Scoliosis. When Is Surgery Necessary?

Atlantic Spine Center

Spine Health Blog


Spine Surgeon Dr. Praveen Kadimcherla Shares his Knowledge on Scoliosis and its Treatment Options.

Scoliosis, characterized by an abnormal curve of the spine, is seen most often in girls between the ages of nine and fifteen. The very gradual change in the curvature of the spine usually causes no discomfort in early stages and may not be easily noticeable. It may be detected by a physician or a routine school screening or there may be subtle changes like one hip or shoulder appearing slightly higher than the other. "Most cases of scoliosis are idiopathic, that is, they have no known cause," says Dr. Praveen Kadimcherla at Atlantic Spine Center. "And many cases never progress beyond a mild curvature. Depending on the severity of the curve and the risk of it getting worse, scoliosis is treated by observation, bracing, or in cases with the most severe curve or risk of progression, surgery."

While idiopathic scoliosis accounts for 80% of cases, there are other types of the disease with known causes. In functional scoliosis, a curve in the spine develops because of a problem elsewhere in the body, such as one leg being longer than the other. Neuromuscular scoliosis is congenital, caused by abnormal development of the bones of the spine; it is usually associated with other disorders such as birth defects, cerebral palsy, or muscular dystrophy. Degenerative scoliosis occurs in older adults, usually as a result of changes in the spine due to arthritis or osteoporosis.

About the same number of boys and girls have mild idiopathic scoliosis but girls are 7-10 times more likely to have the curve progress to the point where treatment is necessary. It may be diagnosed in younger children but is most often associated with growth spurts in adolescence. Although many who develop scoliosis do not have family members who have the condition, a family history does increase risk.

Treatment for scoliosis is determined by the degree of the curve and by the likelihood that it will get worse. In general, the risk of the curve worsening depends on its size and the amount of skeletal growth remaining. The larger the curve and the more skeletal growth remaining, the greater the risk of the curve progressing. If the curve is small when first diagnosed it will be observed and measured every 4-6 months until the patient has reached full skeletal maturity. As long as it stays below 20-25 degrees, no further treatment is necessary. If the curve is between 25-40 degrees and the patient is still growing, a brace may be recommended; if the patient is no longer growing, bracing is unnecessary. "Bracing cannot correct the curve but can slow or stop its progression," says Dr. Kadimcherla. "If the curve progresses to more than 40-50 degrees it is likely to continue to get worse throughout the patient's life and may eventually cause heart or lung problems. At that level of curve, surgery may be advisable."

The goals of surgery for scoliosis are to correct the curve to as close as possible to normal and to stabilize the spine to prevent the curve from progressing further. This is done by permanently fusing two or more adjacent vertebrae so that they grow together and form a single, solid bone. This stops growth in the curved portion of the spine and prevents it from getting worse. Spinal fusion surgery uses bone grafts – small pieces of bone that are placed between the vertebrae to be fused – to help the bones grow together. Metal rods hold the spine in place until fusion occurs. The rods are attached to the spine by screws, hooks, and/or wires which generally do not have to be removed. The number of vertebrae that are fused depends on the degree and location of the curve. The fused portion of the spine will be stiff following surgery but most people will have enough flexibility to perform daily activities and most sports.

"We don't know how to prevent scoliosis," says Dr. Kadimcherla, "and we cannot cure it. But we have excellent treatment options that reduce its effects and prevent its advance. Early detection is important in achieving the best possible result."