Scoliosis: Should I (or My Child) Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Scoliosis: Should I (or My Child) Have Surgery?
Get the facts
- Have surgery to treat scoliosis.
- Don't have surgery. Have regular checkups to see if the curve is getting worse. Children may wear a brace to keep the curve from getting worse.
Key points to remember
- Mild curves are usually checked by the doctor every 4 to 6 months until the bones stop growing, to be sure the curves are not getting worse.
- Moderate curves may need to be braced until the bones stop growing, to keep the curves from getting worse.
- Severe curves or moderate curves that are getting worse may need surgery.
The main type of surgery is a spinal fusion. The curved part of the backbone is straightened with rods, wires, hooks, or screws. Then small pieces of bone are put over the spine. These pieces of bone will grow together, or fuse, with the spine, holding it in the proper position.
Instrumentation without fusion is another type of surgery to straighten the spine. The doctor attaches metal rods to the spine without fusing the bones together. This is only done in small children. It's used when doctors don't want to fuse bones together because it would stop growth in that area of the spine. The child usually has to wear a brace full-time after having this surgery.
Surgery usually can improve the curve and keep it from getting worse. Surgery may also help decrease pain and allow you to do more of your daily activities.
Each person's scoliosis is different. Talk to your doctor about whether surgery can help you.
Risks of surgery to fix a spinal curve include:
- Problems that can happen with back surgery, such as nerve damage, lung problems, or spinal cord damage.
- No more growth in the fused area of a child's spine. This could mean that a child may be slightly less tall than he or she would be without fusion.
- Problems that can happen in any surgery, such as blood clots or infection or problems from anesthesia. The risk of these problems is higher in older adults than in younger people.
Talk to your doctor about your or your child's chances of having problems from surgery.
Other problems include lost time at work or school for recovery and the possible need to wear a body cast or brace for a few months after surgery.
A severe spinal curve that is getting worse and is not fixed with surgery is likely to get worse.
As the spinal curve gets worse, the bones of the spine turn toward the inner part of the curve. If the curve is in the upper part of the spine, the ribs may crowd together on one side of the body and become widely separated on the other side. The curve may force the space between the spinal bones to narrow. The spinal bones may also become thicker on the outer edge of the curve.
In severe curves, the ribs that are pulled out of position may reduce the amount of air the lungs can hold. They also may cause the heart to work harder to pump blood through the compressed lung tissue. Over time, this may lead to heart failure.
Scoliosis that is present at birth or that occurs in infants may be worse over time than a spine that curves later in life. If an infant or young child with a severe spinal curve does not have surgery, it is likely that the curve will get worse. This is because the curve gets worse as the child grows.
Your doctor might suggest surgery for you or your child if:
- Your child has a moderate to severe curve or yours is severe, and the curve is getting worse.
- You have pain or trouble doing your daily activities.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You or your child will likely stay in the hospital for several days after surgery.
- You or your child will have to spend a few weeks at home. Your child can go back to school in 3 or 4 weeks.
- For 6 to 12 months, you or your child can't do anything that could jar the spine—such as roller skating or skiing.
- You or your child may need to wear a body cast or brace for a few months after surgery.
- Surgery usually can improve the curve and keep it from getting worse.
- It may decrease your pain and allow you to do your daily activities.
- It can prevent breathing and heart problems from the curved spine.
- Any surgery can cause problems such as bleeding, blood clots, and infection. Anesthesia also can cause problems.
- Back surgery has a risk of nerve damage, lung problems, or spinal cord damage.
- In a child, spinal fusion will stop growth in the area of the spine that is fused. This could mean that a child may be slightly less tall than he or she would be without fusion.
- You or your child gets checkups every 4 to 6 months to see if the curve is getting worse.
- You can take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
- Children may wear a brace to keep the curve from getting worse.
- Exercises may help back pain.
- Exercise and over-the-counter medicines may ease your pain.
- You or your child won't have the risks of back surgery.
- You or your child won't have to take several weeks off from work or school.
- Wearing a brace may keep your child's spinal curve from getting worse.
- The spinal curve could get worse.
- If the curve gets bad enough, it could affect your breathing and heart.
- You could have pain and trouble doing your daily activities.
Personal stories about surgery for scoliosis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My daughter was diagnosed with a mild to moderate spinal curve when she was 16 years old. Tests showed that she was almost done growing and her doctor said it was likely that the curve would not get worse. We were relieved because we didn't want her to have surgery, but of course we didn't want her to have problems with her back as she got older.
Linda, age 40
When my daughter was in the sixth grade, I noticed that her clothes seemed to hang unevenly. We looked at her back and saw that her shoulders were not even. Her doctor examined her and took X-rays of her spine. To our shock and surprise, she had a large spinal curve. Because of her age, the fact that she was just starting her teenage growth spurt, and the size of her spinal curve, it was likely that her spinal curve would get worse. We decided that surgery would provide the best chance for stopping the curve from growing and for stabilizing her spine.
Marta, age 42
I have lived with scoliosis for most of my life. The curve in my back has not gotten any worse in the past 25 years, so I guess it won't now. My mother had scoliosis and had a lot of problems with it. So my doctor just keeps an eye out for any changes.
Henri, age 44
I was diagnosed with scoliosis when I was 22 years old. I was lucky enough not to have any problems until recently. But my spinal curve has gotten worse, and now, at 28 years old, my doctor said it is likely that my curve will get so bad that it will eventually affect my breathing. I decided to go ahead and have surgery so that I won't have problems as I get older.
Sarah, age 28
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for scoliosis
Reasons not to have surgery for scoliosis
I want to get rid of my back pain.
Exercise and over-the-counter medicine work well to control my pain.
It bothers me that my curved spine keeps me from doing a lot of the activities I like.
I'm still able to do the things I like to do.
I worry that my child's spine will get worse as he or she grows.
I would rather wait and see whether my child's spine gets worse as he or she grows.
I or my child can take a lot of time off from work or school to recover from the surgery.
I or my child can't take a lot of time off right now to recover from the surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
If you have any amount of spinal curve, should you get surgery?
- YesSorry, that's not right. Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
- NoYou're right. Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
- I'm not sureIt may help to go back and read "Key points to remember." Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
Can a brace help keep a spinal curve from getting worse in children and adults?
- YesSorry, that's wrong. A brace can keep a spinal curve from getting worse only in children. It does not help adults.
- NoThat's right. A brace can keep a spinal curve from getting worse only in children. It does not help adults.
- I'm not sureIt may help to go back and read "Key points to remember." A brace can keep a spinal curve from getting worse only in children. It does not help adults.
Should you consider surgery if your child's moderate curve is getting worse?
- YesThat's right. Doctors usually recommend surgery if a moderate spinal curve is getting worse, or for a severe curve.
- NoSorry, that's not right. Doctors usually recommend surgery if a moderate spinal curve is getting worse, or for a severe curve.
- I'm not sureIt may help to go back and read "Key points to remember." Doctors usually recommend surgery if a moderate spinal curve is getting worse, or for a severe curve.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||John Pope, MD - Pediatrics|
|Specialist Medical Reviewer||Robert B. Keller, MD - Orthopedics|