A spinal surgery in which progressive or severe curves are corrected using metal screws and rods and stabilized with fusion.
Indication
- Adolescent idiopathic scoliosis — Cobb angle of 45-50° or greater (with continued progression risk even after skeletal maturity)
- Congenital scoliosis (with vertebral anomalies present at birth) — rapidly progressing cases or those with neurological findings
- Neuromuscular scoliosis (cerebral palsy, muscular dystrophy) — patients with impaired sitting balance
- Adult degenerative scoliosis — severe back pain, radiculopathy, progressive imbalance
- Curves that do not respond to conservative treatment (bracing, physical therapy) and progress despite growth
- Severe thoracic curves affecting respiratory and cardiac function (usually Cobb 70°+)
Preparation
- Complete orthopedic examination, full standing spine radiographs, side-bending tests, and MRI/CT imaging
- Pulmonary function tests and ECG; cardiology consultation in advanced curves
- 8 hours of fasting before surgery; blood thinners are adjusted with physician approval
- Blood tests for autologous blood preparation or cell-saver systems
- Skin assessment and marking of the scoliosis level
How it's performed
- Under general anesthesia, neuromonitoring (live nerve function monitoring) electrodes are placed
- The patient is positioned prone; a midline incision is made on the back and the spinal levels are exposed
- Pedicle screws are placed in the vertebrae; screw position is verified with X-ray or navigation
- Pre-shaped rods are attached to the screws; rotation and correction maneuvers reduce the curvature
- The joint surfaces are cleaned and bone graft is placed (fusion — bone consolidation)
- The skin is closed in layers; neurological assessment is performed after awakening
Post-procedure
- 1-2 days of intensive care follow-up; total hospital stay of 5-7 days
- Pain control and mobilization in the first 24-48 hours (usually standing on day 2)
- Avoidance of heavy lifting, bending, and twisting for the first 6 weeks; a supportive brace in some cases
- Regular radiographic follow-up to monitor fusion (at 3, 6, and 12 months)
- Gradual return to activity: light walking at 4-6 weeks, sports activity at 6-12 months with physician approval
Risks
- Infection (superficial or deep, 1-3%)
- Bleeding, hematoma, and need for transfusion in high-volume procedures
- Neurological complications — nerve or spinal cord injury (rare; risk is reduced with neuromonitoring)
- Screw malposition or rod breakage — revision may be required
- Pseudarthrosis (insufficient fusion), adjacent segment degeneration, anesthesia reactions
FAQ
Will the spine regain its former flexibility after scoliosis surgery?
No, the fused segments become immobile. However, daily living activities can largely be maintained; non-fused segments preserve mobility.
At what age is surgery appropriate in children?
It is generally planned when growth has slowed or completed (on average ages 13-15 in girls and 14-16 in boys) and the curve exceeds 45°. In early-onset scoliosis, different methods such as growing rods are used.
Can I return to sports and physical activity?
Low-impact activities such as walking, swimming, and cycling can resume in 3-6 months. Contact sports and activities requiring heavy lifting wait 6-12 months; the physician evaluates each case individually.
Does surgery fully correct the curvature?
Generally, 50-70% correction of the curve is the goal. Complete correction is not always possible; the aim is to halt progression, restore balance, and reduce pain.
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