Our knowledge of orthopaedics. Your best health.

When should surgery be scheduled?

Most scoliosis surgeons agree that there is rarely a need for emergency or urgent surgery. Most surgeries can be scheduled for a time that works for both the patient and the doctor.

If you decide to postpone your surgery until a school break, your doctor will follow up with you every few months to make sure there is not a rapid increase in the size of the curve once it is greater than 50°.

Should I have allograft bone used for my fusion or my own bone harvested?

Your own bone is still an excellent option, but most scoliosis surgeons now use allograft bone instead. The reason for this is that some patients end up having pain at the donor site (from where the bone was taken), and this can last a long time. Other problems can also happen on rare occasions, such as:

• Bleeding
• Nerve irritation
• Infection
• Fracture

Allograft bone is taken from a deceased donor. It goes through an extensive sterilizing (cleaning) process before it is used on a patient. Allograft bone is often mixed with the patient's own marrow blood to improve its bone fusion capability.

In addition, spine surgeons are using synthetic (artificial or human-made) products to get the spine to fuse. These synthetic products:

• Can be used with your own bone or with an allograft (donor bone).
• Either act as a scaffold (framework) to allow new bone to form and mature, or chemically stimulate new bone formation.

Bone morphogenetic protein (BMP) is a product commonly used in adult spine surgery to stimulate bone formation, but it is not commonly used in pediatric spine deformity surgery.

The exact type of bone graft used will depend on many factors, the most important of which is surgeon preference and experience. That is to say, if your surgeon has had very good success with one method or approach, they will probably recommend it to you.

Of course, you and your family should ask about other options available to you in order to be well-informed.

How much does spinal fusion surgery cost?

The cost of surgery for scoliosis and other types of spinal curvatures depends on many factors. They include:

• The cost of being in the hospital for several days
• The types of materials used (hooks, screws, rods)
• The type of bone graft material used
• The surgeon's fees
• Anesthesia charges

Unexpected events that result in an extended hospital stay will also increase the overall cost.

The actual costs vary from region to region in the U.S., and from country to country.

In the U.S., costs also vary depending on the type of insurance coverage you have. Insurance companies cover the cost of the surgery, the hospital stay, and the instruments to straighten the spine. You may owe a co-payment or deductible depending on the structure of your insurance plan.

Be sure to contact your insurance provider prior to surgery to discuss the extent of your coverage. Talk with your doctor's office, as well as the hospital billing department, to make sure you understand all the costs involved.

Although the exact costs vary from patient to patient, in general, spinal surgery for scoliosis is an expensive operation.

Should my child see a neurosurgeon?

The vast majority of surgeries for scoliosis and other curvatures of the spine have been performed by orthopaedic spine surgeons.

Over the last several years, however, some neurosurgeons have taken a special interest in treating teenagers with scoliosis and have gone through specialized training.

Certain types of curvatures are associated with problems related to the spinal cord. If your child has other symptoms with the curve, like pain, weakness, or numbness, it may mean the nerves from the spine are being compressed (squeezed) by the bones or the disks. This is rare, but it should be watched out for. A neurosurgeon may be requested to be a part of the surgical team.

How many scoliosis surgeries has my surgeon performed, and have they had good results?

Talk to your surgeon about their experience and results. Not all spinal surgeons treat scoliosis patients, so it is important to ask your surgeon if treating scoliosis is a significant part of their practice.

There are many regional spine centers and teaching institutions that specialize in treating teenagers with scoliosis and other curvatures of the spine.

What happens if the rod breaks?

Most rods are made of titanium, cobalt chromium, or stainless steel. The type of implant used in your surgery will depend on your surgeon's preference, as well as your specific needs.

A broken rod is a sign that a portion of the spine did not fuse. Without a solid fusion, the rod will be repeatedly stressed. Even a very strong rod will eventually break if repeatedly stressed for long enough. In most cases, rod breakage requires another operation for revision of the fusion and replacement of the rods.

Will I need more than one spinal fusion?

Most surgeries for scoliosis are done with the purpose of being the only surgery the patient needs. However, the repeat surgery rate has been reported in studies to range from 4 to 13% in the first few years after the procedure. Few patients require planned multiple surgeries. Rarely is repeat surgery necessary as an adult.

What are the permanent side effects of long fusion?

In some patients, nearly the whole spine requires fusion to treat their scoliosis. This is called a long fusion. In these cases, the small, flexible area at the lower end of the spine bears more stress with normal activity like running, jumping, bending, lifting, and twisting. We have a concern that this could contribute to earlier development of arthritis in the lower spine.

However, areas of the spine that remain twisted, or that progressively twist, are also prone to early arthritis. Many patients with scoliosis who do not have fusion end up with stiff, painful, and arthritic areas of the spine.

Will surgery increase the chances of developing arthritis?

Everyone develops wear-and-tear arthritis in their spines as they age, whether they have scoliosis or not. This process is accelerated (sped up) in patients who have scoliosis, because the forces that are transmitted through the twisted and bent spine are concentrated over a smaller area and intensified.

Scoliosis specialists think that most people with large scoliotic curves will be less likely to develop severe and limiting arthritis pain if their curves are corrected with surgery.

Is there a risk of future back pain?

After surgery, some people have trouble with ongoing pain in the lower or upper back. This is usually managed with exercise and other simple treatments, without the need for medication or extensive therapy on an ongoing basis.

Occasionally, patients will have a lot of trouble with ongoing back pain and require physical therapy, medications, or even an additional surgery (called a revision surgery). Over a 20-year period, ongoing back pain has caused between 3 and 10% of patients to require revision surgery or removal of instrumentation.

How long will the scar be?

The incision will be as long as the part of your spine that will be fused. Incisions for a single curve are generally 10 inches long. If you have two or more curves, your scar may start in the middle of your shoulder blades and end up even with your pelvis.

Will the scar be wide?

Your surgeon will try to prevent the scar from widening by placing the sutures (stitches) beneath the skin. Some surgeons use a special type of glue to promote wound healing.

Will the surgery stunt my growth?

When the spine is fused, spinal growth will only stop in the area of the spine that is operated on. Since most fusions are not performed until a child's spinal growth is nearly complete, there should be minimal effect on spinal height.

Will surgery make me taller?

Yes. When your spine is made straighter, it appears longer. After surgery, you may be 1 to 1-1/2  inches taller.

Will surgery correct the hump on my back?

A "hump" on the back can come from the spine being twisted with the attached ribs being bent and prominent. Surgery should make the hump smaller, but it probably will not disappear. Your surgeon will explain to you how much any deformity may improve with the surgery.

After fusion, will I be able to bend over and move my back?

When you bend over to pick something up off of the floor, most of the movement comes from your hip joints and lower spine, neither of which are affected by scoliosis surgery.

You will have less flexibility in your back after fusion. You can simulate what this loss of motion may be like by keeping your upper back straight with "perfect posture" while bending forward at the hips.

Will it be possible for people to see the hardware in my back?

This rarely occurs. However, in extremely thin patients, the implants can sometimes be felt under the skin and muscle.

What will happen to the unevenness of my chest (breasts)?

During surgery, the ribcage shape is made more normal. This will make your chest size more even, but there may still be a difference in the size of your breasts.