For those who have recently received a scoliosis diagnosis, or those who are parents or caregivers of someone who has, the next step will be choosing a treatment path to follow. Making this decision is likely the most important scoliosis-related choice you will make; it will shape your experience with the condition throughout treatment and beyond. While spinal-fusion surgery is still a popular choice for those choosing the traditional approach, there are a lot of risks and unknown factors involved. One of the focuses of my career is to educate people on these risks and provide them with an effective and less-invasive option: the conservative approach.
Scoliosis surgery, technically known as ‘spinal fusion’, has been a go-to treatment method for many years. While the surgery can result in making a crooked spine straighter, this can come at a very high cost and with a lot of unknowns, such as long-term effects. Before we get into the details and logistics of scoliosis surgery, let’s explore the traditional treatment path by considering a hypothetical scenario in which a young scoliosis patient and her parents face the decision of choosing a treatment approach.
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While the traditional treatment path has worked for some, to me, it is deeply flawed; it involves a lot of passive observation while conditions progress and often funnels patients towards spinal-fusion surgery.
Scoliosis surgery is costly, invasive, irreversible, and risky, and in many cases, it is unnecessary.
I firmly believe that scoliosis surgery should be seen as a last resort, only to be considered after every other potential treatment option has been explored and failed.
In the condition’s most common form, adolescent idiopathic scoliosis (AIS), we are talking about adolescents between the ages of 10 and 18. These are young people with their whole lives ahead of them.
To many of these young people, sports and adventure are the best things in life. Post scoliosis surgery, these activities and areas of life can be greatly impacted, and the potential after-effects are what I want people to be aware of.
Let’s take a minute to walk through a typical scenario in which a 13-year-old girl finds out she has scoliosis and her and her parents face the choice of how to proceed with treatment.
Being Funneled Towards Scoliosis Surgery
Let’s call this hypothetical patient ‘Sarah’. Sarah and her parents receive the news that she has scoliosis as her doctor discusses what this means to them and refers to Sarah’s X-ray images.
It turns out that Sarah has a case of moderate adolescent idiopathic scoliosis. Fortunately, Sarah’s scoliosis was caught early on because she is a dancer and spends a lot of time in revealing bodysuits and dance costumes.
While watching Sarah at a dance competition, Sarah’s mom notices that her shoulders don’t seem even and recalls a friend’s daughter who was diagnosed with scoliosis at the same age.
Proactively, she does some research on the condition and tests that can be done at home; she conducts her own ‘Adam’s forward bend test’. When Sarah stands in front of her and bends forward at the waist, her parents notice what appear to be other asymmetries.
One side of her rib cage appears to be slightly arched, and her waist also seems off balance with one hip sitting higher than the other.
When they look at her spine, which is far more visible in this position, they think it doesn’t look as straight as it should. They call in Sarah’s brother and have him bend forward in the same position.
When comparing the two spines, they feel confident and worried that Sarah’s is not as it should be. They make an appointment with their family doctor to go in for an exam and assessment.
Sarah’s doctor also conducts an Adam’s forward bend test with the addition of a Scoliometer. The doctor agrees that Sarah has indicators for scoliosis and sends her for an X-ray.
Sarah’s Cobb angle (the measurement, in degrees, of how much a spine deviates from a straight and healthy alignment) is 27 degrees, which puts her into the ‘moderate scoliosis’ classification.
From here, Sarah’s regular family doctor, who is not a scoliosis specialist, refers her to a scoliosis surgeon for subsequent treatment. This is the point where I feel there is a fork in the road for Sarah and her family, in terms of treatment and the journey ahead.
Sarah is now heading towards treatment from a surgeon, so how likely does it seem that even with other treatment options available, Sarah and her family will be funneled towards spinal-fusion surgery.
Watching and Waiting
Sarah and her parents meet the surgeon who is approachable and confident. He sits down with them and explains that as Sarah’s case is moderate, they should watch and wait to see how and if her condition progresses, meaning the curvature gets worse.
With no other treatment options presented to them, and not knowing to ask about them, they agree to return to see him in three months so they can get another X-ray done and compare the first images to ones taken after three months.
In the meantime, Sarah goes on with her life, her dancing, and her friends. After three months, they return, and the results are that Sarah’s Cobb angle has only increased by one degree.
The surgeon says that as her condition is not progressing quickly, they can return in another three months for another X-ray. During the next three months, Sarah hits a major growth spurt and seems to have shot up three inches overnight.
When they return to the surgeon and the next X-ray is taken, it turns out Sarah’s condition has progressed significantly. This is because growth is the number-one trigger for progression. Now, a Boston brace is recommended to slow progression.
Sarah hates the brace, as many teenagers do, and takes it off as soon as she gets to school, hiding it in her locker. She is embarrassed by it, hates having to wear baggy clothes to hide it, and finds it very uncomfortable. Unless the brace is worn virtually all the time (18-23 hours a day), it’s not effective, so Sarah’s condition has been allowed to progress unimpeded and continues to do so.
At her next X-ray, after going through another major growth spurt, they are all disappointed to find out that Sarah’s Cobb angle now measures at over 40 degrees, moving her into the ‘severe scoliosis’ classification.
As compliance is an issue with the brace and she is now classified as having severe scoliosis that is progressing rapidly, surgery is recommended as the best option, and they consider following the recommendation.
Before we get into the potential costs, risks, and outcomes of scoliosis surgery, let’s take another look at this scenario and return to that fork in the road. At the point of being recommended to a surgeon, Sarah’s mom decides, instead, to do some research on her own and reads about alternative treatment options for scoliosis.
She reads about a conservative scoliosis-specific chiropractic approach that has gained a lot of respect and offers impressive results. She decides to make an appointment to come talk to me here at the Scoliosis Reduction Center.
When Sarah and her parents come in to see me, I tell them how glad I am that they took the time to come discuss alternative treatment options before committing to surgery. This is just the type of case that inspired me to write Scoliosis Hope and guided my career.
Every patient and their families have the right to make their own treatment choices. The issue I have is how so many of them are somewhat blindly funneled towards surgery, simply because they are unaware of other options, or only have one presented to them.
I take my own X-rays from a variety of positions and angles and also diagnose Sarah with moderate adolescent idiopathic scoliosis, but I recommend we start active treatment as soon as possible. Sarah’s parents ask why they were referred to a surgeon when surgery wasn’t the only option.
I explain to them that while I’m sure their family doctor had their best interests at heart, he is not a scoliosis specialist and that his recommendation followed the typical traditional treatment path for scoliosis patients that had been in place for many years.
Sarah’s parents decide to keep their appointment with the surgeon, and I encourage them to do so. I want them to be fully informed, explore all options, and make the choice that feels right for them.
I am very pleased, however, when they return after saying they were uncomfortable with the watching-and-waiting approach and favored my proactive approach.
Here at the Center, we approach each patient with fresh eyes and a blank treatment plan. We customize a plan based on characteristics of the patient such as age, fitness level, and compliance.
Of course, we also address characteristics of their condition such as location of the curvature, current rate of progression, and severity.
In other forms of scoliosis, the cause is taken into consideration; in adolescent idiopathic scoliosis, however, a defining feature is its ‘idiopathic’ designation, meaning no known single cause. As mentioned earlier, this is the main form of scoliosis, accounting for 80 percent of known diagnosed cases.
We see that the curvature is located in the thoracic spine (upper and middle back) and bends to the right; this is a typical case of scoliosis. Cases with a curvature bending to the left, towards the heart, are considered atypical and are a red flag that the scoliosis might be a secondary complication of another medical condition of disease.
So Sarah’s case is very typical, and we proceed with a customized treatment plan that integrates multiple forms of scoliosis-specific treatment: chiropractic, therapy, rehabilitation, and corrective bracing.
Sarah doesn’t seem overly excited about the brace portion of treatment, so I focus on explaining the merits of our customized corrective ScoliBrace. I also explain how different it is from the traditional Boston brace she would have had to wear as part of the traditional treatment approach, had they gone down that road.
I explain how the Boston brace is used to slow/stop progression, but the ScoliBrace is used to actually aid in correcting the abnormal curvature by working towards a curvature reduction.
I also discuss the difference in how a Boston brace is far less customized to suit a patient’s body and condition, so is far more uncomfortable to wear. Sarah and her parents agree that the ScoliBrace seems like a far more appealing option.
We move ahead with treatment and start with targeted chiropractic adjustments, corrective bracing and therapy. We monitor Sarah’s condition closely, especially if we notice a change in growth.
I order X-rays periodically to see how the spine is responding to treatment, and if she grows an inch, I order another to monitor progression. When another growth spurt hits, we tweak the treatment plan in intensity to counteract the condition’s tendency to progress. Sarah is young, healthy, has a good support system, and is determined.
Her treatment is starting to look very successful. The combination of the ScoliBrace, targeted chiropractic adjustments, at-home exercises, and in-office guidance with stretches and additional exercises has started to gradually reduce her Cobb angle.
Once Sarah sees that first reduction result, she is fuelled to work even harder. I explain that because we started treatment early on while her condition was still in the moderate stage, her spine is still very flexible and easier to manipulate to move out of the unhealthy curvature and into a healthy curvature restoration.
Over time and with some effort, her curvature is reduced down to 15 degrees, and she is now in the ‘mild scoliosis’ range.
I have to be clear, as we approach the end of our most intense treatment phase, that even once a curvature is reduced, the work is not over. As a progressive and incurable condition, scoliosis will always be a part of Sarah’s life.
Regular chiropractic care will continue, as will her at-home exercises and in-office rehabilitation. Through combining the different treatment disciplines, the multifactorial nature (thought to be caused by multiple factors) of Sarah’s scoliosis is addressed and treated as the condition necessitates.
Best of all, we achieved these results without medication, injections, or invasive surgery. Sarah and her family are thrilled with the results and that Sarah is able to continue with the activities she loves, with some scoliosis-friendly tips and guidance.
In reading the two above scenarios, you can see how important it is to be fully informed about your treatment options. Especially when it comes to making the decision for an adolescent, you want to be sure you know all the options. Had Sarah’s mom not been proactive in researching alternative treatment options, she would have been passively funneled towards scoliosis surgery.
While every patient’s outcome is different regardless of what treatment path they take, there are some common risk factors and side effects to be aware of when considering scoliosis surgery; before we move on to these, let’s make sure you understand what happens to the spine during surgery.
The procedure of scoliosis surgery is known as ‘spinal fusion’ and involves fusing the vertebrae of the abnormal curvature together to form one solid bone; the goal of this is to eliminate movement and stop progression. Sometimes, depending on the section of the spine affected, intervertebral discs in the area are removed.
An allograft (small piece of bone or bone-like material) is placed in between the vertebrae to act as a bridge between the fused vertebrae. Rods or metal plates are attached to the spine with screws or hooks to hold it in position while the fused section continues to heal.
The section of the spine that is fused will remain stiff and inflexible.
While some people find that the rest of their spine still has enough flexibility, depending on the severity of the curvature and the activities a person enjoys, many find this loss of mobility a high price to pay that affects their every-day life.
There is also no guarantee that a patient’s scoliosis won’t continue to progress after surgery, and there are additional risks associated with the surgery itself.
Scoliosis surgery has been used as a treatment method for many years. While surgeons have their patients’ best interests at heart, any surgery comes with risks, and spinal surgery is no minor procedure.
When deciding whether or not spinal fusion is a good option for you or a loved one, make sure you fully understand all the potential risks, side effects, and outcomes.
The following are some risks associated with the surgery itself:
One of the big concerns I have with scoliosis surgery as a treatment option is the permanency of it. Once a spine is fused, there is no going back. If something goes wrong or the surgery proves ineffective at stopping progression, the only answer is more surgery, and this is rarely a good thing.
In addition to the risks associated with the surgery itself, there are numerous potential side effects to living with a fused spine, and these are what a patient really needs to be aware of. As there are other treatment options available, for many, the cost of having a straighter spine via spinal fusion is simply too high.
What really troubles me is when patients come to see me post surgery and are unhappy with the results. In some cases, the patient was unaware of what life would be like after the surgery and had been hyper-focused on the immediate result of getting a straighter spine.
This is difficult to hear because had they come to me beforehand or were made aware of the potential outcomes and alternative treatment options, they might have made a different choice, such as with the parents of our hypothetical patient, Sarah.
While it is possible to have successful scoliosis surgery, it is also possible to have the opposite and experience negative or unexpected side effects; these are what I want to educate people on so they can make the most informed decision possible and look at other treatment options. If a patient opts for scoliosis surgery, I simply want them going in with their eyes wide open.
Every patient’s experience is different, and a number of factors such as age, fitness level, and condition severity will play a part in just how they adapt to living with a fused spine.
Following is a list of some potential negative side effects of living with a fused spine:
Loss of Mobility and Flexibility
As mentioned earlier, the section of the spine that is fused heals into one solid bone, meaning that section will no longer have mobility.
For some people, loss of mobility is an unexpected outcome, or is worse than they thought it would be. Loss of mobility can range depending on how large of a spinal section was fused. Whatever the result is in terms of range of motion, it is permanent, so this should definitely be considered before committing to surgery.
A spine that experiences a reduction in the normal range of motion is going to be stiff and tight and can affect the muscles that support it. This side effect can also lead to another: pain.
Pain and Discomfort
The more severe a patient’s condition is going into scoliosis surgery, the more invasive the procedure will have to be, and the more likely it is that they will experience adverse side effects, such as increased pain.
Post-surgical pain can be a big issue for a lot of patients. Especially as scoliosis-related pain is one of the primary motivators to have the surgery, patients are often disappointed to still be living with pain, and in some cases, are experiencing an increase in pain.
An increase in pain post surgery is a common reason that patients require subsequent surgeries.
Some patients find that life after surgery is a constant effort to keep pain and stiffness at bay. Staying active is a great way to manage the pain and stiffness of a less-mobile spine, but for many, this can be difficult to sustain, and for others who are not naturally active, it can be more than difficult.
The spine works in tandem with the brain to form the central nervous system. Just as the development of spinal conditions can cause big ripple-effects throughout the body, procedures performed on the spine can also result in multiple side effects.
Neurological damage due to surgical complications can include a loss of strength in areas throughout the body, such as the feet and legs.
Loss of bladder and bowel control can also occur with neurological damage. If there are neurologic complications, these can be expected to appear shortly after surgery, so the team of health-care providers in charge of monitoring your recovery will be watching for these kinds of effects.
The big fear that many people have is total or partial paralysis; this is an understandable concern with any spinal surgery; however, the actual risk of total or partial paralysis is extremely low, sitting at less than one percent.
Adverse Reaction to the Hardware
Placing a foreign element inside the body, such as metal hardware, can cause unexpected reactions, such as an allergic response caused by metal hypersensitivity.
While not a common reaction, it can happen that a person will experience unexplained pain, swelling, and inflammation after surgery. Once more common causes such as fusion failure or infection are ruled out, metal hypersensitivity can be explored.
Exposing metal to biologic systems is known to cause corrosion, and this release of ions inside the body can cause an adverse reaction responsible for unexplained pain, discomfort, swelling, and skin reactions.
One of the factors regarding spinal-fusion surgery that I feel many patients are unaware of is the lack of data on long-term effects. While there are studies done post surgery in the short term, the effects of having hardware in the body after 20, 30, and 40 years is unknown.
Obviously, any hardware will have a lifespan, and we simply don’t know how long this hardware will perform optimally in the body before facing natural degenerative changes.
I have seen rods snap, screws come loose, and a number of unforeseen complications involving hardware malfunction and degeneration, and again, the only response to this is more surgery.
Continued Curvature Progression
The main goal of spinal fusion in treating scoliosis is to stop progression. While some patients experience success with this, there is no way to fully predict how a person’s condition will respond and no guarantee that progression won’t continue.
I have also seen cases where spinal fusion has actually increased a spinal deformity. Imagine going through a surgery like this in the hopes of improvement, only to find that it has worsened your condition.
This is just another unknown that accompanies spinal-fusion surgery that patients should be fully aware of.
Negative Psychological Effects
I find that negative psychological effects are often unexpected and unexplored. There is a cost to living with a fused spine, and for many, the knowledge that their spine has rods and screws attached to it can weigh heavily.
Many patients report anxiety they didn’t anticipate. They are worried about the strength of their spine and the strength of the rods. They often shy away from trying new activities as they are unsure how their spine will respond.
A spine that has been fused is less effective at absorbing and distributing mechanical stress throughout, so they are more vulnerable to injury due to trauma such as a fall or car accident.
For many patients, especially the younger ones, cosmetic reasons are a big motivator for having the surgery. Many are disappointed that the surgery does not produce the visual changes they were hoping for.
In addition to the aforementioned potential physical and emotional costs of scoliosis surgery, there is also the financial cost to consider.
As you can imagine, there is no flat rate for scoliosis surgery, and there are numerous variables that can impact its final cost. For the purposes of this article, we are referring to scoliosis surgeries performed in the United States.
Variables that factor into determining the final cost of scoliosis surgery include the surgeon, how severe the condition is, if there are complications, length of surgery, and length of recovery time spent in the hospital. Of course, most of these variables are unpredictable because they are contingent upon procedure outcome.
While there is a lot of forethought, monitoring, and planning that goes into scoliosis surgery, no one really knows how the surgery will go until it is over, and even then, post-surgical complications can occur.
While you can be given a ballpark estimate for the cost of your surgery, this estimate will likely be based on no complications or unforeseen events during and post surgery, so that estimate can increase quickly.
If there are complications during the surgery, this increases the cost of everything: use of the operating room, amount of anesthesia used, surgeon’s pay, and length of the surgery itself.
If there are complications during or after the surgery, this will also increase the length of hospital stay for recovery and care needed, which can also increase the final cost significantly.
The average cost of scoliosis surgery can range from approximately $140,000 to $175,000. The cost is determined based on the hardware used in the surgery, the cost of the in-patient room, operating room, recovery room based on length of stay and level of care needed, the use of operating-room instruments, the cost of the bone graft, and of course, the surgeon’s fee.
Throughout this article, we have focused on adolescent idiopathic scoliosis as it is the condition’s most common form, but adults can develop the condition too. Let’s spend some time discussing the difference in the reasoning behind getting scoliosis surgery for adolescents and adults.
Scoliosis is a complex condition that can take many forms. Although it’s far more common to develop in adolescents, it can also develop in adults.
When an adult is diagnosed with scoliosis, the two most common forms are ‘adult idiopathic scoliosis’ and ‘adult degenerative scoliosis’.
In adult idiopathic scoliosis, these adults had the condition in adolescence but were unaware. This is not uncommon as scoliosis in adolescents can be mild, produce subtle symptoms that are difficult to notice, and is rarely painful.
It’s often not until an adolescent reaches skeletal maturity and stops growing that their condition truly becomes symptomatic, triggering the awareness that something wrong is happening in the body.
Once growth stops, compression becomes a factor, causing back pain and radiating nerve pain that can extend into the arms, legs, and feet; it’s pain that brings most adults in seeking diagnosis and treatment.
The other common form of scoliosis in adults is adult degenerative scoliosis, and as the name suggests, this form develops as a result of the degenerative effects experienced by the spine during aging. This form is most commonly seen in adults over the age of 40.
When scoliosis surgery is performed on an adult, it is most often because of pain and to address disc degeneration. When scoliosis surgery is performed on adolescents, it is most often to stop progression.
As growth is the big trigger for progression, adolescent cases face a much higher likelihood of their condition progressing rapidly. This is why scoliosis surgery is performed more frequently on adolescents than adults, not to mention the difference in numbers of diagnosed cases (80 percent of diagnosed cases are adolescent).
When skeletal maturity is reached, the big growth-trigger is removed, so these conditions tend to progress at a much slower rate, removing that element of motivation for getting scoliosis surgery in adults.
As discussed, pain becomes the big motivator for scoliosis surgery in adults because once growth stops, the spine becomes vulnerable to the forces of compression, and the condition can become very painful and debilitating.
Also, as is the case with most surgeries, the older a patient is, the more likely they are to experience adverse complications and side effects. When considering scoliosis surgery and adults, the question changes from, “Will surgery cause any adverse side effects?” to “How bad will the adverse side effects be?”
For both adolescents and adults, there are numerous treatment options available that can address both progression and pain.
Can Scoliosis Surgery Kill You?
The chance of scoliosis surgery killing you is very small; death is a risk associated with any type of surgery, simple or invasive. Scoliosis surgery, however, is a lengthy and invasive procedure.
While spinal fusion does have the potential to cause death due to a severe infection, excessive bleeding, or other unforeseen complications, it is not a common result.
Scoliosis, on its own, can not kill you, but for those that choose spinal-fusion surgery as the treatment method for their scoliosis, they are putting themselves at risk for a number of adverse side effects and potential surgical complications.
That list includes post-surgical pain, decreased mobility, nerve damage, paralysis, adverse reaction to the hardware used, hardware malfunctioning, risk of infection, excessive blood loss, fusion failure, and subsequent surgeries.
According to one study, out of 1,288,496 lumbar spinal fusions performed in the United States between 1998 and 2008, the average mortality rate was 0.2 percent. In these cases, timing of death was early on in the recovery stage, while still in the hospital, at around postoperative day 9. The most common complications leading to death included cerebrovascular events, sepsis, and pulmonary embolism.
In another study, mortality rates in a group of 803, 949 patients between the years of 2003 and 2012, who also underwent lumbar spinal fusion revealed the average mortality rate to be 0.13 percent.
Elevated risk factors associated with mortality rate were male gender, patients between the ages of 65 and 74, and those that were 75+. Most common causes of death were pulmonary embolism and shock.
As you can see, the chances of death due to spinal fusion are very low, but even a low number means that people have died as a result of spinal-fusion surgery, and that means that regardless of how unlikely, yes, scoliosis surgery can kill you.
Can Scoliosis Surgery Paralyze You?
Scoliosis surgery comes with a lot of potential risks and complications. As the central nervous system is made up of the brain and spinal cord, you can see how surgery performed on the spine has the potential to cause neurological damage.
Neurologic complications can include a loss of skin sensation, weakness and numbness in the legs and feet, impairment of bowel and bladder function, and paralysis.
When neurologic complications are a factor, they are generally detected in the first days following surgery. While some of these complications can improve with time, others can be permanent.
A common fear associated with scoliosis surgery is paralysis. Paraplegia is characterized by a loss of movement and sensation in the legs and the lower body. This is a rare complication, but it does occur and is a devastating complication to face.
Post-surgical symptoms of neurological damage include partial or total paraplegia, quadriplegia, and/or peripheral nerve deficits. These deficits can be caused by vascular, mechanical, or metabolic complications during spinal surgery. Some examples of these causes include movement of the bone graft into the spinal canal, hardware breaking or malfunctioning, hardware penetrating into the spinal canal, and/or nerve root compression caused by the hardware.
Part of the reason spinal fusion is described as invasive is because it involves precisely working around delicate nerve roots and the spinal cord. During surgery, if precision isn’t employed, it’s possible to cut or bruise a nerve, resulting in neurological damage.
Efforts made to lessen the likelihood of neurological damage and paralysis include the use of surgical microscopes that magnify the area the surgeon is working on. Advanced imaging techniques are also available that allow surgeons to plan the procedure beforehand. During surgery, there is also intraoperative imaging of the surgical field that provides a precise visual aid for ensuring instruments and implants are placed in the ideal location.
While the actual risk of partial or full paralysis is extremely low, sitting at less than one percent, it is still a risk patients need to be aware of.
One of the big issues I have with spinal-fusion surgery as a treatment method is not just the potential side effects and risk of complications it comes with, but also the irreversibility of it.
In spinal fusion, what happens is the most-tilted vertebrae of the curvature are fused together to form one solid bone. Then rods and screws are attached to the spine to hold it in position while the bones permanently fuse.
The idea behind this is that fusing the tilted vertebrae into one solid bone means the curvature can no longer progress, and while this can stop progression, it is not guaranteed to do so.
In addition, along with that elimination of progression comes elimination of movement in the section of the spine that is fused; this loss of movement is a result many patients are unhappy with.
As spinal fusion involves making a structural change to the spine, it cannot be reversed. Once a spine is fused, it will forever remain a fused spine. Not only is there no reversing surgery, if surgery is deemed unsuccessful or a complication such as hardware malfunction arises, the only option is to undergo another surgery to ‘fix’ whatever went wrong.
The other thing I feel people sometimes don’t fully understand is that spinal fusion does not actually correct the abnormal spinal curvature, but merely stops progression; this is why there is no guarantee that a person’s scoliosis won’t continue to progress post-surgery as the underlying condition is still there.
The irreversibility of spinal fusion is why I always advise patients considering the procedure to first try other less-invasive options. A functional approach, for example, that combines scoliosis-specific chiropractic adjustments, therapy, rehabilitation, and corrective bracing doesn’t just just try and stop progression; it can actually produce a structural change, addressing the underlying cause of the abnormal curvature, and not just a symptom of it.
A person can try my functional approach, and if they are unhappy with the results, there is no harm done, but the same cannot be said of spinal fusion surgery which cannot be reversed.
Can Scoliosis Surgery Affect Pregnancy
Any pregnancy comes with its share of risks, both for people with abnormally curved spines and healthy spines. For women with scoliosis, however, they can have additional worries about how their condition will affect their pregnancy and vice versa.
Women who are pregnant and have undergone scoliosis surgery show little to no increased likelihood of developing complications during their pregnancy or delivery. As pregnancy engages the pelvis and not the spine, a fused spine is unlikely to impact a person’s ability to carry a baby or deliver it safely.
One study, however, did find a correlation between spinal fusion and low blood pressure during pregnancy. In terms of back pain, the study also showed a high percentage of pregnant women with spinal-fusion history experiencing back pain, but it’s difficult to determine whether this is directly or indirectly related to having had spinal fusion as back pain is a common complaint for women without scoliosis as well.
One area of delivery to be considered is if a woman who has had spinal-fusion surgery wants an epidural. As an epidural involves the precise delivery of pain medication via a needle inserted into the space between the spinal column and the spinal cord’s outer membrane, having surgical hardware to work around can be tricky and interfere with the precise placement of the needle and catheter in the epidural space.
Where along the spine the fusion took place can also impact the administering of the epidural.
However, as long as the anesthesiologist is provided with current X-ray images and the doctor is comfortable, a woman who has had spinal-fusion surgery can still safely get an epidural during labor.
It has also been suggested that as it can take 6 months to a year for a spine to become fully fused after surgery, it is best to wait outside of that time range before getting pregnant; this is due to the release of hormones and relaxants that soften the body’s joints and ligaments in preparation for delivery.
While there are some variables to consider such as timing of pregnancy after surgery and epidural administration, there are few, if any, additional risk factors facing pregnant women who have had spinal fusion, both in pregnancy and delivery.
Can Scoliosis Return After Surgery
A person’s scoliosis can indeed return after surgery. In fact, once a person is diagnosed with scoliosis, they are going to have the condition for the rest of their lives.
As an incurable and progressive condition, scoliosis can be managed and treated effectively, but even with surgery, the condition is still going to be a factor.
Spinal-fusion surgery does not have the end goal of curing or eliminating a patient’s scoliosis; what it does instead is address the progressive nature of the condition.
Regardless of the form of scoliosis or the age of the person living with it, if left untreated, at some point, the abnormal spinal curvature is very likely to get worse. This can happen rapidly, as can be the case with adolescent idiopathic scoliosis, or it can slow down as tends to be the case with scoliosis in adults.
Spinal fusion takes the most-tilted vertebrae of the abnormal curvature and fuses them into one solid bone; this is done so the curvature can no longer progress; however, there is no guarantee that progression will be permanently halted, and there have been cases where a person’s scoliosis continues to progress, despite having had spinal-fusion surgery.
Growth is a big factor in the condition’s most common form, adolescent idiopathic scoliosis, as it’s growth and development that is the biggest trigger for condition progression.
When spinal-fusion surgery is performed on adolescents and children who have not yet reached skeletal maturity, studies have shown that patients with the most remaining growth to go through are at the highest risk for continued curvature progression post surgery.
This is why I caution parents and caregivers of adolescents considering spinal-fusion surgery as a remedy for rapid progression; the procedure comes with no guarantees that scoliosis won’t return after surgery.
The main take-away I want people to get from reading this article is to be proactive with their condition, or the condition of a loved one.
The medical system is not perfect, nor is the process of being funneled towards invasive scoliosis surgery by the traditional treatment route. You have to advocate for yourself and your loved ones to ensure you are made aware of every treatment option available.
When it comes to spinal-fusion surgery, it’s not just the financial cost that is high, but also the physical and psychological costs, and all these factors should be considered carefully.
I want to ensure that every scoliosis patient has their treatment expectations aligned with the potential outcomes and effects of their treatment choice.
To return to our hypothetical patient, Sarah, how differently might her experience have been had the family chosen spinal fusion? Of course, no one can fully foresee outcomes of any surgery, spinal fusion included.
What if she had gotten the surgery, only to find out that her loss of range of motion was significant and prevented her from doing what she loved most: dancing. How would that have impacted her quality of life and mental health? These are big questions with far-reaching answers.
While this scenario is, again, hypothetical, it is the type of case I have seen many times. Maybe spinal fusion would have turned out okay for Sarah, but what if it didn’t? Taking the time to first try a more conserative approach with few, if any, side effects makes perfect sense to me.
The results of our conservative approach here at the Scoliosis Reduction Center are reached by noninvasive means and are not irreversible. If someone is unhappy with them, they can always choose another path with no harm done; however, the same cannot be said of spinal-fusion surgery as its potential adverse side effects and outcomes can have life-long consequences.