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Surgical Management of Scoliosis

Making the Right Choices in the Treatment of Idiopathic Scoliosis: A Patient's Guide

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Surgical Management

Surgical management of scoliosis is generally intended to prevent future consequences of progressive deformity. Although most adolescents have little impairment or symptoms related to their deformity, future consequences include the possible:

  • development of progressive pain
  • pulmonary or cardiac compromise
  • progressive deformity and unacceptable appearance
  • neurological deterioration

Research from studying the progression of untreated AIS and the results of AIS treated surgically, allows us to make an informed prediction of the future consequences of spinal deformities. However, individual cases differ and future consequences of the deformity are best managed by open discussion between informed patients, families, and care providers.

surgeon, surgery

Progressive Back Pain

The future possibility of disabling back pain is an important concern for patients and families when considering management options for progressive deformity. Back pain is the most common complaint for adults seeking treatment for scoliosis. However, there is little data that persons with AIS are at significantly greater risk of experiencing back complaints than the general population. Specifically, the magnitude of deformity, or size of the curve, has a very poor correlation with the severity of symptoms.

Cardiac and Pulmonary Compromise

Spinal deformity measuring greater than 60 degrees can effect pulmonary function and cardiac dynamics as detected by echocardiography. Patients with severe upper-chest curvatures may develop restrictive pulmonary disease. However, significant pulmonary or cardiac compromise is characteristic of congenital scoliosis and rare in AIS. Patients and families should discuss with the physician concerns about future pulmonary and cardiac compromise knowing the expected effect of deformity on vital structures.

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Updated on: 02/01/10
Thomas G. Lowe, MD
Dr. Berven has provided the reader with an overview of scoliosis developing in the skeletally immature adolescent. The important fact to remember is that only a small fraction of adolescent patients who develop a curvature of the spine will ever require treatment other than periodic observation during the growth period. It is however important, once scoliosis has been diagnosed or is suspected, to be seen by an orthopaedic surgeon, who specializes in spinal problems in children to determine the severity of the deformity by an examination and x-rays and what, if any, treatment is indicated.

Most of the time he/she will recommend periodic follow-up examination during the growth period until growth is complete. Exercises alone have never proven helpful in the treatment of scoliosis. A small number of patients (<0.5%) will require the use of a back brace combined with an exercise program during growth, however the brace, if needed can be removed for daily athletic activities and exercise. Braces are now available which are cosmetically acceptable and easy to wear. Braces often will control curves <40º but a few will increase and require surgery. An even smaller number (<0.25%) with curves greater than 40º- 45º may require surgical correction of their scoliosis. When surgery is necessary, the use of a brace is rarely needed and present surgical techniques are usually very successful.

As Dr. Berven suggested, always discuss treatment options with your orthopaedist so that you thoroughly understand his/her recommendations and seek other opinions if he/she is unable to explain recommendations.

Baron S. Lonner, MD
Dr. Berven provides an excellent review of the management of adolescent idiopathic scoliosis that emphasizes the importance of informed decision-making by the patient, family, and surgeon. New treatment options in AIS include the possibility of modulating or controlling growth of the spine by causing differential growth on one side of the spine more than the other to allow for gradual correction of the scoliosis with growth. This approach, utilizing "staples" or flexible tethers placed by minimally invasive techniques would be utilized in patients who continue to grow and in whom bracing has failed. Flexibility of the spine is preserved by theses techniques. This is currently an experimental area.

Results of surgery in the adolescent patient have been predictable and quite good. Goals of surgery include correction of deformity, preservation of pulmonary (lung) function, avoidance of long-term pain as a consequence of untreated curvature, and preservation of as many motion segments of the spine as possible. Studies assessing outcomes of surgery in patients have shown high rates of satisfaction and improvements in self image, pain, and even function.

Dr. Berven should be congratulated on his approach to patient care based on informed decision-making and inclusion of the patient and family in the process of devising a treatment plan.

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