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Scoliosis is a condition that causes an atypical curvature of the spine. It’s usually diagnosed during childhood or the teen years, and it can cause back pain, balance or posture issues, and breathing difficulties.

Surgery for scoliosis isn’t always necessary right away because different levels of the condition exist.

This article will give you more information about when scoliosis is considered severe enough to require surgery, how that surgical procedure is performed, and what you might expect during recovery.

Whether or not to treat scoliosis with surgery is a decision best made by you and your doctor.

Generally, healthcare professionals do not consider surgery for scoliosis until a person’s pain or disability becomes severe. That’s often determined by spine curvature of 40 degrees or more.

Even if the curve of your spine has not reached that level, your doctor may decide you need surgery if you have other related concerns. Those concerns might include breathing difficulty or if your scoliosis appears to be progressing rapidly.

Scoliosis 101

Scoliosis is defined as an atypical curvature of the spine. The condition is split into 3 categories based on the underlying cause.

  • Congenital scoliosis: This type develops in a baby during pregnancy and may be noticeable at an earlier age than other forms of scoliosis.
  • Neuromuscular scoliosis: This is often the result of another neurological or muscular disease like cerebral palsy or muscular dystrophy. This form of scoliosis usually progresses more quickly than other types.
  • Idiopathic scoliosis: This type develops from an unknown cause and is the most common form of the disease diagnosed in the teen years. This type of scoliosis makes up about 80% of all cases.

Back pain is the most common symptom that signals scoliosis, but you may also notice things like uneven alignment of the shoulders or hips. Using a back brace to improve alignment is one option for treatment, but spinal fusion surgery is seen as the gold standard for treatment.

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Spinal fusion is the most common method for surgically correcting scoliosis. The goal of this surgery is to realign the curved areas of the spine, fusing metal rods or pieces of bone together to form a new, straighter, solid section of spine.

A surgeon will perform the surgery while you are under general anesthesia. It involves incisions that expose the spine, which allow the surgeon to insert various implants into the body.

Impacts may include:

Newer forms of scoliosis surgery

Some newer surgical options don’t require fusion. Instead, they use other techniques to straighten the spine and prevent new curvature.

These options include:

  • Vertebral spinal tethering (VBT) surgery: In this procedure, a surgeon attaches metal anchors to the vertebrae on the side of the spine that curves outward. These anchors attach to a flexible tether to gradually straighten the back. Over time, the goal is for the tether to pull the spine back into the correct position. This technique is often less invasive and allows for quicker recovery than spinal fusion. This option is also sometimes preferred for younger people who have not yet reached their full height, as it allows room for future growth.
  • ApiFix and internal brace technique: This treatment uses an internal bracing system secured to the spine with two screws at the top of the device and a single screw at the bottom. ApiFix has a faster recovery time than the other two methods, and your healthcare professional can adjust the bracing system for further correction over time.

Although alternative surgeries may offer more choices when it comes to accommodating growth for children or teens who have surgery for scoliosis, more complications can arise with these procedures than with a single spinal fusion.

Any type of surgery carries a certain amount of risk, especially when general anesthesia is used during the procedure. Invasive surgeries like spinal fusion can also carry a risk of infection or bleeding.

Some complications and risks specific to scoliosis surgery can include things like:

  • neurological or nerve damage
  • muscle or dural tears
  • vision loss
  • positioning issues
  • blood clots
  • implant malfunctions or problems
  • breathing or respiratory concerns
  • digestive or gastrointestinal symptoms

Overall, many experts in the field note that scoliosis surgery — and specifically spinal fusion — has proven highly effective and safe.

Even back in 2009, this University of Washington Orthopaedics and Sports Medicine Department report stated that “the success rate of stable fusion and correction of spinal deformity is very high in experienced hands. The average curve correction is approximately 70% and the likelihood of complications has been about 2% to 3% overall.”

That success rate has improved with advances in techniques and medical care, according to research from 2012.

For children born with congenital spine differences like scoliosis, surgery can happen as early as 18 months. The decision of when to do surgery will depend on things like:

  • the degree of scoliosis
  • what other complications are developing
  • how fast the curvature is increasing

Different hardware may be used depending on where the child falls in terms of growth and development.

The cost of spinal surgery will depend on where you live, what kind of health insurance coverage you have, and what other conditions or complications may be involved in your recovery.

As with many other healthcare costs, the price tag has skyrocketed over the past 25 years for spinal surgery to correct adolescent idiopathic scoliosis. In 2012, that cost was roughly $177,000, up from about $55,000 in 1997, according to research published in 2017.

Measures taken to prevent complications and speed up your discharge from the hospital could lead to cost savings of up to 21%, the same researchers suggest.

Costs and coverage for scoliosis surgery

Your individual costs and coverage for surgery to correct scoliosis will depend on your health insurance plan and why you are having the surgery. Insurance companies may not cover surgery to correct a minor scoliosis concern to the same extent they would cover surgery for a more severe curvature.

Coverage can also depend on why your healthcare professional says you need the surgery. This reason is designated with medical classification codes called ICD-10 codes.

Some examples of codes that may be used for spinal fusion and other surgeries to treat scoliosis include:

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Bracing is the common nonsurgical treatment for scoliosis. Braces usually work for several months or longer and can be made of hard or soft materials.

Generally, people who are candidates for brace therapy are those who have:

  • a curvature between 20 degrees and 40 degrees
  • a small but progressive curve
  • a larger curve but a lot of spinal growth left to do

In most cases, you can see the effects of spinal fusion surgery immediately after surgery. The same is true for other surgical methods, although tethering devices can take additional time to produce the full effect.

Despite the outward appearance that a curvature is “fixed” after spinal fusion surgery, it can actually take 1 to 2 years following surgery before the implants and bones of the spines completely fuse together.

Spinal fusion surgery itself can take around 4 to 6 hours and requires a hospital stay of 3 to 4 days. Although complications are possible and healing takes time, people who have spinal fusion surgery generally have an improved quality of life after the procedure.

Spinal fusion surgery is the primary surgical treatment for most people with severe scoliosis. Some other methods can accommodate future growth easier, but these options can carry the risk of additional complications.

Nonsurgical options are available but usually for less severe cases of scoliosis.

If you or your child have been diagnosed with scoliosis, talk with your healthcare professional about the best way to track the degree of spine curvature and progression of the condition. Surgery is usually recommended only for more severe curvature, like curves measuring 40 degrees or more.