Scoliosis surgery is typically recommended when the Cobb angle reaches 40 degrees in adolescents or 45 degrees in adults. The primary goal of surgery is to halt progression of the curve. Cases of scoliosis above 40 degrees have a high risk of continuing to progress in the absence of treatment – even after the spine is finished growing.
There are many different types of scoliosis surgeries, but they generally fall into one of two categories: posterior approach or anterior approach. It is also possible to do a combination of the two approaches.
Posterior surgeries are the most common type of scoliosis surgery and are performed with the patient lying face-down. If the patient’s scoliosis involves the upper (thoracic) spine, this is the procedure that most surgeons will recommend.
Anterior surgeries typically involve an incision that follows the bottom ribs and ends in a north-south direction above the navel, allowing surgeons to access the lower spine very easily.
Surgeries Currently Performed
The Cotrel-Dubousset system
In 1984, French surgeons Dr. Ives Cotrel and Dr. Jean Dubousset developed the C-D instrumentation. It typically involves double rods, with hooks or screws that are attached to the top and bottom, and then tightened to straighten the spine.
Third-generation instrumentation: pedicle screws and hook-rod-screw hybrids
The newest scoliosis surgeries typically involve the fusion of the spinal bones, along with a combination of rods, hooks, and/or screws to hold the fusion in place. These are generally referred to as third-generation constructs. They include systems such as Isola, Universal Spine System (USS), and Texas Scottish Rite Hospital (TSRH) instrumentation. Scoliosis surgeries today use either hook-rod hybrids or total pedicle screws. There is some controversy as to which method is superior.
New innovations in scoliosis surgery
There are also new surgeries being developed that involve the use of “growing” rods to help small children with scoliosis whose spines are still growing. Without the use of these growing rods, children with scoliosis who had the surgery when they were young would require additional operations as their spine continued to grow. Additional innovations include endoscopic and video-assisted operations, as well as fusionless procedures such as vertebral body spinal stapling and vertical expandable prosthetic titanium ribs (VEPTR).
Reasons to Choose Surgery
There are many reasons why people with scoliosis decide to have surgery. Some patients want to improve the appearance of their body (particularly the protrusion of the ribs in the back). Others are concerned about preventing long-term disability and eliminating pain.
It is important to have a detailed consultation with an orthopedic surgeon to ensure you can achieve the results you want. The definition of a successful surgery can sometimes be different for the doctor and the patient. Surgery is generally considered successful by the doctor when it reduces and stabilizes the Cobb angle. However, it has been increasingly recognized among scoliosis experts that surgically reducing the Cobb angle does not always mean an improvement in physical appearance, a reduction in pain levels, or an improvement in quality of life.
Surgery for scoliosis is not a medical emergency, in the same way, for example, surgery for a ruptured appendix might be. You shouldn’t feel pressured into choosing surgery for you or your loved one. While surgery may help some people with scoliosis, not every person experiences the same results. If surgery doesn’t achieve the desired results, options for further treatment are limited.
The CLEAR Scoliosis Institute recognizes that not every parent feels comfortable choosing spinal surgery as a treatment for their child, and that not every person with scoliosis wants to have surgery. We are happy to provide an alternative. If, for any reason, CLEAR Treatment is not successful in achieving the results you expected, surgery is always available as a choice down the road.