Scoliosis is the medical term for a sideways curvature of the spine. Spinal fusion surgery (SFS) for scoliosis fuses two or more vertebrae together to help straighten the spine and prevent the curvature from progressing.
Most people with scoliosis do not need surgery, and many do not require any treatment at all. Doctors typically reserve surgery for people with particularly severe scoliosis or those who develop the condition in infancy. Without treatment, these cases may progress and cause certain health complications, such as chronic pain, reduced mobility, and damage to the heart and lungs.
This article describes how SFS affects scoliosis, when doctors recommend the surgery, and whether it is a safe and effective treatment option. It also provides information about the procedure, including the preparation and recovery stages. Finally, we list some alternative treatment options for scoliosis.
The spinal column consists of individual bones called vertebrae. It supports the upper body and protects the spinal cord and nerve roots.
Scoliosis is a condition characterized by a sideways curvature of the spine. SFS involves fusing multiple vertebrae to form a single bone. This reduces the curve, preventing scoliosis curvature from progressing.
Receiving SFS does not always fully correct the curve in a person’s spine but can usually reduce it to 25 degrees or less. The degree to which a surgeon can correct the curve depends on how flexible the spine is.
A 2015 review found no recent trials comparing surgical spinal fusion to other treatments for severe scoliosis. This suggests that researchers do not know for certain how effective SFS is compared with other treatments.
Surgery is usually successful. However, although surgical complication risk is low, complications can be serious. As such, it is important that a person speaks with a doctor about the potential risks and benefits of the surgery.
There is little scientific evidence to determine whether a person should elect to have SFS.
Nevertheless, doctors typically recommend surgery for the most severe cases of scoliosis. They do this because such cases can be disabling, causing problems such as:
- increased curvature of the spine over time
- back pain
- nerve pain
- mobility problems
- damage to the cardiovascular or pulmonary systems
- difficulty breathing
Serious complications are
Most cases of SFS are successful and do not involve serious complications. However, some potential risks include:
- excessive bleeding
- surgery that is not effective
- damage to the spinal cord or spinal bones
- chronic pain
- loss of spinal mobility
- neurological damage
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Before surgery, a person will meet with a surgeon to discuss the procedure. During this meeting, the person will likely undergo the following:
- blood work
- a review of all of their current medications
- a review of their medical history, including any prior surgeries
The night before the surgery, a person will typically need to avoid food and beverages. They should follow their surgeon’s advice on when to begin fasting.
On the day of the surgery, a person will meet with an anesthesiologist. Shortly before the procedure, the anesthesiologist will administer a combination of drugs to help a person sleep through the surgery.
During the procedure, a surgeon cuts into the back with a scalpel, cutting through layers of skin and muscle. The surgeon will push the muscle aside to access the vertebrae.
Next, they insert a bone graft, which is an artificial bone that attaches to the vertebrae. The surgeon places the bone graft between the bones that require fusion. Over time, the vertebrae and the bone graft grow together. A surgeon will insert metal rods to hold the spine in place until the bones fuse.
Surgery usually takes around 4–8 hours, or sometimes longer. A person may have an epidural after surgery to help alleviate the pain. They will wake up in a recovery room with no memory of the procedure.
SFS is major surgery, so a person should expect to have some pain afterward. They will typically need to stay in the hospital for several days for monitoring.
A person should be able to walk immediately after the surgery. However, they will likely need to avoid heavy lifting and challenging physical activity for about 6 months following the procedure. Some people need physical therapy to support their recovery, and most will need to take pain medication.
After surgery, the fused portion of the back will remain stiff but should not be so stiff that it prevents typical movement. Aside from this change, surgery should not result in any other long-term limitations on activity.
Mild to moderate scoliosis does not usually require treatment. Instead, a doctor will monitor the curvature to see if it changes or worsens.
Surgery is not the only treatment option and may not be the best choice. Other options include:
- massage for back pain
- exercises to stretch and strengthen the back, such as yoga and pilates
- physical therapy to improve functioning
- alternative therapies, such as chiropractic care and acupuncture
- other surgeries, such as spinal tethering
However, physical therapy, yoga, pilates, chiropractic care, and acupuncture do not have good research to support their efficacy in helping with scoliosis.
Bracing is one of the most common treatments for less severe cases of scoliosis that require treatment. However, this is only effective for people who are still growing.
Scoliosis is the medical term for a sideways curvature of the spine. The degree of curvature can be minor or severe. Minor cases may not require any treatment. However, severe cases can be painful and disabling and cause other health complications.
Spinal fusion surgery involves fusing two or more vertebrae to correct spinal curvature. Doctors typically reserve this treatment for people with more extreme scoliosis. The aim is to prevent the risk of serious complications. However, there is no recent scientific evidence comparing spinal fusion to other interventions for scoliosis, and doctors cannot say with certainty how well the surgery works compared with other treatments.
Surgery for scoliosis is not without risk. A person should speak with a doctor about the potential risks and benefits before deciding whether to go ahead with the treatment. They can also ask a doctor about any alternative treatment options.