Scoliosis surgery is indicated when conservative management has failed.
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Indications
- Cobb angle ≥45º (skeletally immature) or ≥40-50º (skeletally mature) 1,2
- progressive scoliosis deformity
- spinal functional compromise
- pain not responsive to non-operative treatment
- pulmonary function compromise
- cosmesis 2
Procedure
There are a number of procedures that can be divided into three main groups 1:
- growth modulation
- instrumentation with fusion
- instrumentation without fusion
Complications
The complication rate for scoliosis surgery is relatively high, highest in adult scoliosis (~30%) and in pediatric scoliosis, neuromuscular scoliosis (~17.5%) followed by idiopathic (~8.5%) and congenital scoliosis (~3%) 3. Aside from complications of major surgery (i.e. death, hemorrhage, infection, etc), complications specific to scoliosis surgery include 3:
- neurological damage, e.g. quadriplegia, paraplegia, nerve damage
- hardware-related, e.g. misplacement, failure, migration
- pseudarthrosis
- curve progression
- flat back syndrome
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