Different scoliosis treatment approaches carry different outcomes. When it comes to scoliosis, people can choose between a surgical or non-surgical approach. While every patient and their condition will respond differently, there are some serious potential scoliosis surgery side effects, both in the short and long term, that people need to be aware of.
Scoliosis surgery involves fusing the most-tilted vertebrae of the spine into one solid bone to prevent further progression, not to correct the abnormal spinal curvature. Scoliosis surgery side effects can include pain, a loss of flexibility, decreased range of motion, psychological effects, and more.
The process of spinal fusion is costly, invasive, and risky. Before we move on to the path of treatment that leads to scoliosis surgery, as well as some of the potential short- and long-term side effects, let’s discuss important condition characteristics that help shape treatment plans.
Understanding Scoliosis
When a person develops scoliosis, this means they have an abnormal spinal curvature. While the spine has natural and healthy curvatures that give it added strength and flexibility, those curvatures can be replaced by unhealthy curves.
If an abnormal spinal curvature develops and is diagnosed as scoliosis, this means the curvature is of a certain degree and includes rotation.
Part of the diagnostic and assessment process involves a scoliosis X-ray, and the results of the X-ray, coupled with my physical-exam findings, tells me everything I need to know about a patient’s condition to design an effective and customized treatment plan.
The most important piece of information gained from an X-ray is the patient’s Cobb angle. Cobb angle is a measurement taken from the tops and bottoms of the curvature’s most-tilted vertebrae (bones of the spine). The intersecting lines form an angle that’s measured in degrees. Cobb angle is important not only because it tells us just how far out of alignment a scoliotic spine is, but also because it allows us to classify the condition on its severity scale
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
Generally speaking, the higher the Cobb angle, the more likely it is that the condition will produce noticeable symptoms such as postural changes and pain, although pain is far more commonly a part of the adult experience of scoliosis.
Progression
Another key feature of scoliosis that’s important for patients, and their families, to understand is ‘progression’. Scoliosis is a progressive spinal condition, meaning it’s in its nature to get worse over time, especially if left untreated.
Age is another important condition characteristic. As mentioned, pain is a common part of the adult experience of living with scoliosis, but is rarely a feature of scoliosis in children and adolescents; this is determined by skeletal maturity.
In adults who are no longer growing, their spines have settled due to maturity and gravity, making them vulnerable to the compression caused by the abnormal curvature. This compressive force can be felt by the entire spine and its surrounding muscles, vessels, and nerves.
Compression causes pressure and pain, but in children and adolescents who are still growing, the lengthening motion of the spine counteracts the compression, which is why scoliosis is not commonly painful in younger individuals.
Age is also important because it’s a key progression-related variable. Now, in terms of condition prevalence, the most common age of diagnosis is between 10 and 18, as adolescent idiopathic scoliosis; this form accounts for 80 percent of known diagnosed cases. The other 20 percent consist of different forms with known causes such as neuromuscular, congenital, degenerative, and traumatic.
As scoliosis is progressive, a huge component of treatment, and a determining factor in its efficacy, is how it addresses the key element of progression.
While there is no definitive means by which we can 100-percent predict a patient’s rate of progression, we do know that growth is its number-one trigger. In adults, progression still occurs, but tends to be at a slower rate, at least until degenerative effects of aging come into play.
Adolescents entering into the stage of puberty have rapid and unpredictable growth spurts ahead of them, making them high risk for rapid-phase progression.
The reason I’ve spent so much time discussing key condition characteristics is because they shed light on the treatment process in terms of its end goal. As mentioned earlier, different treatment approaches have different outcomes. This is largely because every form of treatment has an end goal that becomes the guiding force of how that treatment plan is designed and implemented.
With scoliosis surgery, the end goal is not correction, as it is in my functional chiropractic-centered approach; the end goal and driving force behind the traditional approach to scoliosis treatment is slowing/stopping progression.
Traditional Scoliosis Treatment Approach
When a person recently diagnosed with scoliosis faces the choice of which treatment approach to commit to, this is a crucial fork in the road of their scoliosis journey. There are two main approaches for patients to choose between: surgical and nonsurgical.
While the traditional approach has been in place for almost as long as the condition itself, this doesn’t mean it shouldn’t be questioned or improved upon. What we have learned about scoliosis over the years is that just as there is more than one treatment option, there are multiple treatment outcomes.
As mentioned, controlling progression is the driving force behind the traditional scoliosis treatment approach and scoliosis surgery. That’s not to say that managing progression isn’t an equally-important component of the approach I offer here at the Scoliosis Reduction Center®, but it’s managed differently as my approach is characterized by a different end goal: correction and function.
Before we talk more about the different outcomes offered through surgical and nonsurgical approaches to treatment, let’s make sure there is a clear understanding of what the actual procedure of scoliosis surgery entails.
Spinal-Fusion Surgery
The process of spinal-fusion surgery is lengthy and invasive, as are many surgical procedures, and as even the simplest of surgeries comes with risks, spinal fusion is no exception. Spinal fusion has the potential to cause serious side effects both in the short and long term.
For those scoliosis patients on the traditional path of treatment, the first step, often while the condition is still mild, is to watch and wait to observe if a patient’s scoliosis is going to progress; the issue I have with watching and waiting during this stage is that it’s wasting valuable treatment time.
In addition, as scoliosis is progressive, we already know that virtually every case will progress at some point, and it’s far easier, and less complex, to treat a smaller curvature while it is still small, has not yet progressed in severity, and the body has not yet had time to adjust to its presence.
Once watching and waiting has revealed progression, other than surgery, the active form of treatment offered by the traditional approach is bracing. While bracing most certainly has a place in scoliosis treatment, the traditional braces used have not evolved to account for what we have learned about the condition over the years.
In addition, the Boston and Milwaukee brace most commonly used in this approach, again, don’t have a correction as their end goal, and this is reflected in their design. The goal of traditional scoliosis bracing is to slow/stop progression, not to actually correct the abnormal curvature by addressing its underlying structural nature.
While there are different types of surgery, scoliosis surgery typically involves fusing the most-tilted vertebrae of the curvature together into one solid bone, and hardware is attached to the spine (rods and screws) to hold the spine in place while it continues to fuse and heal for months following the surgery.
Depending on the section of the spine that’s fused, the procedure can also include the removal of the section’s intervertebral discs. The intervertebral discs play important roles in facilitating the spine’s flexibility, strength, structure, and maintaining its healthy curvatures.
As the separate vertebrae are fused together, this eliminates movement in that section of the spine, which is how the progression of the curvature is addressed: by fusing the spine and supporting it with hardware to hold that position.
So the curvature has not actually been corrected, but is rather being ‘held’ in a corrective position, and those are two very different things, each offering patients a very different outcome in terms of the spine’s function and quality of life moving forward.
Scoliosis Surgery Side Effects
With any type of surgery, there are going to be potential risks and side effects. Short-term side effects generally refer to those that are directly related to the surgery/recovery and are temporary; long-term side effects include those that can develop over time and tend to be more permanent in nature.
While every patient and their spine is going to respond to surgery differently, with some developing complications during or after surgery, and others not, there are some side effects that are more common than others.
When considering the risks and rewards of any surgical procedure, both the short- and long-term effects should be explored and taken into account. This is particularly the case with long-term effects as these tend to have the biggest impact on quality of life moving forward, while short-term effects are more temporary.
Short-Term Effects of Scoliosis Surgery
The short-term effects of scoliosis surgery mainly include those related to the surgery itself. Obviously, there is going to be a recovery period, during which time activity is limited and healing continues.
Every case is different, but generally, the recovery period, during which time activity restrictions are in place, can range from 3 to 6 months, with post-surgical recovery time spent in hospital ranging from days to weeks. This recovery time involves being monitored, especially for signs of infection, pain management, and learning how to move without straining the fusion site.
As there are risks associated with any surgical procedure, many of the short-term effects associated with spinal fusion involve what happens during the actual procedure and how they are addressed.
While every patient will respond to surgery differently, the procedure itself does come with some risks and potential short-term side effects:
- Excessive blood loss
- Nerve damage
- Infection
- Pain at the site of fusion
While a small amount of blood loss is expected during spinal fusion, excessive blood loss is always a possibility; when this happens, there is an increased likelihood that bleeding will continue after the surgery. This can impact the recovery period if a blood transfusion is needed; in some cases, related blood loss is managed through medications that are known to control bleeding.
Surgery can also cause an infection, which is most commonly treated before it spreads throughout the body, but it is another risk to consider. Infection can also fall into the ‘long-term effects’ category in the form of delayed infection that can appear years after surgery.
Pain at the site of fusion is a common complaint, and while this can be temporary and ease throughout the recovery period, fusion-site pain can also fall into the ‘long-term side effects’ category. Factors such as fusion site location and the number of vertebrae involved play large roles in post-surgical pain levels.
As we know that the spine works in tandem with the brain to form the body’s central nervous system, we also know that the condition, and certain forms of treatment, can result in nerve damage.
Nerve damage that occurs as a direct result of the procedure can be painful, and depending on the extent of the damage, can be temporary, or permanent.
In terms of straightening a crooked spine and returning it to a healthy alignment, in the short term, the procedure can seem successful, but the way that result is achieved can lead to some long-term side effects that can greatly impact a person’s quality of life.
Long-Term Effects of Scoliosis Surgery
It’s the potential long-term effects of scoliosis surgery that concern me the most.
We have to keep in mind who the bulk of scoliosis patients are: adolescents. Remember, adolescent idiopathic scoliosis accounts for 80 percent of diagnosed cases, and when you’re talking about adolescents, they still have growth to go through after surgery. Spinal fusion can’t guarantee it will permanently stop progression: only time will determine that.
In addition, there is a large gap in the research on long-term side effects of spinal fusion because we just don’t know what they are. Most post-surgical spinal fusion follow-ups take place at the two- and five-year mark, but what happens 10, 20, and 30 years down the road?
Let’s think about the hardware used. If spinal fusion is performed on an adolescent, that patient likely has many years of life ahead of them, but what’s the lifespan of the hardware that’s used to hold their spine in place? The answer is we simply don’t know, but what does seem clear to me is that the younger the patient, the longer the hardware has to last, and the more likely it is that its expiration-point will be reached.
Hardware failure is an important potential long-term effect of scoliosis surgery to be considered. Screws can come loose and puncture the spine, and rods can become weaker over time and break. People can also have adverse reactions to the metal used.
When there are hardware-related complications that develop over time, the only recourse is more surgery, which means facing those risks all over again, and surgical risk factors tend to increase as patients get older.
Pain and flexibility loss are among the most commonly reported long-term side effects of scoliosis surgery, and these can greatly affect a person’s ability to live their best life.
Pain and Flexibility
Patients commonly report that their scoliosis-related pain increases post surgery. This is partially due to the fusion site being immovable, which also impacts vertebrae adjacent to the fusion site, as well as muscles surrounding the spine that can become strained and tight.
Surgery-related pain also tends to be more intense in patients who are thin as there is added pressure on parts of the spine.
As a result of the spine being ‘held’ in position, it’s not only less flexible, but also weaker and more prone to injury. Remember, it’s the spine’s natural curvatures that help give it strength, flexibility, and allow mechanical stress that’s incurred during movement and impact to be evenly distributed throughout.
When those natural curves are lost and the spine is unnaturally held in place, the spine’s motion-driven design is compromised, as well as its function and biomechanics.
When spinal fusion has been performed, the spine’s mobility is permanently altered; the related range-of-motion loss can vary from mild to severe, but patients should expect some level of flexibility loss.
Psychological Effects of Scoliosis Surgery
In addition to the potential physical side effects of scoliosis surgery, there are also the emotional and psychological effects to consider.
People with fused spines are often anxious about what their spines can handle. Some patients report feelings of fear when trying new things, and others report that that fear keeps them from trying new things and even participating in activities they enjoyed prior to surgery.
Patients who have had spinal fusion are more likely to sustain spinal trauma in an accident or fall because their spines are not as functional and able to distribute mechanical stress; this knowledge can impact a person’s mental health and comfort level with their own body.
In addition, one of the main reasons that many people choose spinal fusion is cosmetic, but spinal fusion doesn’t always fully return a person’s body to the way it looked prior to developing the condition, and this can disappoint people expecting different results.
In addition, there is also the monetary cost of the surgery that can leave people feeling the effects of financial stress for years to come. While the cost of scoliosis surgery is highly variable based on the type of surgery, patient response, whether or not there are complications, length of hospital stay, etc, the average cost ranges between $140,000 and $175,000.
So to summarize, following are some of the most common potential long-term side effects of scoliosis surgery:
- Nerve damage
- Back pain
- Loss of flexibility
- Limited range of motion
- Hardware malfunction
- Adverse reaction to hardware
- Loss of strength in the spine
- Strained muscles surrounding the spine
- A spine that’s more prone to injury
- Emotional Stress of living with a fused spine
- Financial strain due to surgery cost
It is important to note that not everyone will develop these short- and/or long-term side effects, but the risk is there, and it should be considered carefully. In addition, as progression can still occur after surgery and the loss of spinal flexibility can be significant, this can impact a person’s overall quality of life.
Here at the Center, my approach is functional, meaning I prioritize the spine’s health and function over curvature size. If I can reduce a patient’s curvature through a more natural and less-invasive means, the spine’s function and health are preserved; whereas a larger curvature reduction achieved through surgery can come at the cost of spinal flexibility, comfort, and quality of life.
Does Scoliosis Always Require Surgery?
With two main scoliosis treatment approaches for patients to choose between, it’s important that patients, and their families, are aware of all treatment options available to them, and how they can affect the spine differently.
The reality is that many cases of scoliosis don’t require surgery, particularly those that have been diagnosed and treated early; remember, as progressive condition, scoliosis is virtually guaranteed to get worse over time.
The key to being proactive with treatment is starting it as close to the time of diagnosis as possible, but for those on the path of traditional treatment, this isn’t what happens; traditional treatment doesn’t have a strategy for addressing scoliosis while mild so commonly recommends solely watching and waiting for signs of progression.
The problem with watching and waiting is that in the meantime, an adolescent patient, in the stage of puberty, can have a huge growth spurt, and growth is what triggers scoliosis to progress.
The more a scoliosis is left to progress, the more it will continue to do so, and progression makes scoliosis more complex to treat, so the benefits of early detection are only available to those who commit to a non-surgical treatment approach.
Many Cases of Scoliosis Don’t Require Surgery
When people are diagnosed with scoliosis, they often assume that invasive and costly spinal surgery is in their future, but that doesn’t always have to be the case.
Oftentimes, patients are funneled towards spinal fusion surgery because it’s the common path of treatment and was the only choice for many years, but we’ve since learned enough about the condition, and treatment efficacy, to know that it also responds to non-surgical conservative scoliosis treatment.
There are never treatment guarantees, but here at the Center, I start treatment as close to the time of diagnosis as possible because this is when the scoliosis is going to be at its mildest and more responsive.
As progression occurs, the spine gets increasingly rigid, and the condition’s uneven forces increase, as do their effects, and non-surgical treatment works by impacting the condition on a structural level so preventing progression can be worked towards.
When the condition’s underlying structural nature is addressed through chiropractic care, this means the size of the unnatural scoliotic curve is reduced, along with the condition’s uneven forces, and their effects.
The main effect of scoliosis in children is postural deviation, and in adults, it’s pain.
As scoliosis surgery involves fusing the curve’s most-tilted vertebrae into one solid bone so they can’t become increasingly tilted over time (progress) and attaching rods to the spine with screws, this is contrary to the spine’s movement-based design.
Many patients experience a noticeable loss in spinal flexibility and range of motion, but this will largely depend on condition severity, location of the fusion, and the number of vertebrae fused.
So does scoliosis always require surgery? No, it does not, and for those whose scoliosis is diagnosed early, if a conservative proactive treatment approach is committed to, there are fewer limits to what can be achieved.
Conclusion
While I respect and support every patient’s right to choose their own treatment approach, I do encourage all patients, and their families, to do their due diligence in exploring all options available to them.
As different treatments offer different outcomes, that choice can have far-reaching consequences, and of course, once a spine is fused, there is no unfusing it; if surgery is unsuccessful or a complication arises, there is no recourse other than subsequent surgeries.
Potential short-term side effects are more closely related to the surgery/recovery and include blood loss, infection, nerve damage, and pain.
Potential long-term side effects can include nerve damage, increased pain levels, loss of spinal flexibility, mobility limitations, more surgery due to hardware failure/lifespan, a weaker spine that’s more prone to injury, strained back muscles, the emotional stress of living with a fused spine, and financial strain: all of which can greatly impact a person’s ability to live a full and active life.
So in terms of straightening a scoliotic spine, screws and rods that hold it in place can achieve that, but it can come at a high price. A spine that’s merely ‘held’ in a corrective position through surgery is very different from a functional and chiropractic-centered approach that works towards naturally mobilizing, strengthening, and supporting the spine so it can maintain its corrective position on its own.
If you, or a loved one, is facing the difficult choice of whether or not to have spinal-fusion surgery, the Scoliosis Reduction Center® can help you explore all available treatment options, ensuring that your treatment expectations are aligned with the reality of their potential outcomes.
