The information in this section is based on the results of many different research studies. Sometimes the results of these studies are in conflict with each other. One study may say one thing while another says the opposite. As a result, some of the information in this section may also be conflicting. In these situations, it’s important to understand that there may not be one specific result for all situations and all patients.
There are disadvantages associated with having scoliosis surgery. There are also disadvantages to not having surgery. This table summarizes all of these.
| Concern | Cons of having surgery | Cons of not having surgery |
|---|---|---|
| Neurologic complications | Neurologic complications from surgery can include loss of skin sensation, weakness or loss of strength in their feet or legs, loss of bowel and bladder control, or paralysis. Neurologic complications usually begin very soon after surgery. These complications can improve over time, but some may be permanent. Your teen has a 1% to 4% risk of neurologic complications. They have a less than 1% risk of paralysis. |
If there is no surgery, there is no risk of neurologic complications. |
| Infection | Infection can be superficial, meaning around the surgical incision. Infection can also be deep, meaning within the spinal column. Infection can show up as early as within the first few weeks after surgery. Or it may develop as late as a few years after surgery. Sometimes surgery is needed to clean out the infected tissue. Infection can sometimes cause the spine not to heal in a straightened position. Your teen’s risk of infection is about 2%. |
If there is no surgery, there is no chance of infection from surgery. |
| Failure of spinal fusion (pseudoarthrosis) | Failure of spinal fusion can happen after surgery if the spine doesn’t heal in a straightened position. It can be caused by smoking, second hand smoke, infection, or using non-steroidal anti-inflammatory medications such as ibuprofen. Your teen has a 1% to 3% chance of developing this condition. Failure of spinal fusion can also happen if the rods, hooks, or screws loosen or break. There is about a 5% chance of this happening. |
If there is no surgery, there is no chance of pseudoarthrosis. |
| Lung function | If your teen has surgery on the front (anterior) of their spine or has ribs removed (thoracoplasty), they may have reduced lung function following surgery. This can happen because the surgery involves direct contact with the lungs. If it happens to your teen, they will regain some of their lung function. However, it may not return to the same level it was before surgery. In general, this should not affect their everyday activities. |
If your teen has a curve of 50 degrees or larger when they have finished growing, and they do not have surgery, they are more likely to have shortness of breath in the future because their curve will increase in size by about one degree per year. If your teen has a curve of 80 degrees or larger, they are likely to have shortness of breath during everyday activities. If your teen has a curve of 100 to 120 degrees or larger, it can reduce their lung capacity by 50% and lead to increased shortness of breath during everyday activities. |
| Life span | Scoliosis surgery will have no effect on your teen’s life span. | If your teen has a curve greater than 100 degrees, they may have a reduced life span due to complications with their heart and lungs. |
| Self-image or appearance | Your teen may be bothered by the appearance of their scar. One study reported that 53% of scoliosis surgery patients were satisfied with their scar’s appearance. Sixteen per cent were dissatisfied and 21% were neutral. If your teen has surgery on the front of the spine, they may be more disappointed with the appearance of their scar than if they have surgery on the back of their spine. |
If your teen does not have scoliosis surgery, they may experience problems with their self-image once their curve is 30 degrees or larger. If your teen’s curve is larger than 50 degrees when they finish growing, and they have not had surgery, they have a higher chance of physical deformity later in life because the curve will continue to increase in size by about one degree per year. In a 50-year follow-up study, patients who didn’t have scoliosis surgery were less satisfied with how their body looked than those without scoliosis. |
| Pain | If your teen has surgery, they will feel pain in the hospital and at home during recovery. If they were experiencing pain before surgery, it is hard to say whether surgery can reduce or eliminate this pain. |
In a 50-year follow-up study, scoliosis patients who did not have surgery felt more pain than people without scoliosis. Scoliosis patients reported the pain as occasional. It didn’t affect their ability to work or perform everyday activities. |
| Osteoarthritis in the lower (lumbar) spine | Fusion into the lumbar (lower) spine has its good and bad points. This procedure may cause more stress to the last one or two unfused bones in the lower spine. This stress may lead to osteoarthritis in the unfused area of the lower spine. Sometimes though, when the lower spine is not fused, the curve may continue to get larger. |
In one long-term study, 87% of scoliosis patients who did not have surgery had osteoarthritis in their lower back. However, many people who do not have scoliosis also have osteoarthritis in the lower back. It is not known whether having surgery prevents osteoarthritis. |
| Everyday activities | If your teen does sports that require flexibility of the spine such as dance, gymnastics, or diving, they will be less flexible in the fused area of the spine. One study showed that scoliosis surgery patients had 25% less range of motion in their spine than scoliosis patients who didn’t have surgery. |
A 50-year follow-up study found that patients were equally able to perform everyday activities when compared to people without scoliosis. However, they did these activities less frequently. In the study, acute back pain or shortness of breath affected patients’ ability to perform everyday activities. |
| Need for surgery in the future | Studies show that 14% to 19% of scoliosis surgery patients eventually need more surgery (these are older studies on older surgical techniques; there are no numbers on newer surgical techniques yet). The main causes for re-operation are infection, painful implants, or failure of spinal fusion. |
If your teen decides to have surgery later in life, they may have less correction of their spine due to loss of flexibility. They have an approximately 25% chance of having a complication. |
| Quality of life | A study found that two years after surgery, patients had only a small increase in quality of life compared to patients who didn’t have surgery. Ten to 20 years after diagnosis, both surgical and non-surgical scoliosis patients saw themselves as less healthy than others of the same age who didn’t have scoliosis. Some patients who went through surgery admitted that they were limited socially. This was because they could not physically participate in certain activities. They were also self-conscious about their appearance. |
Ten to 20 years after diagnosis, both surgical and non-surgical scoliosis patients saw themselves as less healthy than others of the same age who didn’t have scoliosis. Body image is an issue for most scoliosis patients. This isn’t related to the type of treatment or severity of the curve. |
| Sexuality and childbirth | Women who had scoliosis surgery also had limits in their sexuality. This was due to limitation of physical activity and self-consciousness about their appearance. Women who underwent scoliosis surgery had more vacuum extractions during childbirth than women without scoliosis. |
In the same study, patients who didn’t have surgery also felt limited in their sexuality. This was due to self-consciousness about their appearance. |
| Curve changes | Some patients with double curves only have their thoracic (mid) spine fused in order to maintain range of motion in their lumbar (lower) spine. Sometimes, if the lumbar curve is not fused, it may get larger over time. |
After 50 years of follow-up in scoliosis patients who did not have surgery, some curve types increased by 35% to 100%. |