Scoliosis Surgery—Finding the Right Clinic | Information & Specialists

Scoliosis is a chronic spinal condition in which the spine is curved to the side and the vertebrae are rotated. If the spinal deformity is left untreated, it worsens over time. This spinal deformity causes patients to experience pain and leads to restricted movement.

Visually, scoliosis may be evident by one shoulder being lower than the other or one shoulder blade protruding further. Furthermore, scoliosis is characterized by deformation and shortening of the trunk. As a result, severe spinal deformity can lead to impairment of the internal organs. This, in turn, has a negative impact on the cardiovascular system and lung function (shortness of breath, heart problems, etc.).

Left: Schematic illustration of scoliosis. Right: Healthy spine © Koterka Studio | AdobeStock

The cause of this spinal condition is unknown in most cases. It is usually a congenital malformation of the spine.

Spinal conditions should be treated by an experienced specialist. Specialists in scoliosis surgery are often medical specialists in orthopedics, pediatric orthopedics, or spinal surgery. Scoliosis surgery is not a simple procedure. Therefore, scoliosis surgery should only be performed by surgeons or orthopedic specialists who have the appropriate experience in scoliosis surgery.

Since scoliosis is usually a congenital deformity of the spine, children and adolescents often show early signs of spinal curvature. This spinal deformity is generally not very pronounced at a young age. However, it increases significantly as the spine grows. That is why it is important for the diagnosis to be made early in childhood and adolescence.

The clinical examination is particularly important in diagnosing spinal disorders. An experienced physician can determine whether a patient has scoliosis—a spinal deformity—simply through a physical examination. To do this, the patient bends forward and lets their arms hang down. The doctor then looks down the patient’s back and identifies early-stage scoliosis based on any asymmetries. Among other things, the doctor checks:

• The alignment of the spine
• Shoulder blades
• Unilateral strengthening of the lumbar muscles

If the doctor finds evidence of a spinal deformity, an X-ray examination follows. An X-ray of the entire spine, taken from the front and the side, reveals the extent of the spinal deformity. This information can then be used to predict how much the spinal deformity will worsen in the future and what treatment will be necessary. Since an X-ray examination always involves radiation exposure, this test should not be performed at too frequent intervals. A lower radiation dose can also be used to measure the angle of curvature.

Specialized centers also offer alternative methods, such as computer-assisted three-dimensional optical measurement (video raster stereography) of the spinal profile.

The treatment of spinal conditions such as scoliosis depends on the severity of the spinal deformity and the patient’s age. If the congenital spinal deformity is only mild, treatment is generally not required.

To prevent further progression of the spinal deformity, physical therapy is necessary once the deformity reaches a certain degree.

In addition to physical therapy, a scoliosis specialist may recommend bracing. An individually fitted brace helps prevent further deterioration until the end of growth. This approach is even intended to improve the existing curvature.

Scoliosis surgery is recommended for very severe curvatures exceeding 45°. Scoliosis surgery is advisable if:

• conservative treatments are no longer effective,
• the scoliosis continues to worsen, and
• the pain cannot be managed by other means.

Such scoliosis surgery may be necessary even in children with a very severe spinal deformity. Early surgery also prevents the spinal curvature from worsening. 

The goal of the surgery is to straighten the spine and reduce pain.

Various procedures are available for the surgical treatment of scoliosis. There are essentially two surgical approaches:

• anterior (from the front)
• dorsal (from the back)

The choice of approach depends on the individual case.

The advantage of an anterior scoliosis surgery is the shorter fusion segment; the disadvantage, however, is that the chest must be opened. The anterior approach is also only possible for specific curvatures of the thoracic or lumbar spine.

For this reason, the surgeon usually chooses the dorsal approach for scoliosis surgery. Thanks to continuous improvements in surgical techniques for the dorsal approach, the fusion segment is no longer significantly longer today, and the results are similarly good to those of ventral scoliosis surgery.

A special variant is the mini-thoracotomy. In this procedure, surgeons make a short incision of 7–8 cm on the right side of the chest and operate between two ribs. In women, the incision is made under the right breast crease so that the scar—which is barely visible anyway—is concealed by the breast. This approach is possible for idiopathic scoliosis with a curvature of less than 70°.

Regardless of the approach, a metal screw-and-rod system is inserted to correct the spinal deformity. After the procedure, the vertebrae are intended to fuse together (spondylodesis) to stabilize the spine in the long term. Without this fusion, the rods and screws would loosen again over time. However, this fusion restricts the mobility of the spine.

Left: Scoliosis on an X-ray. Right: After scoliosis surgery with rods and screws in place © stockdevil | AdobeStock

For patients who are still growing, non-fusion techniques may also be used, depending on the case. This prevents the bones from fusing together.

For example, magnetic Magec rods are used, which can be lengthened through additional procedures as the patient grows. Another non-fusion procedure is VEPTR (Vertically Expandable Titanium Rib Prosthesis). The rods are attached to the ribs rather than to the spine.

A brace is generally no longer needed after scoliosis surgery.

The duration of the recovery period depends on the individual case—for example,

• how severe the curvature was,
• which surgical approach was chosen,
• how many rods were inserted,
• and, last but not least, on the patient’s overall health.

In most cases, however, patients have recovered enough after a few days to get up and walk around again. They can leave the hospital about a week after scoliosis surgery. The hospital stay is followed, however, by a rehabilitation phase lasting several weeks. Sports are not possible again until several months after the procedure.

The surgical scars usually heal well and are barely visible after two years.

Scoliosis surgery is a complex and major operation that also carries risks. The more severe the curvature, the more difficult the scoliosis procedure is.

Potential complications include loosening of the implant or neurological deficits. In the experienced hands of a scoliosis surgery specialist, complications from scoliosis surgery are rare.

One consequence of scoliosis surgery is the fusion of parts of the spine. The fused vertebrae grow together and thus lose their function as joints. This effect is intentional, but it also imposes limitations on the patient.

Depending on the length of the fused segment, this loss of spinal mobility can be more or less significant. Consequently, those affected may experience noticeable limitations in their daily lives and may be unable to participate in certain sports.

In rare cases, some patients develop back pain as a long-term complication, which may require further surgery.

Scoliosis surgery should be performed by experienced spinal surgeons. Finding the right clinic isn’t always easy. Subjective reviews online often give a misleading impression.

At Leading Medicine Guide, all listed doctors undergo a quality review before being included in the portal. With our award-winning surgeons, you’re in good hands. Contact them for a free, no-obligation consultation.