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26th Mar 2025
To better comprehend the treatment choices for scoliosis or curvature of the spine, it is necessary to first understand the various causes of the condition. Idiopathic, congenital, and neuromuscular scoliosis are most commonly diagnosed in childhood, while degenerative scoliosis is acquired as an adult. There are different factors for children, adolescents, and adults when deciding whether to have scoliosis surgery; each curve is unique!
For children and adolescents, the reason for scoliosis surgery is usually to avoid further advancement, i.e. a rise in the size of the curve. Idiopathic scoliosis, which implies there is no evident underlying reason, is the most frequent type of scoliosis observed in children and adolescents. These curves tend to develop the most during a growth spurt. As a result, if a curve reaches a specific size before a patient has completed a growth spurt, the patient may be evaluated for surgical intervention.
Medium-sized curves are usually considered for brace management if a patient is still growing. If the curvature is in the thoracic spine, which is the section of the spine that includes the rib cage, surgery is an option when the curve measures 45 degrees on X-rays. However, between 45 and 55 degrees, it is uncertain if the risk of advancement is significant enough to necessitate surgical intervention.
When a curve measures 55 degrees, there is a greater fear that the curve will continue to rise even after a patient has stopped growing, according to prior research on numerous people with scoliosis. As a result, surgery will most likely be advised in this patient population. Even yet, it comes down to patient and family preference, as there are patients with bigger curves treated non-operatively who remain asymptomatic as they age!
Adults are more likely to undergo surgical management to alleviate symptoms. Adult symptoms may include discomfort in the back muscles or tiny joints of the spine as a result of deformity and arthritic changes, as well as neurologic symptoms such as nerve pain or weakness caused by nerve compression. These symptoms can occur either in patients with idiopathic curves who did not have surgical treatment as adolescents or in patients with a scoliosis that has developed with time due to arthritic changes, i.e. a degenerative scoliosis.
If a patient's leg weakness worsens as a result of arthritic changes that put pressure on the nerves in the lower back, surgical intervention should be considered. This can comprise a fusion treatment or, in certain cases, a lesser decompression procedure, which is performed with caution to avoid worsening the curve size. If the primary symptoms are caused only by nerve pain, more conservative treatments, such as medical management or epidural injections, can be used. Meanwhile, muscular-based back discomfort is best addressed with therapy exercises that strengthen the stabilizing musculature; there are even specialized therapy regimens for scoliosis patients, such as the Schroth technique.
Another rationale for surgical therapy is the advancement of curvature detected across numerous X-rays to determine the extent of the curve. If the curvature increases significantly over time, surgery may be indicated to prevent future advancement. Maintaining bone density is especially important for postmenopausal women since low bone density increases the likelihood of a curve expanding in adulthood.
For people who do not have diminishing neurologic function, the best time for surgical management is when the symptoms are severe enough to significantly influence daily activities, outweighing the risks of a lengthy surgical operation and the possibility of consequences. If surgical management is being considered, it is best to consult with a surgeon who has experience working with patients who have deformities such as scoliosis; some specialist spinal surgeons specialize in treating patients with spine deformities. It can be beneficial to understand exactly what to expect during the healing time following scoliosis surgery; many people have posted blogs about their experience.
Finally, the optimal time for surgery is when one feels prepared to have spinal surgery following a thorough discussion with a medical professional. Many people can successfully manage their scoliosis without surgery, however, those who do need surgery must thoroughly understand what to expect!
