Surgical Management of Scoliosis

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.

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.