 complications were reported after scoliosis surgery, including 12 superficial infections (1.14%). Researchers also found 5 transient neurological deficits (0.47%), 2 deep infections (0.19%), and 2 cases of superior mesenteric artery syndrome. In addition, the following complications may occur after scoliosis surgery:

• Excessive bleeding: Large incisions and bone work can lead to heavy blood loss.
• Loss of motion: Fusing vertebrae permanently reduces flexibility and range of motion in the spine.
• Adjacent segment disease: Extra stress can wear down vertebrae located just above or below the fusion area.
• Blood clots: Clots can form in the legs (deep vein thrombosis) or travel to the lungs (pulmonary embolism).
• Broken bones: The vertebrae or other bones around the surgical area may fracture, particularly when the bone is weakened or force is applied on the spine.

How Long Does Scoliosis Surgery Take?

Scoliosis surgery typically takes between 4–8 hours to complete. Most patients stay in the hospital for 3 to 7 days after the operation. However, the exact duration depends on the complexity of the spinal curve and the number of vertebrae being fused.

It also depends on whether the procedure is approached from the front, back, or both sides of the spine. Here’s how these factors can impact the time surgery takes:

• Curve Severity: Larger or more rigid spinal curves require more time to safely correct and stabilize.
• Surgical Approach: Operations that involve incisions on both the front and back of the body take longer than single-sided procedures.
• Extent of Fusion: Fusing a larger section of the spine (10 to 14 vertebrae) takes significantly longer than fusing a smaller region.

How Long Does It Take to Recover After Scoliosis Surgery?

The total recovery time after scoliosis surgery (spinal fusion) typically takes 6 to 12 months. Most patients can return to school or light desk work in 4 to 6 weeks and resume full, unrestricted activities around the one-year mark.

However, during this time, bending, lifting, or twisting is not allowed. Additionally, lifting is limited to under 5 pounds. After 2 to 6 weeks of surgery, you can continue gentle exercises. Non-contact sports and light exercises are often permitted around 6 months. Moreover, if you experience pain while performing these exercises, you can take opioid pain medicines. Most patients also don’t need opioid pain medications to reduce pain within 2 weeks.

What Happens If Scoliosis Surgery Is Delayed?

Delaying scoliosis surgery may allow the spinal curve to progress, particularly when it is severe or worsening rapidly. As the deformity increases, pain, posture problems, reduced mobility, and breathing difficulties may develop. In advanced cases, delaying treatment can make correction more complex and bone healing more challenging.

Additionally, uncorrected curves may crowd the chest cavity and put pressure on the heart and lungs. However, the impact of postponing surgery may depend on factors such as the Cobb angle, age, skeletal maturity, curve progression, and symptoms. Therefore, regular monitoring is essential to determine whether the condition is stable or requires timely surgical intervention.

Can Scoliosis Return After Surgery?

Scoliosis can recur after surgery, but significant curve recurrence is uncommon when spinal fusion heals properly. However, significant recurrence may occur due to continued spinal growth, incomplete fusion, implant complications, or progression in unfused spinal segments. Similarly, pseudarthrosis, hardware failure, or spinal imbalance can contribute to recurrent deformity. Therefore, doctors typically monitor patients’ condition with physical examinations and follow-up X-rays to assess spinal alignment and hardware position.

Discuss Your Scoliosis Treatment Options With Dr. Karen Avanesov in Massapequa

If you have scoliosis, it may cause persistent back or neck pain, stiffness, reduced mobility, and difficulty maintaining your usual activities. Severe curves can also affect chest expansion and breathing. As the curve progresses or symptoms worsen, delaying scoliosis surgery may lead to severe deformity and reduced lung function.

At Total Orthopedics and Sports Medicine, Dr. Karen Avanesov, our board-certified orthopedic spine surgeon, provides personalized scoliosis care using advanced surgical techniques. Depending on your curve and patient needs, he uses carefully planned, tissue-sparing vertebral instrumentation techniques to protect spinal stability. Additionally, these approaches improve spinal alignment and protect surrounding tissues. Visit us at 5500 Merrick Road, Massapequa, NY 11758, or contact us at 855-321-6784 to get expert treatment.

FAQs