Scoliosis Surgery: Goals and Considerations

Why Surgery?
The reasons an adult undergoes scoliosis surgery may differ from a child. Most adults are treated for pain related to the scoliosis and deformity progression. Sometimes neurological deficits accompany adult scoliosis and require treatment. On the other hand, children are treated for progressive curves more than 40-degrees (for idiopathic scoliosis). Common to both adults and children is the goal of surgery: to avoid or stop pulmonary (lung) disease caused by severe thoracic (ribbed spine) curvature and to correct disfiguring spinal deformity.

Spinal Deformity

Arrow points to rib prominence

Surgical Goals
Although surgery to treat scoliosis is often complicated, the goals are simple:

• Stop and correct progressive spinal deformity
  
• Improve back and or leg pain
  
• Prevent or stop restrictive lung disease that is associated with severe thoracic curvature and more common in congenital scoliosis (lungs cannot expand fully making breathing difficult, the body may not get enough oxygen)
  
• Create a balanced and stable spine
  
• Create a solid fusion
  
• Save as many motion segments in the lumbar (lower) spine as possible to preserve motion (flexibility) and function
  
• Achieve a fine cosmetic result

Surgical Considerations
The type of scoliosis surgical treatment is based on many factors.

• The size and location of the curve
  
• Curve flexibility
  
• Number of curves
  
• The patient's age and biological maturity
  
• Bone quality
  
• Presence of arthritis and or degenerative disc disease
  
• Side view (sagittal plane) of the spine; including evidence of kyphosis (round back) or lordosis (swayback)