Surgery for scoliosis

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.

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.

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 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.

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.

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.