Scoliosis surgery is performed with the goal of stopping progression, but even when successful, that success can come at the cost of the spine’s overall health and function. While all surgical procedures come with their share of risks, spinal fusion is a costly, invasive, and risky procedure, and there are non-surgical treatment options that should also be considered.
Scoliosis surgery is a type of spinal fusion during which the most-tilted vertebrae of the scoliotic curve are fused together into one solid bone; this is done to eliminate movement (progression) in the area. The reality, however, is that most cases of scoliosis can be treated non-surgically.
Let’s start our discussion of how scoliosis surgery is performed by first explaining the parameters that have to be met in order to reach a diagnosis of scoliosis.
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With current estimates at between 6 and 9 million people currently living with scoliosis in the United States alone, clearly, there are many diagnoses of scoliosis being given.
In addition, scoliosis is the leading spinal condition amongst school-aged children, and while there are different types of the condition, adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, is the most prevalent form.
Being diagnosed with scoliosis means a person has developed an unnatural sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees.
It’s the spine’s rotational component that makes scoliosis a 3-dimensional condition as it both twists and bends unnaturally.
The minimum Cobb angle measurement of 10 degrees refers to the size of the unnatural spinal curve, and the higher the Cobb angle, the more severe the condition:
Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
Severe scoliosis: Cobb angle measurement of 40+ degrees
Very-severe scoliosis: Cobb angle measurement of 80+ degrees
Part of the diagnostic process involves comprehensively assessing conditions so they can be further classified based on important patient/condition variables: patient age, condition type (cause), curvature location, and condition severity.
In addition, as a progressive condition, scoliosis has it in its nature to worsen over time, so where a scoliosis is at the time of diagnosis is not indicative of where it will stay; mild scoliosis can easily progress to moderate, severe, or very severe, particularly if left untreated, or not treated proactively.
So now that we’ve defined the condition, and explored the parameters that have to be met to fulfill the requirements of a scoliosis diagnosis, let’s move on to treatment options.
There are two main scoliosis treatment approaches to choose between, each offering patients a different potential outcome: traditional and conservative.
The traditional approach to scoliosis treatment has been in place for hundreds of years, but despite our growing understanding of the condition, and how it responds to different forms of treatment, it has changed little over those years.
In fact, traditional treatment doesn’t have a strategy in place for treating scoliosis until it’s severe, when patients become surgical candidates, but applying proactive conservative treatment has proven results, without patients having to face the risks of invasive spinal surgery.
Traditional scoliosis treatment takes a case of mild scoliosis, and rather than applying proactive treatment to impact the condition while mild, and at its easiest to treat, it opts for watching and waiting for signs of further progression.
Meanwhile, particularly in adolescent idiopathic scoliosis, as growth and development is the main trigger for progression, young patient’s curves are progressing unimpeded, until they cross the surgical-level threshold at 40+ degrees, when they become surgical candidates.
So when we’re talking about surgical scoliosis treatment, how is scoliosis surgery performed?
Commonly referred to as scoliosis surgery or scoliosis back surgery, the actual name of the surgical procedure is spinal fusion, and while surgeons have their patients’ best interests at heart, like all surgeries, spinal fusion comes with its share of risks.
Before getting to the outcome of spinal fusion, let’s discuss the procedure itself.
While there are different types of spinal fusion, most commonly, the procedure involves fusing the most-tilted vertebrae of the curve, at its apex, into one solid bone.
Rods are attached to the spine with pedicle screws to hold it in place, and the hardware that’s attached to the spine is permanent.
The end goal of spinal fusion is not to actually correct the scoliosis, but rather to stop the condition from progressing and getting worse.
By fusing the most-tilted vertebrae into one solid bone, the theory is that movement in that section of the spine is eliminated, meaning the vertebrae can’t become more tilted, and the curve can’t progress; however, there are no guarantees that progression will be permanently stopped.
In addition, there are a number of potential risks, complications, and side effects that should be considered carefully, particularly as results of non-surgical scoliosis treatment have been so successful.
The procedure itself comes with the following potential risks:
Something I want patients, and their families, to fully understand before committing to spinal fusion is that there is a large gap in the research/data on how spinal fusion affects people long term, as in 20, 30, 40+ years down the road.
We, quite simply, don’t know what the natural lifespan of the hardware used is, and if hardware is to fail or malfunction in some way, at some point, there is no recourse other than more surgery, and surgery only gets riskier with age.
Also, keep in mind, the younger the patient is having spinal fusion done, the longer the hardware has to last.
Following are some potential risks and side effects associated with living with a fused spine:
While there is no guarantee that patients will experience any of the aforementioned potential side effects and complications, the risk is there so should be considered carefully.
So for those who choose to forgo a surgical recommendation, or who simply prefer to try a less-invasive form of treatment first, there is a non-surgical conservative treatment alternative with proven results.
Here at the Scoliosis Reduction Center, I offer patients a non-surgical alternative to traditional scoliosis treatment that tends to funnel patients towards spinal fusion surgery.
I believe in the merits of proactive treatment applied as close to the time of diagnosis as possible so progression is prevented and the hardships associated with increasing condition severity, escalating symptoms, and the need for invasive treatment can be avoided.
The goal of conservative treatment is to actually correct scoliosis; corrective results means achieving a curvature reduction on a structural level, first and foremost, and once structural results are evident, shifting the focus to increasing core strength and further stabilizing the spine.
Through condition-specific chiropractic care that can involve a series of manual adjustments and chiropractic techniques, I work towards adjusting the position of the most-tilted vertebrae back into alignment with the rest of the spine: reducing the scoliotic curve and the uneven forces it introduces to the body, restoring as much of the spine’s healthy curves as possible, and improving overall spinal biomechanics, health, and function.
Through a variety of therapies and scoliosis-specific exercises (SSEs) and stretches, I can help patients work towards increasing their core strength so the spine is optimally supported by its surrounding muscles.
Corrective bracing can also help augment corrective results achieved through other disciplines by pushing the spine into a corrective position.
In addition, custom-prescribed exercises can help establish a home-rehabilitation program for long-term sustainable results and to further stabilize the spine.
By integrating multiple condition-specific treatment disciplines, I can work towards impacting conditions on every level and truly customizing each and every treatment plan: something the complex nature of scoliosis necessitates.
So how is scoliosis surgery performed, and are there possible alternatives to a surgical treatment response?
Scoliosis surgery is a type of spinal fusion that involves fusing multiple vertebrae together into one solid bone to eliminate movement (progression) in the area.
While there are a number of variables that factor into how a patient will respond to spinal fusion such as patient age and overall health, the angle of trunk rotation (ATR), condition severity, and the number of vertebrae fused, a common result is a loss of spinal flexibility and range of motion.
In addition, the most common reason patients opt for a surgical response to scoliosis is cosmetic results; the reality is that spinal fusion focuses solely on the spine, so doesn’t address the areas of the body commonly affected by condition-related postural deviation.
While there is still a place for spinal fusion in scoliosis treatment, a modern conservative alternative that doesn’t carry such high potential costs, risks, and side effects provides another option: chiropractic-centered treatment.
Also commonly referred to as a functional approach, because it prioritizes preserving as much of the spine’s natural function as possible, chiropractic-centered conservative treatment integrates multiple treatment disciplines so curves can be reduced on a structural level, core strength can be increased to address muscle imbalance and increase spinal support, corrective bracing can augment corrective results, and further rehabilitation can be established at home.
If you, or someone you care about, is facing a diagnosis of scoliosis and is unsure of their treatment options, don’t hesitate to reach out for further support and guidance.