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Your doctor will probably give you most of this information, but this website is meant to be a central, comprehensive, user-friendly source to answer your questions. For the last year and a half, I have spent countless hours scouring the internet for information on scoliosis and spinal fusion surgery, and the results of that research are included on this page. The sources for this information are included in my Links and Bibliography page at the end of this site. Throughout this page, click on blue underlined words to see definitions, pictures, printable lists or extra information.

On this page:

What is scoliosis? Where does it come from?

Scoliosis is defined as a spinal curvature of greater than ten degrees. When a healthy person stands up straight, their spine forms a straight line (see right) when seen from behind. A scoliosis patient’s spine will have curves in it from side to side (see left).

Scoliosis does not come from bad posture or a lack of calcium. In fact, about 80% of the time it is idiopathic, meaning that the doctors don’t know the cause. Although scoliosis often runs in families, it is not actually genetic, as far as we know. (That is, no one has isolated a certain “scoliosis gene.”)

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Who gets scoliosis? Are there certain risk factors?

About 10% of the general population has some level of scoliosis, although only about three kids in every thousand (0.3% of the entire population) requires treatment for it.

Sometimes scoliosis may be caused by a disease, such as cerebral palsy, but scoliosis itself is not a disease. Most of the time its cause is unknown (idiopathic). There are a number of theories as to what may cause idiopathic scoliosis, including:

  • hormonal and/or nutritional deficit or imbalance
  • connective tissue disorder
  • nervous system abnormality
  • spinal cord or brain stem abnormalities

Curves usually increase during the adolescent growth spurt, but may continue into adulthood if left untreated. The onset of scoliosis is rare in adults. Usually an adult case is the progression of an undiagnosed childhood case. Sometimes it may be the result of a degenerative joint condition in the spine. Scoliosis is occasionally seen in small children as well, but again, this is rare.

The majority of infantile cases occur in boys, but the vast majority of juvenile and adolescent cases are seen in girls. Overall, boys and girls get scoliosis at about the same rate, but girls’ curves progress seven times as much as boys’ do, so the vast majority of treated cases are girls.

Research indicates that progression is seen more frequently in girls who are immature (premenstrual) and have larger curves at the time of detection. Progression is more likely for:

  • girls
  • younger diagnosed
  • bigger curves
  • upper curves
  • congenital scoliosis (scoliosis at birth)

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Are there different kinds of scoliosis?

Yes! A single curve is most common, but a person may have two or three curves (see right). Some cases also rotate the rib cage.

Curves are defined by:

  • shape -- C or S
  • dimension
    • “structural” involves twisting/rotation (three-dimensional curvature)
    • “nonstructural” is only side-to-side curving
  • location
    • upper back (thoracic)
    • lower back (lumbar)
    • both (thoracolumbar)
  • direction -- right or left
  • angle -- measured in degrees
  • cause -- 80% of cases are idiopathic
  • age range
    • infantile idiopathic scoliosis = onset age 0-3 years
    • juvenile idiopathic scoliosis = onset age 3-10 years
    • adolescent idiopathic scoliosis = onset age 10 years or older

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How is scoliosis detected?

School Screenings

Many states have school screenings which look for scoliosis, as well as kyphosis (excessive round back) and hyperlordosis (excessive sway back). The criteria for these screenings were set up by the American Academy of Orthopedic Surgeons because when the condition is detected early, conservative treatment is more effective and there is less need for surgery.

X-Rays

Your doctor will take x-rays to detect and measure any curves. (This is why some children are unexpectedly diagnosed with scoliosis when they go in for a chest x-ray for some other reason.) X-rays will also be used to monitor curve progression.

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What are the signs/symptoms of scoliosis?

  • uneven shoulders
  • prominent shoulder blade(s)
  • uneven waist
  • uneven hips
  • leaning to one side
  • protruding rib cage
  • poor posture
  • crooked neck
  • uneven dressline or pantline
  • one leg shorter than the other
  • one side of the back looks higher than the other when bending over (see picture)
  • inability to bend over
  • “growing pains” in back

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What are the treatment methods for scoliosis?

Exercise

Exercise does not stop curvature, but may improve the curve pattern and will help keep back muscles strong. However, if exercise is the only treatment given, especially for moderate to large curves, it may actually exacerbate the curves.

Some doctors prescribe physical therapy for scoliosis, but the popular opinion at this point in time is that physical therapy is not very successful in reducing curves, so it is not a common treatment method anymore.

Observation

For curves under 20 degrees, observation is generally the treatment of choice. This is the only treatment needed in about 80% of scoliosis cases. Checkups are scheduled every three to six months while the patient is still growing to make sure the curves don’t progress.

Bracing

For curves between 25 and 40 degrees, braces are sometimes prescribed to try to prevent the curves from getting any larger. Bracing generally does not reduce the size of curves, and is only useful during years of active growth and while the curve is below 40 degrees. Most normal physical activity is allowed while wearing the brace, and there are almost never any long-term complications.

Surgery

  • For serious curves (i.e. those over 40 degrees) surgery is usually recommended. There are a few different kinds of surgery, but all revolve around the same basic concept: fuse the affected vertebrae using bone graft, and secure with instrumentation (rods and screws or hooks). Once the vertebrae fuse into one long bone, they will no longer be able to curve.
  • The incision may be made down the back (posterior spinal fusion) or from the side (anterior spinal fusion). There is also a newer endoscopic method which involves multiple half-inch incisions. This method is more expensive, riskier, and as of right now, does not usually have as positive an outcome as the other methods do. Your surgeon will tell you which approach is best for you -- probably either posterior or anterior -- depending upon the location, size, and flexibility of your curves.
  • Technically, the goal of spinal fusion surgery is to stop the progression of the curves by “welding” the affected vertebrae into a single bone. The surgeons do their best, and a significant amount of correction (often up to 50%) is usually achieved, but realize that cosmetics are not the first priority. Similarly, your doctor will not operate just to cure a “sore back.”
  • In larger curves, vertebrae have often become wedge-shaped (see picture), in which case surgery is the only way to correct the curves.
  • It is very rare for the rods and screws to need to be removed. This would require another surgery, and would probably only be done after the fusion is complete.

Other Methods

Technically there is no medical evidence of other methods (such as chiropractic, yoga, pilates, or electrical stimulation) being effective. Personally, I think that you should talk with your family, find doctors you trust, and do what feels right to you. You can also consider a combination of these alternatives with traditional methods, such as practicing yoga to make your back feel better until surgery.

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What are the possible complications of surgery?

  • blood loss and transfusion risks
  • gastrointestinal problems
  • bladder infection
  • medical problems including blood clot, stroke, heart attack, death (all very, very rare, and generally only happen in people who have other health risks)
  • paralysis - very low chance (maybe 1 in 8000), especially with new spinal cord monitors
  • infection
  • nonunion (pseudoarthrosis)
  • rod/hook/screw dislodging or pulling out
  • persistent pain
  • nerve damage
  • bone graft shifting out of place

I know these all look scary, but many are temporary (such as bladder infection) and all are unusual. You also have to compare these low risks to the very serious risks of not having surgery if you need it.

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What kind of outcome can I expect from surgery?

Flexibility and Correction

Most patients experience very little loss of flexibility/mobility. True, your back won’t make a perfect C-shape when you bend over to tie your shoes, and you won’t be quite as twistable, but most bending is really done from your hips and lower back anyway. You will hardly notice a difference at all.

Complete correction is not necessary. People can function just fine with a slight curve. Complete correction (i.e. returning your back to a perfectly straight line) can actually be quite dangerous because your whole body has adapted to being curvy, so you can get nerve damage and/or balance problems from being pulled too straight.

The Procedure

The spine is “welded” together. Bone grafts are placed between the affected vertebrae such that they will eventually become one long bone that will not continue to curve.

Bone grafts may or may not require a separate incision, depending on where the graft is taken and where your fusion is. The bone graft site may be sore for several months. “Autogenous bone” is from your own body. Grafts are usually taken from the pelvis or from protruding ribs to try to reduce the “rib hump” that can result from rotation. Sometimes they don’t use your own bone for the graft. “Allograft bone” is from “a bank of bone harvested from other individuals” (cadavers), or they may use a new bone substitute.

Instruments hold spinal segments immobile during fusion. Your surgeon may use wires, hooks or the newer “pedicle screws” to attach the rods to your vertebrae. An external brace or cast may sometimes be used instead of or in addition to internal instrumentation, depending upon the individual case.

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What will happen if I choose to do nothing?

Without Treatment

It will be much harder to treat your curves later without some action now. Possible complications include:

  • deformity/disability; bad posture, disfigurement, backache
  • damage to spinal cord (rare)
  • reduced chest size and difficulty breathing
  • difficulty with childbirth
    • inadequate room to grow
    • back pain
    • possible curve increase
  • impact breathing at 70˚
  • damage to heart and lungs at 100˚
  • higher risk of loss of bone density (osteopenia)
  • chronic back pain
  • inflammation and arthritis
  • numbness
  • menstrual cycle disturbances
  • emotional impact of physical deformity

With Treatment

With treatment, you can enjoy an almost completely normal life, including appearance, posture, activity, and childbirth. Surgery can be a very frightening prospect, but look at the big picture. Your results and recovery will be better the younger you are, so it is best to simply get it over with. You deserve better than to spend your life worrying about your back and your appearance, and suffering through the side effects that inevitably come with larger curves. Don’t let fear keep you from giving yourself the best possible chance at a great future.

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