Scoliosis Surgery: Curve Considerations

• Double "S" curves may require fusing both curves.
  
• Sometimes a selective fusion of only one curve can be done.
  
• Selective fusions require that one curve be relatively flexible; therefore, it does not need to be operated on.
  
• If a selective fusion is performed, the second curve will be closely observed. If the second curve becomes larger, it may be treated by bracing (growing children) or may require surgery at a later time.
  
• The advantage of a selective fusion is that more motion segments are preserved than when more than one curve is fused.

Selective Fusion (below): Correction of the thoracic curve results in partial correction of the lumbar curve without fusing most of the lumbar spine.

• Large, stiff (rigid) curves may require a combined front and back (anterior-posterior) surgery.
  
• Front and back surgeries are either performed on the same day or are staged to be performed as two separate procedures several days apart (sometimes longer).
  
• Occasionally, a rigid severe curve can be addressed all from a posterior approach with a procedure termed "vertebral column resection".

Rigid Curve (below): The bending x-ray shows very little correction of the thoracic curve revealing its stiffness.

Arrow denotes direction; side bending x-ray

Patient's Age
The patient's age is a general consideration. For example, older patients have more arthritis and degenerative changes affecting the spine's discs than younger patients. Curves tend to be more rigid in adults and more flexible in younger patients.

Crankshaft phenomenon (the front part of a fused spine twists as the spine grows) can occur in patients who are skeletally immature. This is more common in patients under 10 years of age. Other considerations include:

• Adults tend to have softer bone because of osteopenia or osteoporosis.
  
• Adults are more likely to have disabling or limiting pain related to their scoliosis.
  
• Adult surgeries usually take longer to perform and recovery is longer than a child's.