SPINE
Scoliosis Surgery
Spinal deformities in adolescents and adults: evaluation, follow-up and when surgical correction comes in.
Book an evaluationX-ray of the spine showing a lateral curvature (scoliosis)
Dr. Victor BatistelaNeurosurgeonCRM-PR 35044 · RQE 30580 (Brazilian medical registration)
What scoliosis is
A lateral curve, with rotation
Scoliosis is a lateral curvature of the spine, usually accompanied by rotation of the vertebrae. Seen from behind, the spine should be straight; in scoliosis, it forms one or more C- or S-shaped curves. The curvature is measured in degrees, the Cobb angle, on a full-length X-ray.
The most common form is adolescent idiopathic scoliosis, which appears during the growth spurt without an identifiable cause. There are also congenital and neuromuscular forms, and adult degenerative scoliosis, which appears with wear of the discs and joints.
In most people, scoliosis is mild and causes no problems. What defines the management is the magnitude of the curve, the likelihood of progression and the symptoms.
Anatomy
How the curve is measured
The standing full-length X-ray is the test that measures the curve and tracks its progression.
- 1
Apex of the curve
The vertebra farthest from the midline — the point of greatest deviation.
- 2
End vertebrae
The most tilted vertebrae above and below the apex, which delimit the curve.
- 3
Cobb angle
The angle between the end vertebrae. It is the measurement, in degrees, used to track the curve.
- 4
Vertebral rotation
In addition to curving, the vertebrae rotate — this is what produces the prominence on one side of the back.
Adolescent and adult
Different paths
In adolescents, the focus is the potential for progression during growth. Scoliosis is usually noticed through visible signs — one shoulder or shoulder blade higher than the other, an asymmetric waist, a prominence on one side of the back when bending forward — more than through pain.
In adults, scoliosis is usually associated with wear of the discs and joints, and the main reason for the appointment is low back pain, pain radiating to the legs or difficulty standing for long periods — not the curve itself.
- Adolescent: monitor progression during growth
- Adult: treat the associated pain and nerve compression
- In both: physical activity is recommended and does not worsen the curve
How the evaluation is done
Measure, monitor, decide
Step 01
Clinical evaluation
Physical examination with the forward-bend test, height and, in adolescents, an estimate of remaining growth.
Step 02
Full-length X-ray
Standing, front and side views: measures the Cobb angle and assesses overall alignment. MRI in specific situations.
Step 03
Monitoring progression
X-rays every few months show whether the curve is stable or progressing. The decision depends on this evolution.
Step 04
Decision
Observe, brace or surgery — according to magnitude, progression, age and symptoms.
Two paths
Observation and bracing or surgical correction
Observation and bracing
- Small curves, without progression and without symptoms: follow-up with periodic X-rays
- Bracing in adolescents with moderate curves and remaining growth: it does not correct the curve, but may reduce the chance of progression
- Specific physical therapy for postural control and pain
- In adults: medication, physical therapy and nerve blocks when indicated
Surgical correction
- Curves of high magnitude that tend to progress even after growth has ended (in general, above 45–50 degrees in adolescents)
- Documented progression despite bracing or follow-up
- In adults: pain that does not respond to conservative treatment, nerve compression or trunk imbalance
- Very large curves affecting respiratory function
The criteria are general and depend on individual evaluation. // TODO(validar): degree ranges and criteria — clinical review.
What corrective surgery is like
Fix, correct, preserve mobility
The most common technique is instrumented spinal fusion: screws and rods correct the curve and fix the operated levels, which consolidate with bone graft. The extent of the fixation is planned to correct alignment while preserving as much mobility as possible in the remaining levels.
In selected cases, planning may rely on robotic navigation for screw placement. After surgery, follow-up checks consolidation and alignment with periodic X-rays, and rehabilitation is gradual.
When not to wait
Signs that should not wait for an appointment
The first three call for the emergency room. The last calls for an appointment soon.
- sudden weakness or numbness in the legs
- difficulty controlling urine or bowel
- severe pain after trauma
- visible progression of the curve within a few months, during growth (prompt evaluation, not the emergency room)
Frequently asked questions
- No. Small curves, without progression and without symptoms, are in general simply monitored with periodic X-rays. Treatment depends on the degree of the curve, age, growth potential and symptoms.
- The brace does not correct the existing curve; its purpose is to reduce the chance of progression during growth, in adolescents with moderate curves. Once growth ends, the brace is no longer indicated.
- Spinal fusion fixes the operated levels, which lose mobility between them. The remaining segments stay mobile. The extent of the fixation is planned to correct the curve while preserving as many free levels as possible.
- Yes. In adolescents, the focus is the potential for progression during growth. In adults, scoliosis is usually associated with wear of the discs and joints, and the main reason for the appointment is pain or nerve compression, not the curve itself.
- Physical activity is recommended and does not worsen the curve. Specific physical therapy programs can help with postural control and pain. No exercise, on its own, corrects a structural curve.
Read also
Book an evaluation
The appointment serves to understand the condition and define the next step. Not every condition requires surgery.
This channel is not a substitute for emergency care. In an emergency, go to the nearest emergency room.
