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When Is Spinal Fusion Surgery Necessary? [TREATMENT OPTIONS]

when is spinal fusion necessary

Just as different types of scoliosis can develop, there are different ways to respond to the condition in terms of treatment. Under a traditional treatment approach, patients are commonly funneled into a surgical recommendation, but under a conservative chiropractic-centered treatment approach, patients can work towards achieving curvature reductions and increasing core strength through more natural means.

Spinal fusion surgery is deemed necessary under a traditional scoliosis treatment approach when a scoliotic curve progresses past the severe classification. However, there is a conservative scoliosis treatment approach that has helped patients avoid invasive surgery as one of its goals.

Firstly, let’s start our discussion on spinal fusion with an explanation of what it means to receive a scoliosis diagnosis.

Being Diagnosed with Scoliosis

If a person is diagnosed with scoliosis, this means their spine has developed an unnatural sideways curvature, with rotation and is of a minimum size.

Scoliosis is progressive, meaning it’s in its very nature to worsen over time, especially if left untreated or not treated proactively.

Scoliosis also develops across a wide severity spectrum of mild to moderate and severe to very severe, and condition severity is assessed and classified based on a measurement taken during X-ray known as Cobb angle:

  • 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

In addition to the condition ranging widely in severity and related symptoms, there are also multiple condition types that vary based on different causes.

The most prevalent type of scoliosis to be diagnosed is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, so this is the form referred to throughout the article.

Within this age group, these young patients are in, or are entering into, the stage of puberty characterized by rapid and unpredictable growth spurts, and while the idiopathic designation in AIS means we don’t understand why this form develops initially, we do understand what triggers its progression: growth and development.

So let’s walk through the basic path of traditional treatment that many adolescents find themselves on and how they can get funneled into a surgical recommendation.

When is Spinal Fusion Necessary?

The Traditional Scoliosis Treatment Approach

As mentioned, there is more than one scoliosis treatment approach for patients, and their families, to choose between, and I encourage all patients to ensure they are aware of all treatment options available to them.

Different treatment approaches offer patients different potential outcomes, so patients have to advocate for themselves in making sure their treatment expectations are aligned with the reality of their potential outcomes.

So for an adolescent recently diagnosed with mild scoliosis by their family doctor, this is how the treatment path commonly unfolds.

Remember, a general practitioner is not a scoliosis specialist, and if you are diagnosed by a GP, the next step often involves being referred to a spinal surgeon, who while an expert in spinal surgery, is not an expert in non-surgical forms of treatment.

Once referred to a spinal surgeon, for a mild case, patients are generally told that their only recourse is to be monitored for further progression, and this means returning for periodic exams at predetermined intervals; these are doctor-dependent but tend to occur every 3, 6, or even 12 months.

The issue I have with this is that as a progressive condition, we know that, at some point, every condition is going to get worse, although progressive rates are difficult to predict.

What happens if, during one of the intervals between checkups, the young patient has a significant growth spurt and progresses from mild to moderate; to me, this is wasting valuable treatment time because had treatment been started while the condition was mild, that progression might not have occurred, instead of simply observing while the unnatural spinal curve progressed unimpeded.

the traditional scoliosis treatment 400The traditional scoliosis treatment approach is more reactive than proactive, meaning that little is done to prevent patients from progressing, and active treatment is only initiated once conditions reach a certain severity level.

When in the moderate stage and showing signs of further progression, the only form of treatment applied under the traditional approach is traditional bracing, which is associated with a number of shortfalls as it doesn’t address the condition’s true 3-dimensional nature.

If bracing is ineffective at stopping progression and the patient progresses into the severe or very-severe classification, this is commonly when spinal fusion surgery is recommended as the best, and sometimes the only, treatment option available.

What is a Spinal Fusion?

Spinal fusion surgery is costly, lengthy, and invasive, and as all surgical procedures come with their share of risks, spinal fusion is no exception.

While the main goal of spinal fusion is to prevent further progression, results can never be guaranteed, and when successful, it can carry some heavy side effects and risk of complications, which can impact the quality of life.

The process of spinal fusion involves fusing together the most-tilted vertebrae at the apex of the curve as this eliminates movement (progression) in the area; however, the cost of this can be in spinal flexibility and range of motion.

While there are different types of spinal fusion, most often, the spine is held in a corrective position by rods and screws throughout the fusion process.

Every case is different and will depend on a number of factors such as patient age and overall health, condition severity, curvature location, and how many vertebrae are involved.

Spinal fusion surgery itself is associated with the following risks:

  • Nerve damage
  • Excessive blood loss
  • Infection
  • Pain at the fusion site

The following long-term effects and risks are associated with life post-surgery:

  • Nerve damage
  • Loss of spinal flexibility, strength, and range of motion
  • Back pain
  • Hardware malfunction
  • Adverse reaction to hardware
  • Strained spinal muscles/muscle pain
  • A spine that’s more prone to injury
  • The psychological effect of living with a fused spine
  • Disappointing cosmetic results

Perhaps the two most common complaints I hear from patients who have undergone spinal fusion is disappointment with the loss of flexibility they experience, which can equate to activity restrictions, and the unrealistic expectation that spinal fusion can fully return a body to its pre-scoliosis state.

Once a spine becomes less flexible, it can become stiff and painful, and when it comes to living with a fused spine, many experience stress and anxiety at the thought of trying new things, and this can also impact the quality of life.

In addition, a fused spine is a fused spine; if unsuccessful, or if a patient is disappointed with the results, the only recourse is subsequent surgery.

Fortunately, there is another treatment option available: one that helps patients avoid the need for invasive forms of treatment and one I encourage patients to try before committing to spinal fusion.

What Are The Long Term Effects of Spinal Fusion?

Non-surgical Treatment Options

Surgery is not always the best, nor the only, scoliosis treatment option available.

Here at the Scoliosis Reduction Center, as a scoliosis chiropractor, I offer patients proactive treatment delivered under a conservative treatment approach that strives to preserve the spine’s overall health and function.

While treatment becomes more complex in severe cases, non-invasive forms of treatment can be effective at reducing surgical-level curves and helping patients stay off the operating table.

Through an integrative approach that combines various condition-specific treatment disciplines such as chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing, I can help patients reduce their surgical-level curves and increase core strength so the spine is optimally supported and stabilized by its surrounding muscles.

through chiropractic adjustments remodeling 400Through chiropractic adjustments/remodeling, I can work towards realigning the spine by altering the position of affected vertebrae.

Even a slight adjustment can make a big difference in terms of restoring as much of the spine’s healthy curves as possible and improving spinal biomechanics.

Through physical therapy and a variety of scoliosis-specific exercises (SSEs), core strength can be improved so the muscles that support the spine can function optimally, helping the spine maintain its natural curvatures and alignment.

SSEs, when performed as prescribed, can also help activate certain areas of the brain to facilitate brain-body communication and better body positioning.

To meet my patients’ bracing needs, I favor the use of the modern and ultra-corrective ScoliBrace, which represents the culmination of what we’ve learned about the condition and how it responds to treatment over the years.

In addition, the ScoliBrace addresses many of the efficacy and compliance issues associated with traditional bracing by its 3-dimensional design and customization options.

While there are no treatment guarantees, there are fewer limits to what we can achieve if proactive treatment is started as close to the time of diagnosis as possible, and while a traditional approach favors watching and waiting, this only increases the likelihood of curvature progression across the surgical-level threshold.

Here at the Center, our results speak for themselves, and while achieved through hard work and commitment, they were reached without invasive and irreversible spinal surgery.


To clearly address the question, when is spinal fusion surgery necessary, the answer will be case-specific, but in many cases, scoliosis can be treated nonsurgically.

While there is a place for spinal fusion in the treatment of severe and very severe cases of scoliosis, a conservative treatment path offers nonsurgical forms of treatment that can help patients reduce their scoliotic curves and increase core strength for an optimally-supported spine.

When it comes to spinal fusion as a treatment option, as the surgery is irreversible and can impact the quality of life in a number of areas, I do believe that patients should explore less-invasive treatment options first.

Here at the Scoliosis Reduction Center, there are numerous ways that we work towards reducing curves below the surgical-level threshold: condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing.

For those who have decided to forgo a surgical recommendation or who want first to try less-invasive and more-natural forms of treatment, please reach out to us here so we can ensure that you are aware of, and fully understand all treatment options available to you.

demystifying scoliosis guide

Ready to discuss next steps for scoliosis treatment? Reach out to us here.
Dr. Tony Nalda
Doctor of Chiropractic
Severe migraines as a young teen introduced Dr. Nalda to chiropractic care. After experiencing life changing results, he set his sights on helping others who face debilitating illness through providing more natural approaches.

After receiving an undergraduate degree in psychology and his Doctorate of Chiropractic from Life University, Dr. Nalda settled in Celebration, Florida and proceeded to build one of Central Florida’s most successful chiropractic clinics.

His experience with patients suffering from scoliosis, and the confusion and frustration they faced, led him to seek a specialty in scoliosis care. In 2006 he completed his Intensive Care Certification from CLEAR Institute, a leading scoliosis educational and certification center.
About Scoliosis Reduction Center
Welcome to Scoliosis Reduction Center. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible.
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