Scoliosis Correction Surgery

Scoliosis is a sideways curvature of the spine combined with rotation of the vertebrae, which is why it also produces a rib prominence and uneven shoulders or waist. Correction surgery restores as much of the normal alignment as is safe and then holds it. In the standard operation, screws are placed into the vertebrae along the curve and connected to contoured rods that pull the spine into its new shape; bone graft is added so that the treated segment gradually fuses into one solid block. For severe or rigid deformity the surgeon may also cut and reshape bone, an osteotomy, to allow the correction. In growing children, growth-friendly systems can be used instead, controlling the curve while allowing the spine and chest to keep developing.

Surgery is usually recommended when a curve passes a threshold beyond which it is likely to keep progressing through adult life, commonly discussed at around 45 to 50 degrees in adolescent idiopathic scoliosis, or when documented progression continues despite a brace. It is also recommended for congenital deformity caused by malformed vertebrae, for neuromuscular scoliosis where sitting balance and breathing are affected, and for adult scoliosis that causes persistent pain, a spine that leans forward or sideways, or nerve compression with leg symptoms. Appearance matters too, and a marked rib hump or trunk imbalance is a legitimate part of the discussion. Curves that are mild or stable are watched and treated without surgery.

The operation is planned from standing full-spine radiographs and, where needed, computed tomography and magnetic resonance imaging, so that the correction and the levels to be fused are decided before the day. Under general anaesthesia the patient lies face down, and the spine is exposed through an incision along the midline of the back; some curves are approached from the side or the chest instead. Screws are placed into the vertebrae, with imaging guidance and often navigation or a surgical robot to confirm their position, and the surgeon then attaches pre-contoured rods and progressively derotates and straightens the spine. Bone graft is laid along the fused segment. Throughout the operation, neuromonitoring records signals travelling through the spinal cord so that any change is detected immediately. Blood conservation techniques such as cell salvage are routine, and the operation generally takes about 4 to 8 hours.

A good candidate has a curve that warrants correction, is fit for a long anaesthetic and understands the trade-off between correction and spinal stiffness. Preparation includes standing radiographs with bending views to see how flexible the curve is, cross-sectional imaging, blood tests, breathing tests when the chest is affected, and a review of nutrition and any underlying neuromuscular or connective tissue condition. Smoking impairs bone fusion and is stopped well in advance. Adolescents and their families are counselled on the fused levels and what movement will feel like afterwards. For international patients, imaging and clinic letters can be reviewed remotely, and the plan is confirmed in person on arrival with fresh radiographs.

Patients are usually helped out of bed within 1 to 3 days, with a physiotherapist teaching safe ways to move, sit and stand. Pain is managed with a planned regimen that is stepped down over the first weeks. The hospital stay is commonly about 4 to 7 days. Most people return to school or light work at around 3 to 6 weeks, avoid lifting and bending for about 3 months, and return to full sport between 6 and 12 months, guided by how the fusion is progressing. A brace is not usually needed after modern instrumented fusion. When treatment is arranged abroad, plan about 2 to 3 weeks in the destination city so the wound can be checked, walking is confident and the first radiographs are taken before flying. Follow-up radiographs and clinic reviews continue at home, shared remotely with the operating team.

Scoliosis correction is major surgery and is performed in centres set up for it, with monitoring and blood conservation as standard. Expected effects include significant back soreness for several weeks, tiredness and a temporary loss of appetite. Recognised risks include bleeding requiring transfusion, wound infection, screw malposition, failure of the bone to fuse, implant prominence or breakage, and the need for further surgery. Neurological injury is uncommon and is the reason continuous spinal cord monitoring is used. Adjacent parts of the spine carry more load after fusion and may become symptomatic years later. Results are generally durable: the curve is substantially reduced, trunk balance and the rib prominence improve, height often increases, and progression through adult life is halted. Movement in the fused segment is permanently lost, which is why the number of levels fused is kept as low as the deformity allows.