Scoliosis: Should I (or my child) have surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Scoliosis: Should I (or my child) have surgery?

Get the facts

Your options

  • Have surgery to treat scoliosis.
  • Don't have surgery. Have regular checkups to see if the curve is getting worse. Children may wear a brace to keep the curve from getting worse.

Key points to remember

  • Surgery for scoliosis is only done to fix severe spinal curves. Most spinal curves are not bad enough to need surgery.
  • If the spinal curve is less than 25 degrees, have checkups every 4 to 6 months to see whether the curve is getting worse. Treatment is not needed.
  • If your child's spinal curve is between 25 and 40 degrees, your child may need treatment with a brace. Some doctors may use brace treatment for curves up to 45 degrees. Bracing usually keeps a spinal curve from getting worse, but it cannot correct a curve. A child may wear a brace until he or she stops growing. Bracing will not help an adult's spinal curve.
  • If your child's spinal curve is greater than 40 degrees or yours is greater than 50 degrees, and if the curve is likely to get worse, you may want to choose surgery.
FAQs

What is scoliosis?

Scoliosis is an abnormal curve in the spine. The spine curves from side to side rather than being straight. It curves more than 10 degrees and is usually S-shaped or C-shaped. The spine also may be twisted.

This problem occurs most often in girls ages 10 to 16. In general, about 1 out of 100 people have some type of spinal curve.1

What kind of surgery can fix a spinal curve?

The main type of surgery is a spinal fusion. The curved part of the backbone is straightened with rods, wires, hooks, or screws. Then small pieces of bone are put over the spine. These pieces of bone will grow together, or fuse, with the spine, holding it in the proper position.

Instrumentation without fusion is another type of surgery to straighten the spine. The doctor attaches metal rods to the spine without fusing the bones together. This is only done in small children. It's used when doctors don't want to fuse bones together because it would stop growth in that area of the spine. The child usually has to wear a brace full-time after having this surgery.

How can surgery help?

Surgery usually can improve the curve and keep it from getting worse. Surgery may also help decrease pain and allow you to do more of your daily activities.

Each person's scoliosis is different. Talk to your doctor about whether surgery can help you.

What are the risks of surgery?

Risks of surgery to fix a spinal curve include:

  • Problems that can happen with back surgery, such as nerve damage, lung problems, or spinal cord damage.
  • No more growth in the fused area of a child's spine. This could mean that a child may be slightly less tall than he or she would be without fusion.
  • Problems that can happen in any surgery, such as blood clots or infection or problems from anesthesia. The risk of these problems is higher in older adults than in younger people.

Talk to your doctor about your or your child's chances of having problems from surgery.

Other problems include lost time at work or school for recovery and the possible need to wear a body cast or brace for a few months after surgery.

What are the risks of not having surgery?

A severe spinal curve that is getting worse and is not fixed with surgery is likely to get worse.

As the spinal curve gets worse, the bones of the spine turn toward the inner part of the curve. If the curve is in the upper part of the spine, the ribs may crowd together on one side of the body and become widely separated on the other side. The curve may force the space between the spinal bones to narrow. The spinal bones may also become thicker on the outer edge of the curve.

In severe curves, the ribs that are pulled out of position may reduce the amount of air the lungs can hold. They also may cause the heart to work harder to pump blood through the compressed lung tissue. Over time, this may lead to heart failure.

Scoliosis that is present at birth or that occurs in infants may be worse over time than a spine that curves later in life. If an infant or young child with a severe spinal curve does not have surgery, it is likely that the curve will get worse. This is because the curve gets worse as the child grows.

Why might your doctor recommend surgery to fix scoliosis?

Your doctor might suggest surgery for you or your child if:

  • Your child's spinal curve is greater than 40 degrees (some doctors may brace curves up to 45 degrees in children) or yours is greater than 50 degrees, and the curve is getting worse.
  • You have pain or trouble doing your daily activities.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery Have surgery
  • You or your child will likely stay in the hospital for several days after surgery.
  • You or your child will have to spend a few weeks at home. Your child can go back to school in 3 or 4 weeks.
  • For 6 to 12 months, you or your child can't do anything that could jar the spine—such as roller skating or skiing.
  • You or your child may need to wear a body cast or brace for a few months after surgery.
  • Surgery usually can improve the curve and keep it from getting worse.
  • It may decrease your pain and allow you to do your daily activities.
  • It can prevent breathing and heart problems from the curved spine.
  • Any surgery can cause problems such as bleeding, blood clots, and infection. Anesthesia also can cause problems.
  • Back surgery has a risk of nerve damage, lung problems, or spinal cord damage.
  • In a child, spinal fusion will stop growth in the area of the spine that is fused. This could mean that a child may be slightly less tall than he or she would be without fusion.
Don't have surgery Don't have surgery
  • You or your child gets checkups every 4 to 6 months to see if the curve is getting worse.
  • You can take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
  • Children may wear a brace to keep the curve from getting worse.
  • Exercises may help back pain.
  • Exercise and over-the-counter medicines may ease your pain.
  • You or your child won't have the risks of back surgery.
  • You or your child won't have to take several weeks off from work or school.
  • Wearing a brace may keep your child's spinal curve from getting worse.
  • The spinal curve could get worse.
  • If the curve gets bad enough, it could affect your breathing and heart.
  • You could have pain and trouble doing your daily activities.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about surgery for scoliosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My daughter was diagnosed with a 25-degree spinal curve when she was 16 years old. Tests showed that she was almost done growing and her doctor said it was likely that the curve would not get worse. We were relieved because we didn't want her to have surgery, but of course we didn't want her to have problems with her back as she got older.

Linda, age 40

When my daughter was in the sixth grade, I noticed that her clothes seemed to hang unevenly. We looked at her back and saw that her shoulders were not even. Her doctor examined her and took X-rays of her spine. To our shock and surprise, she had a 45-degree spinal curve. Because of her age, the fact that she was just starting her teenage growth spurt, and the size of her spinal curve, it was likely that her spinal curve would get worse. We decided that surgery would provide the best chance for stopping the curve from growing and for stabilizing her spine.

Marta, age 42

I have lived with scoliosis for most of my life. The curve in my back has not gotten any worse in the past 25 years, so I guess it won't now. My mother had scoliosis and had a lot of problems with it. So my doctor just keeps an eye out for any changes.

Henri, age 44

I was diagnosed with scoliosis when I was 22 years old. I was lucky enough not to have any problems until recently. But my spinal curve has gotten worse, and now, at 28 years old, my doctor said it is likely that my curve will get so bad that it will eventually affect my breathing. I decided to go ahead and have surgery so that I won't have problems as I get older.

Sarah, age 28

If you need more information, see the topic Scoliosis.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for scoliosis

Reasons not to have surgery for scoliosis

I want to get rid of my back pain.

Exercise and over-the-counter medicine work well to control my pain.

More important
Equally important
More important

It bothers me that my curved spine keeps me from doing a lot of the activities I like.

I'm still able to do the things I like to do.

More important
Equally important
More important

I worry that my child's spine will get worse as he or she grows.

I would rather wait and see whether my child's spine gets worse as he or she grows.

More important
Equally important
More important

I or my child can take a lot of time off from work or school to recover from the surgery.

I or my child can't take a lot of time off right now to recover from the surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

If you have any degree of spinal curve, should you get surgery?

  • Yes Sorry, that's not right. Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
  • No You're right. Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
  • I'm not sure It may help to go back and read "Key points to remember." Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.
2.

Can a brace help keep a spinal curve from getting worse in children and adults?

  • Yes Sorry, that's wrong. A brace can keep a spinal curve from getting worse only in children. It does not help adults.
  • No That's right. A brace can keep a spinal curve from getting worse only in children. It does not help adults.
  • I'm not sure It may help to go back and read "Key points to remember." A brace can keep a spinal curve from getting worse only in children. It does not help adults.
3.

Should you consider surgery if your child's spinal curve is more than 45 degrees?

  • Yes That's right. Doctors usually recommend surgery if a child's spinal curve is more than 45 degrees or an adult's is more than 50 degrees and the curve is getting worse.
  • No Sorry, that's not right. Doctors usually recommend surgery if a child's spinal curve is more than 45 degrees or an adult's is more than 50 degrees and the curve is getting worse.
  • I'm not sure It may help to go back and read "Key points to remember." Doctors usually recommend surgery if a child's spinal curve is more than 45 degrees or an adult's is more than 50 degrees and the curve is getting worse.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Thomas S. Renshaw, MD - Orthopedics

References
Citations
  1. Hu SS, et al. (2006). Scoliosis section of Disorders, diseases and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., chap. 5, pp. 255–269. New York: Lange Medical/McGraw-Hill.

Scoliosis: Should I (or my child) have surgery?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have surgery to treat scoliosis.
  • Don't have surgery. Have regular checkups to see if the curve is getting worse. Children may wear a brace to keep the curve from getting worse.

Key points to remember

  • Surgery for scoliosis is only done to fix severe spinal curves. Most spinal curves are not bad enough to need surgery.
  • If the spinal curve is less than 25 degrees, have checkups every 4 to 6 months to see whether the curve is getting worse. Treatment is not needed.
  • If your child's spinal curve is between 25 and 40 degrees, your child may need treatment with a brace. Some doctors may use brace treatment for curves up to 45 degrees. Bracing usually keeps a spinal curve from getting worse, but it cannot correct a curve. A child may wear a brace until he or she stops growing. Bracing will not help an adult's spinal curve.
  • If your child's spinal curve is greater than 40 degrees or yours is greater than 50 degrees, and if the curve is likely to get worse, you may want to choose surgery.
FAQs

What is scoliosis?

Scoliosis is an abnormal curve in the spine . The spine curves from side to side rather than being straight. It curves more than 10 degrees and is usually S-shaped or C-shaped. The spine also may be twisted.

This problem occurs most often in girls ages 10 to 16. In general, about 1 out of 100 people have some type of spinal curve.1

What kind of surgery can fix a spinal curve?

The main type of surgery is a spinal fusion. The curved part of the backbone is straightened with rods, wires, hooks, or screws. Then small pieces of bone are put over the spine. These pieces of bone will grow together, or fuse, with the spine, holding it in the proper position.

Instrumentation without fusion is another type of surgery to straighten the spine. The doctor attaches metal rods to the spine without fusing the bones together. This is only done in small children. It's used when doctors don't want to fuse bones together because it would stop growth in that area of the spine. The child usually has to wear a brace full-time after having this surgery.

How can surgery help?

Surgery usually can improve the curve and keep it from getting worse. Surgery may also help decrease pain and allow you to do more of your daily activities.

Each person's scoliosis is different. Talk to your doctor about whether surgery can help you.

What are the risks of surgery?

Risks of surgery to fix a spinal curve include:

  • Problems that can happen with back surgery, such as nerve damage, lung problems, or spinal cord damage.
  • No more growth in the fused area of a child's spine. This could mean that a child may be slightly less tall than he or she would be without fusion.
  • Problems that can happen in any surgery, such as blood clots or infection or problems from anesthesia. The risk of these problems is higher in older adults than in younger people.

Talk to your doctor about your or your child's chances of having problems from surgery.

Other problems include lost time at work or school for recovery and the possible need to wear a body cast or brace for a few months after surgery.

What are the risks of not having surgery?

A severe spinal curve that is getting worse and is not fixed with surgery is likely to get worse.

As the spinal curve gets worse, the bones of the spine turn toward the inner part of the curve. If the curve is in the upper part of the spine, the ribs may crowd together on one side of the body and become widely separated on the other side. The curve may force the space between the spinal bones to narrow. The spinal bones may also become thicker on the outer edge of the curve.

In severe curves, the ribs that are pulled out of position may reduce the amount of air the lungs can hold. They also may cause the heart to work harder to pump blood through the compressed lung tissue. Over time, this may lead to heart failure.

Scoliosis that is present at birth or that occurs in infants may be worse over time than a spine that curves later in life. If an infant or young child with a severe spinal curve does not have surgery, it is likely that the curve will get worse. This is because the curve gets worse as the child grows.

Why might your doctor recommend surgery to fix scoliosis?

Your doctor might suggest surgery for you or your child if:

  • Your child's spinal curve is greater than 40 degrees (some doctors may brace curves up to 45 degrees in children) or yours is greater than 50 degrees, and the curve is getting worse.
  • You have pain or trouble doing your daily activities.

2. Compare your options

  Have surgery Don't have surgery
What is usually involved?
  • You or your child will likely stay in the hospital for several days after surgery.
  • You or your child will have to spend a few weeks at home. Your child can go back to school in 3 or 4 weeks.
  • For 6 to 12 months, you or your child can't do anything that could jar the spine—such as roller skating or skiing.
  • You or your child may need to wear a body cast or brace for a few months after surgery.
  • You or your child gets checkups every 4 to 6 months to see if the curve is getting worse.
  • You can take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
  • Children may wear a brace to keep the curve from getting worse.
  • Exercises may help back pain.
What are the benefits?
  • Surgery usually can improve the curve and keep it from getting worse.
  • It may decrease your pain and allow you to do your daily activities.
  • It can prevent breathing and heart problems from the curved spine.
  • Exercise and over-the-counter medicines may ease your pain.
  • You or your child won't have the risks of back surgery.
  • You or your child won't have to take several weeks off from work or school.
  • Wearing a brace may keep your child's spinal curve from getting worse.
What are the risks and side effects?
  • Any surgery can cause problems such as bleeding, blood clots, and infection. Anesthesia also can cause problems.
  • Back surgery has a risk of nerve damage, lung problems, or spinal cord damage.
  • In a child, spinal fusion will stop growth in the area of the spine that is fused. This could mean that a child may be slightly less tall than he or she would be without fusion.
  • The spinal curve could get worse.
  • If the curve gets bad enough, it could affect your breathing and heart.
  • You could have pain and trouble doing your daily activities.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Scoliosis.

Personal stories about surgery for scoliosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My daughter was diagnosed with a 25-degree spinal curve when she was 16 years old. Tests showed that she was almost done growing and her doctor said it was likely that the curve would not get worse. We were relieved because we didn't want her to have surgery, but of course we didn't want her to have problems with her back as she got older."

— Linda, age 40

"When my daughter was in the sixth grade, I noticed that her clothes seemed to hang unevenly. We looked at her back and saw that her shoulders were not even. Her doctor examined her and took X-rays of her spine. To our shock and surprise, she had a 45-degree spinal curve. Because of her age, the fact that she was just starting her teenage growth spurt, and the size of her spinal curve, it was likely that her spinal curve would get worse. We decided that surgery would provide the best chance for stopping the curve from growing and for stabilizing her spine."

— Marta, age 42

"I have lived with scoliosis for most of my life. The curve in my back has not gotten any worse in the past 25 years, so I guess it won't now. My mother had scoliosis and had a lot of problems with it. So my doctor just keeps an eye out for any changes."

— Henri, age 44

"I was diagnosed with scoliosis when I was 22 years old. I was lucky enough not to have any problems until recently. But my spinal curve has gotten worse, and now, at 28 years old, my doctor said it is likely that my curve will get so bad that it will eventually affect my breathing. I decided to go ahead and have surgery so that I won't have problems as I get older."

— Sarah, age 28

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for scoliosis

Reasons not to have surgery for scoliosis

I want to get rid of my back pain.

Exercise and over-the-counter medicine work well to control my pain.

More important
Equally important
More important

It bothers me that my curved spine keeps me from doing a lot of the activities I like.

I'm still able to do the things I like to do.

More important
Equally important
More important

I worry that my child's spine will get worse as he or she grows.

I would rather wait and see whether my child's spine gets worse as he or she grows.

More important
Equally important
More important

I or my child can take a lot of time off from work or school to recover from the surgery.

I or my child can't take a lot of time off right now to recover from the surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. If you have any degree of spinal curve, should you get surgery?

  • Yes
  • No
  • I'm not sure
You're right. Surgery is recommended only for severe spinal curve. Most spinal curves are not bad enough to need surgery.

2. Can a brace help keep a spinal curve from getting worse in children and adults?

  • Yes
  • No
  • I'm not sure
That's right. A brace can keep a spinal curve from getting worse only in children. It does not help adults.

3. Should you consider surgery if your child's spinal curve is more than 45 degrees?

  • Yes
  • No
  • I'm not sure
That's right. Doctors usually recommend surgery if a child's spinal curve is more than 45 degrees or an adult's is more than 50 degrees and the curve is getting worse.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Thomas S. Renshaw, MD - Orthopedics

References
Citations
  1. Hu SS, et al. (2006). Scoliosis section of Disorders, diseases and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., chap. 5, pp. 255–269. New York: Lange Medical/McGraw-Hill.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: August 27, 2009

Author: Shannon Erstad, MBA/MPH

Medical Review: Michael J. Sexton, MD - Pediatrics & Thomas S. Renshaw, MD - Orthopedics

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