Scoliosis surgery is a highly specialized subspecialty of spine surgery and focuses on the operative treatment of scoliosis—i.e., a lateral curvature of the spine accompanied by rotation of the vertebral bodies. In Germany, an estimated 900,000+ people are affected by scoliosis.
In an interview with Professor Dr. Kröber, Chief Physician at Helios Klinik in Rottweil as well as at the Helios Hospital in Überlingen, the editorial team of the Leading Medicine Guide learned more about the causes and symptoms, and which treatment options are available.
Scoliosis develops when the spine curves sideways and simultaneously rotates, resulting in an S- or C-shaped malalignment. The causes can vary widely.
„There are different types of scoliosis. In children and adolescents, these are either congenital curvatures—for example, due to vertebral malformations—or those that develop during growth. The most common form is idiopathic scoliosis, which is presumed to be genetic and usually becomes apparent for the first time during the pubertal growth spurt.
In addition, there is adult degenerative scoliosis, which typically develops in the fifth or sixth decade of life—triggered by wear and tear, asymmetric loading, or degenerative changes. Adolescents often do not notice their scoliosis themselves because it initially causes no symptoms. It is usually parents, relatives, or teachers who first notice it, seeing a deformity of the back when viewed from behind. After diagnosis, the question arises as to whether treatment is necessary.
The decisive factors are primarily the degree of curvature and the remaining growth potential. If the angle is below 20 degrees, the condition is initially just monitored. If the curvature increases and exceeds 20 degrees, conservative therapy is started—typically a brace combined with physical therapy. If the curve continues to progress or is already over 45 degrees at initial diagnosis, surgery is recommended, because conservative measures are then no longer sufficient and there is a high long-term risk of degenerative wear and symptoms.
Pain does not necessarily have to be present—pronounced curvatures can still be symptom-free in adolescence. In adulthood, it is different. Patients usually come in because of chronic symptoms, not because of the visible deformity. Degenerative scoliosis causes back pain and often radiating nerve pain, because the spinal canal narrows and nerves are compressed.
This can lead to sensory disturbances, muscle weakness, or even paralysis. A changed posture is also typical: In addition to the lateral curvature (scoliosis), a forward-leaning posture often develops, known as kyphosis. Together, these shape the typical picture of adult deformity“, Prof. Dr. Kröber explains at the beginning of our conversation and goes on to discuss the most common form, idiopathic scoliosis, in more detail:
„Here, the changes usually occur during adolescence, with genetic factors, growth spurts, and muscular imbalances playing a role. Congenital malformations of the vertebral bodies can cause scoliosis at birth or in early childhood, while neuromuscular diseases such as muscular dystrophies or spinal cord injuries can also lead to a lateral curvature.
In adults, scoliosis often develops due to degenerative changes—for example, wear and tear, disc damage, or osteoporosis. The symptoms of scoliosis are varied and depend on the extent and location of the curvature. Common findings include uneven shoulders, hips at different heights, or a visible rib hump. Those affected may experience back pain or muscle tension, especially with pronounced malalignment or in adulthood.
Mobility may also be limited, and in rare cases neurological symptoms such as numbness, tingling, or weakness in the arms or legs can occur if nerve structures are involved. Very severe thoracic scoliosis can also impair lung or heart function. Symptoms typically develop gradually and are often first identified during routine checkups in adolescence, while in adults they can worsen due to degenerative processes if the malalignment remains untreated“.
Scoliosis is considered to require treatment when the lateral curvature of the spine exceeds a certain degree, the malalignment progresses, or symptoms such as pain, restricted mobility, or functional problems already occur.
Curvatures over 40 to 50 degrees often need to be corrected surgically, especially if they progress. Age, growth potential, and symptoms also play an important role in decision-making. „In idiopathic, i.e., adolescent scoliosis, the goal of surgery is to correct the primary curve far enough that the remaining compensatory curve can balance itself out through further growth.
Many scolioses are double-curved: If the spine curves in one area, the body often forms a compensatory curve to maintain balance. Because children still have growth potential, surgery focuses on the primary curve. This is straightened using a screw-and-rod system—essentially like brace rods. The idea is that the second curve will correct itself through the child’s continued longitudinal growth. This can be compared to a young tree that has grown crooked and is tied to a stake so it continues to grow straight.
In this way, a lasting correction can be achieved with a comparatively smaller operation—one that does not cause symptoms later on. In adults, this principle no longer works because there is no growth. Therefore, surgery must extend over a longer segment, and the correction includes both curves. That is the key difference between adolescent and age-related scoliosis. The surgical technique itself—straightening the spine using a screw-and-rod system—is similar in both forms“, Prof. Dr. Kröber explains.
Scoliosis surgery is a highly specialized procedure aimed at correcting the lateral curvature and rotation of the spine, stopping progression of the deformity, and preserving spinal function.
The process typically begins with precise surgical planning, in which the extent and location of the curvature are determined using X-ray, CT, or MRI imaging. Based on this, the team decides which spinal segments need to be corrected and stabilized and which fixation techniques will be used.
Surgical access is usually via a posterior or lateral approach, depending on the location and type of curvature. Modern scoliosis surgery almost always uses posterior instrumentation techniques, meaning that screws and rods are placed on the back side of the spine to bring the vertebrae into the desired position and fix them in place. This involves pedicle screws (metal screws, usually titanium), contoured titanium rods, or flexible rods, which stabilize the spine while preserving as much natural mobility as possible.
Prof. Dr. Kröber explains: „During surgery, the implants are inserted and anchored deep beneath the muscles and directly to the bone. From the outside, you cannot see or feel them. These implants stabilize the spine, realign it using biomechanical techniques, and keep it permanently in the corrected position.
That is why they are not removed later—they generally remain in the body. How many screws are used depends on the length of the curve that needs to be corrected. Typically, two screws are placed per vertebra, so with larger curves it can be as many as 20 screws. This also shows how extensive such spine surgeries are. In particular, correcting scoliosis is among the largest procedures performed in this field“.
During the operation, the spine is monitored continuously with intraoperative neurophysiological monitoring to ensure that nerve structures are not damaged.
„Many patients are initially very afraid of scoliosis surgery, especially because they worry about possible paralysis. In children and adolescents, however, we see that they usually tolerate the procedure surprisingly well: They recover quickly, are mobilized early, and often perceive the postoperative pain as significantly less than expected. Of course—as with any spine surgery—there is always a fundamental risk of nerve or spinal cord injury.
Today, however, this risk can be reduced to virtually zero, because nerve conduction is measured throughout the entire operation. This neuromonitoring immediately indicates if a nerve is irritated or at risk due to a malpositioned screw, so it can be corrected right away. As a result, permanent nerve damage—which used to be the main risk—is now extremely rare. The clinic performs about 60 to 80 of these procedures each year—not only in adolescents, but especially in adults with degenerative scoliosis, whose numbers are increasing significantly due to rising life expectancy.
The duration of surgery varies: In adolescents, the procedure takes about two hours; in adults, due to the more complex starting point, five to seven hours. Despite the scope of the operation, it is also recommended for older patients. Thanks to modern anesthesia, intensive care support, and improved surgical techniques, many risks can be well controlled today, so even patients in their 70s or 80s can be operated on successfully“, Prof. Dr. Kröber says, adding:
„If surgery is clearly ruled out due to anesthetic risk, then of course the procedure cannot be performed. In that case, only further conservative treatment remains—usually in the form of pain management—just as the patient may already have been accustomed to for years. In general, however, the decision for or against surgery is always individual and depends heavily on how much quality of life is impaired.
Each person assesses their resilience and expectations for daily life differently; even two patients of the same age can have completely different standards. That is why risk must always be weighed against potential benefit.
It is also important that patients understand what they can realistically expect. The effect of the surgery is not immediate; it develops over months. The operation first creates the structural prerequisites, and only after three to six months of rehabilitation does the actual result become apparent. Studies and experience show, however, that quality of life improves significantly afterward and patient satisfaction is high“.
The goal of modern scoliosis surgery is not only to correct the deformity, but also to ensure safety, protect the nerves, and sustainably restore mobility.
„After surgery, depending on the scope of the procedure, the patient stays in the hospital for about 10 to 14 days—on average around 10 days. After that, they go home, initially take it easy, and recover from the operation. About six weeks later, physical therapy or rehabilitation begins—either outpatient or inpatient, depending on personal needs and individual resilience.
Follow-up care takes place in clearly defined steps: After six weeks, there is an initial follow-up examination—immediately before rehabilitation begins. Another check takes place after about six months, when the maximum effect of the operation has been achieved and the final evaluation is due“, Prof. Dr. Kröber clarifies and explains the success of the operation:
„Whether mobility is restored to 100% after surgery cannot be answered in that way, because the focus is not full mobility, but pain reduction and thus an improvement in quality of life. As a rule, this improves noticeably, even though complete and permanent freedom from pain is rarely achieved.
The goal is to alleviate the chronic symptoms that have developed over years to the point where the patient is satisfied again, needs less strong pain medication, or can even stop it entirely. To make success measurable, we use a pain scale from 0 to 10, which is recorded before and after surgery“.
What happens if scoliosis is not treated?
Many affected individuals hesitate out of fear or uncertainty—often for years. As a result, the situation continues to worsen: Pain increases, the curvature progresses, and conservative measures help less and less. Many patients report after late surgery that they should have undergone the procedure much earlier. Education is therefore crucial: There are effective treatment options beyond pain management alone, and an early step to a specialized center can spare a great deal of suffering.
In Germany, an estimated 900,000 people have scoliosis, although only a portion of these patients require surgical treatment. As a rule, surgery is performed only for a small percentage—namely those whose curvature is severe, progressive, or already leads to pain, functional limitations, or postural damage.
„With such a major spine operation, it is crucial that patients pay close attention to which center they choose for treatment. The most important factor is surgical expertise—it must clearly be present. Everything else follows from that: capable intensive care medicine and anesthesia, established neuromonitoring during surgery, and an infrastructure that enables procedures at the highest level.
Equally important is qualified follow-up care—well-trained physical therapists and a coordinated treatment team. For patients to be able to recognize all of this, transparent communication is important—through websites, informational materials, or conversations like this one, which show what matters.
Of course, not everyone affected needs surgery, but the need for good therapy is great. In fact, only a few hundred to perhaps a little over a thousand scoliosis surgeries are performed each year. This is also because there are only a few centers that are truly specialized in this field and can perform such complex procedures at a high level“, Prof. Dr. Kröber emphasizes—and with that we conclude our conversation.
- Chief Physician of Orthopedics, Trauma Surgery, and Spine Surgery, HELIOS Klinik Rottweil and Helios Hospital Überlingen
- Recognized specialist in spine surgery, particularly scoliosis and deformity surgery
- Master certification from the German Spine Society (DWG)
- Regionally and internationally recognized spine expert
- Areas of focus: Spinal deformities and degenerative disease, acute injuries and trauma care, spinal tumors and infections, revision procedures, and second opinions
- Holistic, indication-driven treatment approach with priority on conservative methods
- Extensive expertise in complex and interdisciplinary spine procedures
