Surgery for scoliosis

Photo of a teenage girl talking to a doctor

If your spine is very curved, surgery might be an option. Scoliosis surgery aims to straighten the spine by joining together a number of the vertebrae (spine bones) along the curve. The process of joining bones together is known as "fusion."

Once a person’s bones have stopped growing, their scoliosis tends not to get any worse – unless the spine is extremely curved. Research shows that severe scoliosis (with a Cobb angle of 50 degrees or more) often gets worse over the person's lifetime. Because of this, doctors usually recommend surgery for people with such severe scoliosis. The procedure stabilizes the spine and largely straightens the curve. This stops the scoliosis from getting any worse.

Sometimes, surgery is also considered when the Cobb angle is between 40 and 50 degrees – for example, if the bones still have to grow a lot.

Various aspects need to be considered when deciding whether surgery is the right option:

  • Exactly how severe the scoliosis is
  • The possible pros and cons of surgery
  • How much the scoliosis is affecting quality of life
  • Any other medical problems the patient has

There is no research to show that surgery reduces back pain. Often, the surgery itself can cause temporary back pain.


Scoliosis only gets worse slowly, so there’s usually no need to make a decision about surgery right away. A second medical opinion can be helpful too.

What does surgery involve?

In most cases, surgery for scoliosis involves what’s known as “spinal fusion.” This is also referred to as “spondylodesis” or “back fusion” surgery. The aim of the surgery is to straighten the vertebrae in the curve and fuse them together. This technique can make the spine almost completely straight again.

The surgery is usually done with the patient lying on their stomach. Typically, a long incision (cut) is made along the spine. First, special screws are inserted into the vertebrae. Then, metal rods are used to connect the screws and straighten the spine.

To help the vertebrae fuse together better, small bone fragments (grafts) are placed along the spine too. They can be taken from the patient’s own body (from the outer edge of the pelvic bone, called the “iliac crest”) or from a bone bank.

Illustration: X-ray image of a spine after spinal fusion surgery

What are the risks of surgery?

The potential serious complications of surgery include nerve damage in the spinal cord. Pinched nerves only cause temporary numbness. But injury to – or overstretching of – the spinal cord can lead to paraplegia (paralysis in both legs and sometimes other parts of the lower body). The spinal cord is injured or overstretched in about 1% of these procedures. But resulting long-term damage is less common.

Other risks of surgery include infections and major blood loss that needs to be treated with a blood transfusion. There is also a low risk that the surgery might not be successful or that screws might come loose after some time, making further surgery necessary. All in all, complications occur in around 5% of spinal fusion operations.

When is it the right time for surgery?

The best time for surgery will depend on your specific situation. Generally speaking, doctors recommend operating once the teenage growth spurts have ended but before the spine stops growing overall.

Two things are particularly important to bear in mind: If surgery is done too early, there’s a risk of more surgery being needed later if the spine continues to curve. But if surgery is done too late, it can be more difficult (if the curve has got worse).

How long does it take to recover?

How long it takes to recover from scoliosis surgery depends on various factors, including things like how many vertebrae have been fused. So the following information is only meant as a rough guide.

You will usually stay in hospital for up to ten days after surgery. People often feel nauseous and lose their appetite in the first few days afterwards because of the anesthetic. Your back will feel a little strange to start with. It is typically difficult to get up and to walk, but people often find it easier to walk short distances again after just a few days. After about four weeks, it’s possible to do most everyday activities again, and teenagers can usually go back to school.

It is normal to have aches and pains in the first few weeks after surgery. They are sometimes severe but there are good medications to treat them. You might have to take strong painkillers for a short time after surgery. Proper pain management is important because it supports the healing process and helps you get back on your feet again. As soon as the pain starts to get better, you will be given weaker medication.

It takes roughly four to six months after surgery to be able to start low-risk sports like running again. The vertebrae take about twelve months to fuse completely. So you shouldn’t do any sports that involve a lot of physical contact or a high risk of injury (such as soccer) during this time. Your doctor might also recommend avoiding certain high-risk sports altogether.

What are the side effects of surgery?

Spinal fusion makes your back stiffer. This makes it more difficult to do sports that require a lot of flexibility, like dancing or certain fitness exercises. But many people don’t have any major problems in their day-to-day lives because movements like bending over mostly come from the hips.

The surgery may leave a large scar on your back. Your doctor can advise you on how to make sure the tissue heals well and the scar isn't too noticeable. Some of the things you can do include carefully massaging the scar and taking good care of it. It is also important to protect the scar from the sun in the first few months after surgery.

Are there alternatives to spinal fusion?

Vertebral body tethering is another type of surgery that involves inserting screws into the vertebrae. But they’re joined together with a special synthetic cord afterwards, instead of the metal rods used in fusion. The aim is to allow a certain amount of flexibility in the spine while also straightening the spine. A further potential advantage is that patients recover more quickly.

One possible risk of this approach is that the cord can tear. The curve may be overcorrected, too. In a few small-scale studies, around half the teenagers who had a tethering procedure needed more surgery later.

There is generally very little experience with this technique, and only very few hospitals offer it. There is also a lack of high-quality research comparing tethering with fusion over a period of several years. So it’s not yet possible to say what people with scoliosis can expect from vertebral body tethering.

Altaf F, Gibson A, Dannawi Z et al. Adolescent idiopathic scoliosis. BMJ 2013; 346: f2508.

Deutsche Wirbelsäulengesellschaft (DWG), Vereinigung für Kinderorthopädie (VKO), Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU). Adoleszente Idiopathische Skoliose (S2k-Leitlinie). AWMF-Registernr.: 151-002. 2023.

Rullander AC, Isberg S, Karling M et al. Adolescents' experience with scoliosis surgery: a qualitative study. Pain Manag Nurs 2013; 14(1): 50-59.

Rullander AC, Jonsson H, Lundstrom M et al. Young people's experiences with scoliosis surgery: a survey of pain, nausea, and global satisfaction. Orthop Nurs 2013; 32(6): 327-333; quiz 334-335.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on March 25, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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