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When To Get Surgery For Scoliosis: Is Surgery Necessary?

When To Get Surgery For Scoliosis Is Surgery Necessary

Surgery for scoliosis is also known as spinal fusion surgery, and like all surgical procedures, it comes with its share of potential risks, side effects, and complications. In addition, the end goal of scoliosis surgery is not correction, but stopping progression: two very different things. Modern conservative treatment works towards corrective results as its end goal.

Traditional scoliosis treatment commonly funnels patients towards spinal fusion surgery; modern conservative treatment is proactive and has corrective potential. Most cases of scoliosis can be treated non-surgically, and spinal fusion comes with some heavy potential risks and side effects.

Before getting to the specifics of scoliosis surgery, let's first address some important condition features, for a clearer understanding of potential treatment efficacy.

What is Scoliosis, and How is it Diagnosed?

Scoliosis involves the development of an unnatural sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees; these three parameters have to be met in order to reach an official diagnosis of scoliosis.

The fact that a scoliotic spine doesn't just bend unnaturally to the side, but also twists, is what makes scoliosis a 3-dimensional condition: its rotational component.

The condition's rotational component is an important factor in treatment efficacy, which we'll return to later.

Cobb angle is known as the orthopedic gold standard in the assessment of scoliosis and is taken during X-ray by drawing lines from the tops and bottoms of the curve's most-tilted vertebrae, at its apex; the resulting angle is expressed in degrees.

A patient's Cobb angle tells me how far out of alignment a scoliotic spine is, and classifies conditions by severity:

  • 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

So as you can see from the wide range of Cobb angle measurements, scoliosis is a highly-variable condition, and in addition, it's progressive in nature.

Scoliosis is a Progressive Condition

Scoliosis is complex to treat not just because it can range so widely from mild to very severe, but also because of its progressive nature.

Scoliosis has it in its very nature to worsen over time, and this means that the unnatural spinal curve will increase in size, at varying progressive rates.

So where a scoliosis is at the time of diagnosis is not indicative of where it will stay, nor are scoliosis symptoms one patient experiences indicative of what others will face.

Even mild scoliosis can progress to become moderate, severe, or very-severe scoliosis; only proactive treatment can counteract the condition's progressive nature.

The reality is that as scoliosis is progressive, small curves are virtually guaranteed to become big curves, and whether it happens slowly over time, or quickly, the result is the same: significant progression that makes the scoliosis harder to treat.

Let me direct you to a video from our Scoliosis Reduction Center YouTube channel that highlights the dangers of leaving mild scoliosis untreated, and the benefits of responding proactively.

It's progression that makes how a diagnosis of scoliosis is responded to so important; in fact, as an incurable condition, how it's treated, and when treatment is started, can have far-reaching effects.

So what types of scoliosis treatment options are available to those recently diagnosed?

Treatment for Scoliosis: What Are My Best Options?

Scoliosis Treatment Approaches

There are two main scoliosis treatment approaches to choose between: traditional and conservative.

Different treatment approaches have different end goals, different focuses, and offer patients different potential results, which is why it's so important for patients to fully understand the differences; they need to ensure their treatment expectations are aligned with the reality of their potential outcomes.

Traditional treatment is more reactive than proactive, and conservative treatment believes in starting treatment as close to the time of diagnosis as possible.

While traditional treatment options have been in place for many years, the approach has changed little over those years, despite our evolving understanding of the condition.

Traditional Surgical Scoliosis Treatment

So the reason traditional treatment can be described as reactive is that it responds to cases of mild scoliosis by simply watching and waiting: monitoring for progression.

As a progressive condition, we know that scoliosis is going to progress at some point, so waiting for it to happen before acting is wasting valuable treatment time.

An adolescent on the path of traditional treatment, with mild scoliosis, is likely to be told to return for periodic assessments every 3, 6, or even every 12 months, but what happens if the young patient experiences significant progression during one of these intervals?

As growth and development is the condition's trigger for progression, the scoliosis can progress rapidly, because it was left untreated.

Traditional treatment doesn't start treatment while conditions are mild, quite simply, because it doesn't have a strategy for treating scoliosis while mild, only surgically when severe.

In fact, prior to crossing the surgical-level threshold at 40+ degrees when scoliosis is classified as severe, the only form of treatment applied is traditional bracing, the most common of which is the Boston brace.

The Boston brace is associated with a number of shortfalls:

  • End goal is to stop progression, not correction
  • Squeezes the spine unnaturally: known to weaken it over time
  • Can increase postural deviation
  • Doesn't address the condition's rotational component (3-dimensional nature)
  • Brace is mass produced = uncomfortable and bulky to wear
  • Compliance issues

The Boston brace is often prescribed for full-time wear, meaning for anywhere between 18 to 23 hours a day for up to five years, and if the brace isn't worn as prescribed, its efficacy is limited.

The Boston brace wants to stop the condition from getting worse, which is different from having correction as an end goal.

If the Boston brace is ineffective at stopping the adolescent patient's scoliosis from progressing, and the patient crosses into the severe classification, with signs of continued progression, spinal fusion surgery is commonly recommended.

Spinal Fusion Surgery for Scoliosis

While there are different kinds of spinal fusion surgery, the procedure commonly involves fusing the most-tilted vertebrae of the curve, at its apex, into one solid bone; this is done to eliminate movement (progression) in the fused section of the spine.

Commonly, rods are attached to the spine with screws to hold it in place, and this hardware is permanent.

While all surgical procedures come 400While all surgical procedures come with their share of risks, spinal fusion is no exception and is a costly, lengthy, and invasive procedure.

Surgical treatment for scoliosis has the end goal of stopping scoliosis from getting worse, and it does so by holding the spine in a corrective position through artificial means, and this is not the same as actually correcting the scoliosis on a structural level.

While invasive surgery can be successful at straightening a crooked spine, it can do so at the cost of the spine's overall strength and function.

Following are some risks associated with the procedure itself:

  • Excessive blood loss
  • Infection
  • Nerve damage
  • Adverse reaction to hardware

Following are some potential risks, side effects, and complications associated with living with a fused spine:

  • Pain at the fusion site
  • Nerve damage
  • Hardware malfunction over time
  • Loss of spinal flexibility and range of motion
  • Disappointing cosmetic results
  • Living with a spine that's more vulnerable to injury
  • Psychological effects of living with a fused spine

With a spine that's rigid comes sore and stiff muscles surrounding the rigid section, so the muscles that surround the fused section of the spine, not to mention the rigid spine itself, can cause increased levels of pain post-surgery: a result many patients are disappointed with.

Spinal nerve damage is a risk associated with any spinal surgery.

One of the real concerns I have with spinal fusion surgery is that there is a gap in the research on the long-term effects of living with a fused spine 10, 20, 30+ years down the road.

With the hardware used, for example, what's its natural longevity? It seems obvious to me that, at some point, it's going to experience some level of deterioration and/or failure, and then what?

The only recourse for hardware failing is more surgery, facing all the associated risks all over again, and keep in mind, the younger a patient is at the time of the surgery, the longer the hardware has to last, and the risks associated with surgery only increase with age.

The loss of spinal flexibility and range of motion is commonly the most disappointing result for those who have undergone the surgical treatment.

As multiple vertebrae are fused together, this means there is no movement in the fused section of the spine, meaning it is unnaturally stiff, and the muscles surrounding the fused section are also likely to become stiff and sore.

Now, not everyone will experience a noticeable loss in spinal flexibility, and this will depend largely on the number of vertebrae fused, the location of the fused vertebrae, and condition severity.

Some people still maintain enough flexibility above and below the fused section to not notice a significant change, but it is a common complaint regarding a significant loss in natural spinal function.

The number-one reason most people opt for surgical treatment is they think it's the best way to return their body to its pre-scoliosis state, but as scoliosis disrupts the body's overall symmetry and surgery focuses solely on the spine, patients are often disappointed with the cosmetic results, particularly in the hips.

A spine that's held in place unnaturally is not as strong and is more vulnerable to injury; this can have a significant psychological effect as many people find the knowledge makes them fearful of trying new things and/or participating in once-loved activities, impacting quality of life.

Fortunately, there is a modern non-surgical form of treatment with proven results, and the reality is that most cases of scoliosis can be treated non-surgically, particularly with early detection and proactive treatment.

Modern Conservative Scoliosis Treatment

Modern conservative scoliosis treatment is also known as chiropractic-centered and/or functional treatment, and this is because the way the condition is treated preserves as much of the spine's natural function as possible.

Here at the Center, patients benefit from a modern conservative treatment approach that combines multiple treatment modalities so each and every treatment plan can be fully customized to address key patient/condition variables.

I have helped hundreds of patients improve their condition and quality of life through proactive treatment that values prevention, and for those who think severe scoliosis can only be treated with surgery, listen to Kaley's story of severe adolescent idiopathic scoliosis.

Scoliosis is a complex structural spinal deformity that has to be impacted on every level, and I work towards this by, first and foremost, impacting it on a structural level, and once I start to see structural results, I can shift the focus to increasing core strength so the spine is optimally supported by its surrounding muscles.

Traditional treatment focuses on monitoring for progression, which I do as well, but the difference is I'm actually treating the scoliosis at the same time, and apportioning treatment disciplines accordingly, based on how the spine is responding to treatment.

I combine condition-specific treatment such as chiropractic care, in-office therapy, corrective bracing, and custom-prescribed home exercises to proactively treat the condition and prevent further progression.

Chiropractic Care

Through a series of chiropractic techniques and adjustments, I can work towards adjusting the position of the curve's most-tilted spinal bones back into alignment with the rest of the spine.

By addressing any areas of vertebral subluxation, the spine's natural curves are being restored, which means the uneven forces of the condition are being reduced, and overall spinal biomechanics are being improved.

The spine's natural curves make it stronger, more flexible, and better able to absorb and distribute mechanical stress incurred during movement, so treatment that aims to restore the spine's natural curves, structurally, is preserving its natural function.

In-Office Physical Therapy

Through a variety of therapies, I can work towards helping patients increase their core strength for optimal spinal support; after all, it's not just the spine that's in charge of maintaining its natural curves and alignment, but also the spine's surrounding muscles.

While the majority of condition-related pain is caused by compression (scoliosis becomes a compressive condition once skeletal maturity has been reached), muscle pain is a common complaint.

As the muscles that surround the spine struggle to support an unnaturally-curved spine, they can become tight and sore, and due to uneven wear caused by the condition's uneven forces, muscle imbalance can also develop.

Condition-specific physical therapy can not only increase core strength, but can also address muscle imbalance, which can help with pain control.

In addition, certain scoliosis-specific exercises (SSEs) are known to activate specific areas of the brain for improved brain-body communication, postural remodeling, and improved body positioning.

Boston Brace vs Modern Scoliosis Brace: Which is Best?

Corrective Bracing

While traditional bracing is associated with a number of shortfalls, modern corrective bracing addresses a number of those shortcomings with its modern corrective design.

To meet my patients' bracing needs, I opt for the ultra-corrective ScoliBrace because it has corrective potential.

The ScoliBrace differs from the traditional Boston brace in the following ways:

  • Its end goal is correction
  • It pushes the spine into a corrective position, vs squeezing it unnaturally
  • It can improve postural deviation
  • It addresses the condition's 3-dimensional nature
  • Each brace is custom-designed to suit each patient's body/curvature type
  • The brace is less bulky and more comfortable to wear
  • The brace has better compliance rates

Corrective bracing, when integrated with other forms of proactive treatment, can help augment corrective results by pushing the spine into a corrective position.

Mia's story shows how the inefficacy of traditional bracing highlights the potential of corrective bracing, particularly when integrated into a proactive treatment plan combining multiple treatment disciplines.

Custom-Prescribed Home Exercises

As a progressive structural spinal condition, once a person develops scoliosis, it will be with them for life, and while this can sound bleak, I have to be clear that although incurable, scoliosis is highly treatable.

After successful corrective treatment, meaning the unnatural curvature of the spine has been reduced on a structural level, and core strength has been increased, work will have to be continued to sustain those results.

I liken this to an adolescent needing orthodontic braces to correct the structure of their teeth; even after the braces are removed and the teeth are repositioned as desired, often a retainer has to be worn to hold those results.

The same can be said of scoliosis: that after successful treatment, continued effort will be needed to sustain those results, and this can mean periodic visits to a scoliosis chiropractor, custom-prescribed home exercises, and leading a scoliosis-friendly lifestyle.

A series of custom-prescribed exercises can help patients establish a home-rehabilitation program for further stabilizing the spine for long-term sustainable results, and guidance on how to maintain a scoliosis-friendly lifestyle can involve dietary, exercise, and rehabilitation tips.

So to summarize, let's compare the pros and cons of a surgical versus a non-surgical response to scoliosis.

A Surgical versus a Non-Surgical Response to Scoliosis

So to summarize, traditional treatment focuses on monitoring for progression until a condition progresses into the severe classification, when the patient becomes a surgical candidate, and spinal fusion surgery is commonly recommended.

Conservative treatment focuses on responding 400Conservative treatment focuses on responding proactively by starting treatment as close to the time of diagnosis as possible.

While there are no treatment guarantees, early detection increases chances of treatment success, but only if responded to proactively, as in Josiah's success story.

Curvatures that are mild are more responsive to treatment, prior to spinal rigidity increasing with progression, and before the body has had time to adjust to its presence.

This is why it can be so harmful to ignore scoliosis while mild because as a progressive condition, where a scoliosis is at the time of diagnosis is not indicative of where it will stay; only proactive treatment can successfully counteract the condition's progressive nature.

When treatment is started early, there are fewer limits to what we can achieve, and there are plenty of patient success stories that prove how successful non-surgical scoliosis treatment can be.

From mild to severe scoliosis, regardless of patient age or condition severity, the best time to start treatment is always now; that way, progression, increasing condition severity, escalating symptoms, and the need for invasive surgical intervention in the future can be prevented.

Why not start treatment while scoliosis is at its mildest, is at its simplest to treat, prior to progression, and while the spine is going to be the most responsive to treatment?

So for those who choose to forgo surgical intervention, or for those who simply want to try a less-invasive treatment option first, a modern conservative chiropractic-centered treatment approach has proven results.


When a person receives a diagnosis of scoliosis, the most important choice is how to treat it moving forward; this is because, as a progressive condition, scoliosis has it in its very nature to worsen over time, especially if left untreated, or not treated proactively.

There are two main scoliosis treatment approaches to choose between, each offering patients a different potential outcome: traditional and conservative.

Traditional scoliosis treatment was the dominant choice for many years, but over the years, we have learned a lot about the condition, and how it responds to different forms of treatment.

As traditional treatment doesn't have a strategy for treating scoliosis while mild, it's missing out on the potential of early detection and proactively working towards preventing progression through achieving corrective results.

A modern conservative chiropractic-centered treatment approach values proactive treatment started as close to the time of diagnosis as possible; the Scoliosis Reduction Center's results speak for themselves in hundreds of patient success stories.

If you, or someone you care about, is weighing the pros and cons of the different scoliosis treatment approaches, don't hesitate to reach out so my team and I can provide information, guidance, and support.

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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