Life After Scoliosis Surgery

Today we delve into a bit of a somber subject: Out of every 100 children, three will be diagnosed with scoliosis. Out of those 3 diagnosed, one of those children’s scoliosis will progress to a magnitude that requires surgery.

Why surgery?

There is not a parent out there who wants to hear the words, “your child needs surgery”. Especially on the spine! It sounds invasive and scary. But here is why surgery is indicated, and this may come as a surprise to some of you: the child’s ability to breathe. 

I met and talked with a leading pediatric scoliosis surgeon in Boston in 2022, and he always says to his scoliosis patients, “I don’t care how your back looks. [i.e. Scoliosis surgery is never about aesthetics.] I care about how well you can breathe, and that is why we are discussing surgery.” 

Severe Scoliosis

As a scoliosis progresses beyond 50 degrees, it begins to mechanically restrict air from entering the lung on the “inside” of the curve; what we call the concavity. Lung capacity, the amount of air that we are able to take into the lungs, diminishes significantly with severe scoliosis. Even a layperson glancing at the adjacent photo can see why the left lung would be restricted by the scoliosis.

Before surgery was available to patients with severe scoliosis, their bodies were so contorted, and their lung capacity so diminished that they were often bedridden.

Knowing this, we are grateful for modern surgical intervention for scoliosis: it can save today’s children from the fate of those with scoliosis before the 1940s (at which point surgery became commonplace for idiopathic scoliosis).

What kinds of surgery are used for correcting scoliosis? 

There are two main types of scoliosis surgery: Spinal Fusion, which has been the gold standard for scoliosis for decades, and Vertebral Body Tethering (VBT), which is the new kid on the block, just approved by the FDA in 2019.

Spinal Fusion has (thankfully) evolved over the years. Where surgeons once used long rods with hooks along the spine to straighten it, they now fuse multiple vertebrae together with metal plates and screws and sometimes with short rods or bone grafts. As the surgeons fuse one vertebra to the next, they can straighten and somewhat de-rotate the spine. For a severe scoliosis, the end result can be miraculous and life changing.

Spinal Fusion

VBT is packaged as less invasive, bloodless, and offers a quicker recovery time. It involves placing anchors into only the convex (curved) side of the vertebrae and using a flexible cord to pull the top vertebra of the scoliosis toward the bottom vertebra of the scoliosis, which can straighten that segment of the spine.

This type of surgery is indicated for flexible curves between 30-65 degrees in skeletally immature patients (i.e., patients who are not done growing yet). Because VBT is so incredibly new, many professionals in the field feel there are substantial kinks to work out, and it is far from being the predominant form of scoliosis correction.

Vertebral Body Tethering

Who will need surgery?

Kiddos who have greater than 40 degree curves that have a lot of growth left will likely be referred to surgery, as well as anyone with a scoliosis greater than 50 degrees, regardless of growth status.

What surgical options are available for adults?

Although some surgeons are experimenting with VBT in skeletally mature teens and adults, experimental is the keyword. Dr. Baron Lonner, the Mount Sinai surgeon who helped develop the device used in VBT, is finding that it is working for adults but much less so than in the child and adolescent population.

Most adults with scoliosis will be offered some form of spinal fusion. The number of vertebrae that will be fused together depends entirely on the patient’s symptoms. If symptoms are clearly being generated only from the L5/S1 segment, the surgeon will fuse only L5/S1. If symptoms are coming from multiple levels of the spine, more vertebrae will be fused together.

In extremely rare instances, the entire spine from head to pelvis will be fused together. This is an extreme form of spinal fusion that is typically reserved for those who are “doubled over” and can no longer stand upright.

What does recovery from surgery look like?

As mentioned, VBT offers a quicker recovery timeline. Kiddos who have VBT will be instructed to start aquatic exercise in just 3-4 weeks post-operatively. At 6 weeks, they can begin physical therapy. By week 8 post-op, they can return to their desired sports or activities.

Spinal fusion recovery is a bit longer. Although post-operative protocols vary greatly by surgeon, the average return to sport/activity is between 3 and 6 months.

Are patients instructed to go to Physical Therapy after Scoliosis surgery? 

Sadly, not often. It’s rare when a surgeon recommends PT after scoliosis surgery. The mentality of spinal surgeons in the United States is, “I’ve fixed your spine; now go live your life.”

Can Physical Therapy be helpful after scoliosis surgery?

Resounding yes (Obviously. This is a PT writing this, remember.) Why?

Scoliosis is defined as multiple vertebrae bending and twisting. As that process happens, the surrounding soft tissues – think ligaments, muscles, and fascia – get pulled into an asymmetrical position. Those with scoliosis will have very short spinal muscles on the inside of their curve and very overly stretched spinal muscles on the side of their curve. This is just the tip of the iceberg – the traps, the lats, the psoas, and many more muscles – all are profoundly affected by the bony abnormalities of scoliosis.

So the surgeons “fix” the bones, yes (and again, we are grateful for this). But they haven’t done a thing for the patient’s muscles, fascia, etc. Enter physical therapy, especially something as specific as the Schroth Method, invented specifically for those with scoliosis and kyphosis.

We love working with post-surgical patients. We get to teach them how to re-train their muscles to function symmetrically. We teach them to support their surgical site with strong muscles and better posture, lessening the risk of future repeat surgery.

We also serve as advisors on the “What can I do?” and “What should I do?” after scoliosis surgery. We help patients overcome kinesiophobia – the fear of movement – that many will experience after spinal surgery. Building confidence is one of our main objectives as Schroth practitioners.

Life After Scoliosis Surgery

Spinal surgery can be scary, but life after spinal surgery for scoliosis doesn’t have to be. In fact, we hope that life after scoliosis surgery (for those who need it) is actually better.

There are many resources for any of you coming face to face with this prospect: Eric and I of SchrothDC, for starters. And our many colleagues in the scoliosis field who provide mental health therapy, physical therapy, strength training instruction, Pilates instruction; the list goes on and on.

We scoliosis experts are a small community, but with that comes an intense specialization and a “small-world, we-all-know-each-other” kind of vibe. We invite you to join us, come learn with us, and, as is plastered on our website, “Live the Life You Want!”