What is Scoliosis?
Scoliosis Research Society
What is Scoliosis?
Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side, and rotate. Unlike poor posture, these curves can’t be corrected simply by learning to stand up straight.
This condition of side-to-side spinal curves is called “scoliosis”. On an x-ray, the spine of a person with scoliosis looks more like an “S” or a “C” than a straight line. These curves can make the person’s shoulders or waist appear uneven. Some of these bones may also be rotated slightly, making one shoulder blade more prominent than the other.
Scoliosis is a descriptive term and not a diagnosis. In more than 80% of cases, a specific cause is not known. Such cases are termed “idiopathic”, meaning “of undetermined cause”. This is particularly common in adolescent girls. Idiopathic scoliosis is typically called “infantile” in children 0-3 years old, “juvenile” in children 4-10 years old, “adolescent” in adolescents 11-18 years old, and “adult” in patients over 18 years old. Conditions known to cause spinal deformity are congenital spinal column abnormalities (present at birth – called congenital scoliosis), neurologic disorders (neuromuscular scoliosis), genetic conditions, and many other causes. Scoliosis does not come from carrying heavy things, athletic involvement, sleeping/standing postures, or minor leg length abnormalities.
Do I Have Scoliosis?
Determining whether or not you have scoliosis is best done by a physician who performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence). Following this simple examination, the physician will usually initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.
What Are My Treatment Options?
- Observation
This is for curves that have a small degree measurement when you are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when you are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves which are not large.
- Bracing
This is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves.
- Surgical Treatment
This reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression. This is generally achieved by placing metal implants onto the spine which are then attached to rods which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.
Determining whether or not you have scoliosis is best done by a physician who performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence). Following this simple examination, the physician will usually initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.
This is for curves that have a small degree measurement when you are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when you are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves which are not large.
This is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves.
This reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression. This is generally achieved by placing metal implants onto the spine which are then attached to rods which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.
Surgical Treatment for Scoliosis
Most scoliosis surgeons agree that children who have very severe curves (50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.
The operation for scoliosis is a spinal fusion. This is essentially a "welding" process. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone.
With the tools and technology available today, scoliosis surgeons are able to improve curves significantly.
Do I need surgery?
If your curve is greater than 50 degrees, it will most likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. Surgery is recommended.
Curves between 40 and 50 degrees in a growing child fall into a grey area — several factors may influence whether surgery is recommended. These should be discussed with your surgeon.
How successful is surgery for scoliosis?
Spinal fusion is very successful in stopping the curve from growing. Today, doctors are also able to straighten the curve significantly, which improves the patient's appearance.
How straight will my spine be after surgery?
Because your spinal bones protect your spinal cord, your surgeon will move the bones only as far as is safe.
The degree of correction from surgery depends on how flexible your scoliosis is before your operation. In general, the more flexible your curve is, the better the correction from surgery. Your doctor can measure your flexibility before surgery with special x-rays called bending or traction films.
Most patients recover from surgery with curves less than 25 degrees. In many cases, these small curves are hardly noticeable.
I have back pain associated with my scoliosis. Will the surgery relieve it?
Immediately after surgery, there will be more pain than before, but this usually resolves over a period of a few weeks to a few months. Most patients report that their back pain is better at 1 year from surgery than it was beforehand.
The x-ray on the left shows two large curves that require surgery.
The x-ray of the same patient on the right after surgery to correct the curves.
Courtesy of Texas Scottish Rite Hospital for Children.
Everyone — whether there is scoliosis or not — has some back discomfort from time to time. Expecting to never have any future back pain would be unrealistic.
What is involved with a spinal fusion surgery?
In a spinal fusion, the curved vertebrae are fused together so that they heal into a single, solid bone. This will stop growth completely in the abnormal segment of the spine and prevent the curve from getting worse.
All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. Generally, small pieces of bone are placed into the spaces between the vertebrae to be fused. The bone grows together - similar to when a broken bone heals.
Metal rods are typically used to hold the spine in place until fusion happens. The rods are attached to the spine by screws, hooks, and/or wires.
Exactly how much of the spine is fused depends upon your curve(s).
Bone is scooped out of the iliac crest to be used as a bone graft.
What is a bone graft?
A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone.
In the past, a bone graft harvested from the patient's hip was the only option for fusing the vertebrae. This type of graft is called an autograft. Harvesting a bone graft requires an additional incision during the operation. It increases the length of surgery and can cause increased pain after the operation.
One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank.
Today, several artificial bone graft materials have also been developed.
How long does the surgery take?
Most fusions last from 4 to 12 hours, depending on the size of the patient's curve and how much of the spine needs to be fused.
How much pain will I be in after surgery?
The amount of pain people report after surgery varies a great deal from patient to patient. The surgery is a major procedure that involves moving muscles and realigning the skeleton.
The first few days are usually quite uncomfortable, but most people improve rapidly by the third or fourth day, and they can walk around, and get in and out of bed well enough to go home. The pain continues to improve gradually and most teenagers can return to school by 2 to 3 weeks after surgery.
Mild pain may persist, but by 3 to 6 weeks after surgery, pain medicine should no longer be necessary.
What type of pain control will there be after the operation?
Pain control varies between different doctors and hospitals. In many cases, a PCA (patient controlled anesthesia machine) is used, which injects a small dose of pain medicine intravenously when you push a button. Some surgeons use an intravenous catheter (small plastic tube placed in a vein) to provide the medication. The pain relief system that your doctor is accustomed to using is probably the safest and most reliable for you after surgery.
On the second or third day after surgery, your doctor will most likely change your medication to pills or liquid pain relievers taken by mouth. These medicines are an opiate (morphine-like medicine.) Because these medications are known to be addictive if taken for a long time, you will be encouraged to switch to acetaminaphen as soon as possible after you go home.
Do the hooks and rods stay in my spine even after it has fused?
If rods are used in a fusion, they usually do not need to be removed. However, a few people may require rod removal for a variety of reasons.
Will fusion make my back stiff and unable to move?
After spinal fusion most people have enough motion in their backs to perform all activities of daily living and most sports. If you participate in activities that require a tremendous amount of flexibility, it may take awhile to adapt. Most people find that within a year or so their backs begin to feel "normal" when participating in those activities.
Can I have my scoliosis corrected without a fusion?
We wish that we had a method and materials that would straighten the spine and also allow normal motion between all the bones. Unfortunately, we do not have this capability. Anything we put in to hold the spine straight, also makes the spine stiff in the area of surgery.
Scoliosis surgery can be done without performing a fusion. Unfortunately, the rods that straighten the spine will eventually break if the bones between them do not grow together. So if fusionless surgery is done, it will probably need to be redone over and over again.
Common Questions About Surgical Recovery
Most patients are in the hospital for 4 to10 days, out of school for 2 to 6 weeks, and back into activities in 2 to 6 months.
How long do patients need pain medication after being discharged home?
Most surgeons prescribe strong pain medicines to patients after scoliosis surgery. Patients who have not used opiate pain killers before usually stop needing them within 2 to 4 weeks after surgery. If the patient has used these medicines frequently before surgery, it may take longer to stop needing them.
It is best to stop taking these strong medicines as soon as possible because they can be addictive if taken for long periods of time.
Does surgery lead to permanent restrictions on activities?
No, most patients are able to return to all their favorite activities and sports.
Most patients return to non-contact sporting activities (running, weightlifting, exercises) approximately 4 to 6 months after surgery.
Before returning to all activities, including contact sports, the spine must be fully healed. It typically takes 6 to 12 months after surgery to obtain a solid fusion of the spine and get back to all activities.
Will I be able to walk after surgery?
Yes. Some patients may need physical therapy after surgery, but they are able to walk when they are discharged from the hospital.
When can I go back to school after the operation?
Most children miss between 2 to 4 weeks of school after surgery. It typically takes about 4 weeks before the spine is healed enough for carrying a backpack.
When can I start hanging out with my friends again?
Your friends can visit you after surgery in the hospital and at home. Going out with your friends — like to school functions or the movies — can occur after you are off all pain medications and are feeling back to normal (this usually happens about 4 weeks after surgery).
The operation for scoliosis is a spinal fusion. This is essentially a "welding" process. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone.
With the tools and technology available today, scoliosis surgeons are able to improve curves significantly.
Do I need surgery?
If your curve is greater than 50 degrees, it will most likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. Surgery is recommended.
If your curve is greater than 50 degrees, it will most likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. Surgery is recommended.
Curves between 40 and 50 degrees in a growing child fall into a grey area — several factors may influence whether surgery is recommended. These should be discussed with your surgeon.
How successful is surgery for scoliosis?
Spinal fusion is very successful in stopping the curve from growing. Today, doctors are also able to straighten the curve significantly, which improves the patient's appearance.
Spinal fusion is very successful in stopping the curve from growing. Today, doctors are also able to straighten the curve significantly, which improves the patient's appearance.
How straight will my spine be after surgery?
Because your spinal bones protect your spinal cord, your surgeon will move the bones only as far as is safe.
Because your spinal bones protect your spinal cord, your surgeon will move the bones only as far as is safe.
The degree of correction from surgery depends on how flexible your scoliosis is before your operation. In general, the more flexible your curve is, the better the correction from surgery. Your doctor can measure your flexibility before surgery with special x-rays called bending or traction films.
Most patients recover from surgery with curves less than 25 degrees. In many cases, these small curves are hardly noticeable.
I have back pain associated with my scoliosis. Will the surgery relieve it?
Immediately after surgery, there will be more pain than before, but this usually resolves over a period of a few weeks to a few months. Most patients report that their back pain is better at 1 year from surgery than it was beforehand.
Immediately after surgery, there will be more pain than before, but this usually resolves over a period of a few weeks to a few months. Most patients report that their back pain is better at 1 year from surgery than it was beforehand.
The x-ray on the left shows two large curves that require surgery.
The x-ray of the same patient on the right after surgery to correct the curves.
Courtesy of Texas Scottish Rite Hospital for Children.
The x-ray of the same patient on the right after surgery to correct the curves.
Courtesy of Texas Scottish Rite Hospital for Children.
Everyone — whether there is scoliosis or not — has some back discomfort from time to time. Expecting to never have any future back pain would be unrealistic.
What is involved with a spinal fusion surgery?
In a spinal fusion, the curved vertebrae are fused together so that they heal into a single, solid bone. This will stop growth completely in the abnormal segment of the spine and prevent the curve from getting worse.
In a spinal fusion, the curved vertebrae are fused together so that they heal into a single, solid bone. This will stop growth completely in the abnormal segment of the spine and prevent the curve from getting worse.
All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. Generally, small pieces of bone are placed into the spaces between the vertebrae to be fused. The bone grows together - similar to when a broken bone heals.
Metal rods are typically used to hold the spine in place until fusion happens. The rods are attached to the spine by screws, hooks, and/or wires.
Exactly how much of the spine is fused depends upon your curve(s).
Bone is scooped out of the iliac crest to be used as a bone graft.
What is a bone graft?
A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone.
A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone.
In the past, a bone graft harvested from the patient's hip was the only option for fusing the vertebrae. This type of graft is called an autograft. Harvesting a bone graft requires an additional incision during the operation. It increases the length of surgery and can cause increased pain after the operation.
One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank.
Today, several artificial bone graft materials have also been developed.
How long does the surgery take?
Most fusions last from 4 to 12 hours, depending on the size of the patient's curve and how much of the spine needs to be fused.
Most fusions last from 4 to 12 hours, depending on the size of the patient's curve and how much of the spine needs to be fused.
How much pain will I be in after surgery?
The amount of pain people report after surgery varies a great deal from patient to patient. The surgery is a major procedure that involves moving muscles and realigning the skeleton.
The amount of pain people report after surgery varies a great deal from patient to patient. The surgery is a major procedure that involves moving muscles and realigning the skeleton.
The first few days are usually quite uncomfortable, but most people improve rapidly by the third or fourth day, and they can walk around, and get in and out of bed well enough to go home. The pain continues to improve gradually and most teenagers can return to school by 2 to 3 weeks after surgery.
Mild pain may persist, but by 3 to 6 weeks after surgery, pain medicine should no longer be necessary.
What type of pain control will there be after the operation?
Pain control varies between different doctors and hospitals. In many cases, a PCA (patient controlled anesthesia machine) is used, which injects a small dose of pain medicine intravenously when you push a button. Some surgeons use an intravenous catheter (small plastic tube placed in a vein) to provide the medication. The pain relief system that your doctor is accustomed to using is probably the safest and most reliable for you after surgery.
Pain control varies between different doctors and hospitals. In many cases, a PCA (patient controlled anesthesia machine) is used, which injects a small dose of pain medicine intravenously when you push a button. Some surgeons use an intravenous catheter (small plastic tube placed in a vein) to provide the medication. The pain relief system that your doctor is accustomed to using is probably the safest and most reliable for you after surgery.
On the second or third day after surgery, your doctor will most likely change your medication to pills or liquid pain relievers taken by mouth. These medicines are an opiate (morphine-like medicine.) Because these medications are known to be addictive if taken for a long time, you will be encouraged to switch to acetaminaphen as soon as possible after you go home.
Do the hooks and rods stay in my spine even after it has fused?
If rods are used in a fusion, they usually do not need to be removed. However, a few people may require rod removal for a variety of reasons.
If rods are used in a fusion, they usually do not need to be removed. However, a few people may require rod removal for a variety of reasons.
Will fusion make my back stiff and unable to move?
After spinal fusion most people have enough motion in their backs to perform all activities of daily living and most sports. If you participate in activities that require a tremendous amount of flexibility, it may take awhile to adapt. Most people find that within a year or so their backs begin to feel "normal" when participating in those activities.
After spinal fusion most people have enough motion in their backs to perform all activities of daily living and most sports. If you participate in activities that require a tremendous amount of flexibility, it may take awhile to adapt. Most people find that within a year or so their backs begin to feel "normal" when participating in those activities.
Can I have my scoliosis corrected without a fusion?
We wish that we had a method and materials that would straighten the spine and also allow normal motion between all the bones. Unfortunately, we do not have this capability. Anything we put in to hold the spine straight, also makes the spine stiff in the area of surgery.
We wish that we had a method and materials that would straighten the spine and also allow normal motion between all the bones. Unfortunately, we do not have this capability. Anything we put in to hold the spine straight, also makes the spine stiff in the area of surgery.
Scoliosis surgery can be done without performing a fusion. Unfortunately, the rods that straighten the spine will eventually break if the bones between them do not grow together. So if fusionless surgery is done, it will probably need to be redone over and over again.
Common Questions About Surgical Recovery
Most patients are in the hospital for 4 to10 days, out of school for 2 to 6 weeks, and back into activities in 2 to 6 months.
Most patients are in the hospital for 4 to10 days, out of school for 2 to 6 weeks, and back into activities in 2 to 6 months.
How long do patients need pain medication after being discharged home?
Most surgeons prescribe strong pain medicines to patients after scoliosis surgery. Patients who have not used opiate pain killers before usually stop needing them within 2 to 4 weeks after surgery. If the patient has used these medicines frequently before surgery, it may take longer to stop needing them.
Most surgeons prescribe strong pain medicines to patients after scoliosis surgery. Patients who have not used opiate pain killers before usually stop needing them within 2 to 4 weeks after surgery. If the patient has used these medicines frequently before surgery, it may take longer to stop needing them.
It is best to stop taking these strong medicines as soon as possible because they can be addictive if taken for long periods of time.
Does surgery lead to permanent restrictions on activities?
No, most patients are able to return to all their favorite activities and sports.
No, most patients are able to return to all their favorite activities and sports.
Most patients return to non-contact sporting activities (running, weightlifting, exercises) approximately 4 to 6 months after surgery.
Before returning to all activities, including contact sports, the spine must be fully healed. It typically takes 6 to 12 months after surgery to obtain a solid fusion of the spine and get back to all activities.
Will I be able to walk after surgery?
Yes. Some patients may need physical therapy after surgery, but they are able to walk when they are discharged from the hospital.
Yes. Some patients may need physical therapy after surgery, but they are able to walk when they are discharged from the hospital.
When can I go back to school after the operation?
Most children miss between 2 to 4 weeks of school after surgery. It typically takes about 4 weeks before the spine is healed enough for carrying a backpack.
Most children miss between 2 to 4 weeks of school after surgery. It typically takes about 4 weeks before the spine is healed enough for carrying a backpack.
When can I start hanging out with my friends again?
Your friends can visit you after surgery in the hospital and at home. Going out with your friends — like to school functions or the movies — can occur after you are off all pain medications and are feeling back to normal (this usually happens about 4 weeks after surgery).
Your friends can visit you after surgery in the hospital and at home. Going out with your friends — like to school functions or the movies — can occur after you are off all pain medications and are feeling back to normal (this usually happens about 4 weeks after surgery).
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