The title of this post is broad by necessity. But the answer to the question is multi-faceted and complex. There are different types and acuities of scoliosis, all governing the response in individual situations.
So, when is the right time to consider scoliosis surgery? That depends. The three main categories of the condition are idiopathic, congenital and neuromuscular and under all these categories fall a variety of situations, mostly concerned with the needs of the individual patient.
Let’s take a closer look.
Adolescent idiopathic scoliosis
The most common form of scoliosis seen in children and teens is AIS. “Idiopathic” means there’s no known cause.
The purpose of surgery for people of this age group is to stop the curvature’s progression, as the patient is still growing.
Growth spurts influence decision-making in this regard, as curvatures, can increase dramatically during a rapid period of growth. When the curve is in the thoracic, or mid-back region, surgery may be indicated when the curve reaches an acuity of 45%. Because the rib cage is located here, allowing the curve to progress may cause impingement of organs like the lungs, causing respiratory difficulties.
But at 55%, surgery is probably indicated, even though this is not the case for every patient. Much depends on symptoms. Also, in cases of AIS, bracing is a preferred option, allowing the patient to stop growing prior to a decision being made about surgical intervention.
Describing spinal abnormalities seen early in a patient’s life, congenital scoliosis is more likely to be treated surgically, as curvature associated with congenital cases is known to progress rapidly. This usually prompts a surgical response at an earlier age.
This type of scoliosis is relatively rare, but with the risk of progression, surgical correction is often indicated.
This variety of scoliosis is often called “secondary scoliosis”, as it’s known to result from a pre-existing condition which has provoked a spinal curvature. This may be anything from spina bifida to Duchenne’s muscular dystrophy.
As with congenital scoliosis, curvatures progress rapidly. But it’s important to note that the underlying condition responsible may preclude surgery. Approaches to this variety of the condition are various and require vigilance by a pediatric specialist team.
In the case of adults, surgery is usually indicated to stop symptoms of pain. Scoliosis in adults may be due to degeneration of the spine caused by arthritis, which can be the case of severe pain, attributable to nerve compression.
If weakness and pain are progressive, surgery is usually indicated to help restore patient mobility and quality of life.
Should successive X-rays show an appreciable progression of the curvature over time, surgery is indicated to stop and correct it.
So, when is it the right time to consider scoliosis surgery? That’s when both you and your specialist know that you’ve done all you can via conservative solutions. Every curvature is different. Every patient is different. There’s no simple answer.
Spine Care NYC is committed to tailored solutions for patients with spinal dysfunction. Contact us.