Correction surgery is recommended for growing children with curves greater than 40 degrees, and patients with increased risk of curve progression during adulthood (i.e. greater than 40 to 45 degrees). For curve greater than 50 degrees, surgical correction is recommended for patients regardless of age group.
The primary goal of surgery is to prevent progression of the scoliotic curve by achieving a spinal fusion of the curves. Spinal fusion refers to joining vertebrae together after the curve is being straighten. Surgery involves the insertion of screws and rods to maintain the position of the corrected spine. These implants are made up of biocompatible materials and will remain in the body. Apart from spinal fusion, there are surgery using growing rods which are expandable rods that can be distracted/lengthened during growth period in a patient who is still growing. The growing rods will be removed and final spinal fusion is performed when the patient has reached skeletal maturity.
The purposes of surgery are:
- To prevent the curve from progressing further
- To control the curve after brace has been worn and it is not effective
- To improve cosmetic appearance
- To reduce discomfort associated with scoliosis or postural fatigue
Factors which may affect the recommendation of surgery:
- Size of the curve
- Levels and extent of the spine affected by scoliosis
- Presence of increased or decreased kyphosis
- Maturity status and growth potential remaining
- Individual factors
Apart from the consideration of progressive curve, large curve size and cosmesis, it is important to be aware of the fact that a severe curve can decrease the amount of space within the chest and this can lead to compromised cardiopulmonary function of the patient.
The main risks of surgery include nerve injury, infection, implant failure or fusion failure, recurrence of scoliosis or other deformities, and long-term fusion of the lower lumbar spine may also accelerate bone degeneration.
There is consideration of whether it is worthwhile to attempt bracing for large curves before surgery as compared to direct surgery. The pros and cons of having a child going through months of wearing a brace when the outcome is uncertain, as compared to the ‘golden time’ for surgery with best outcome in terms of overall balance, curve size correction, cosmesis. These vary case by case and a detailed explanation about the risks and benefits of surgery will be given by orthopaedic surgeon.