Also known as spinal fusion surgery

By Blyss Splane 

 Medically reviewed by Yaw Boachie-Adjei, MD

Scoliosis causes an abnormal C-shaped or S-shaped curve of the spine. Usually the curvature of the spine is monitored over time, and intervention may be recommended when the curve of the spine is more than 25 to 30 degrees.

The curve can create an uneven waistline, one shoulder higher than the other, or compression of the lung depending on the severity of the curve.

Experts agree that children with spine curvatures of 45 to 50 degrees will need surgery to reduce the curve and prevent further curvature over time.1 The curvature of the spine is measured by the Cobb angle measurement. Spinal fusion surgery is generally very successful in straightening the spine and reducing further curvature.

Verywell / Julie Bang

What Is Scoliosis Surgery?

The gold standard for surgical treatment of scoliosis is spinal fusion surgery.1 It can be performed on children, teenagers, or adults following unsuccessful nonsurgical treatments.

Contraindications

For people whose nonoperative treatments were unsuccessful, there are two reasons someone may not be a candidate for surgical treatment of scoliosis:2

• An elderly person who would not survive the surgery due to age, chronic conditions, or length of time under general anesthesia

• Osteoporosis that makes a successful surgical fusion highly unlikely

What Is Osteoporosis?

Osteoporosis is a condition in which bones become weak and brittle.

Potential Risks

As with any surgery, there are risks of potential complications associated with having this type of procedure, which include:3

• Pseudoarthrosis, or non-union of the vertebrae of the spine

• Nerve injury as minor as numbness or as severe as paralysis (nerve functioning will be monitored throughout the procedure to alert the surgeon of any nerve changes occurring at that specific moment of the surgery)

• Excessive bleeding depending on the number of bones being worked on during the procedure (this will also be monitored and contained throughout the surgery)

• Broken hardware or fracture of the vertebrae around the hardware4

Purpose of Scoliosis Surgery

The standard surgical treatment for scoliosis is a spinal fusion that corrects spinal deformity curves. The general idea is to move the bones of the spine (vertebrae) back into anatomical alignment and then fuse the bones in place to form a solid bone.

A rigid fusion of the spinal bones prevents further growth in the section of abnormal spine and keeps the curve from getting worse.1 This can provide pain relief, improve breathing for those with lung compression, and improve cosmetic appearance for those with severe curvatures.

How to Prepare

Spinal fusion for scoliosis is considered an elective procedure. It’s important to find out which orthopedic spine or neurological surgeons in your area perform spinal deformity surgeries frequently. This complicated procedure requires advanced training, exposure to spinal deformity surgeries during residency, and expert mentorship for high success rates.4

Location

Spinal fusion surgery takes place in a hospital operating room with a surgical team consisting of a surgeon, resident, physician assistant, or nurse practitioner, surgical nurses, scrub technologists, and an anesthesia team to monitor the patient under general anesthesia.

What to Wear

It’s important to arrive on the day of surgery wearing comfortable pants, shoes, and potentially a sweater or jacket because the hospital can be cold.

Food and Drink

The surgeon will direct patients not to eat or drink anything after midnight the night before the surgery. Certain medications can be taken with small sips of water, but nothing else should be consumed unless otherwise directed by the surgeon.

Medications

Patients should provide a thorough list of current medications and alert the surgeon to any changes in or skipped medications on the day of surgery. The surgeon will determine if medications that cause increased bleeding should be continued or stopped depending on the medical situation of each patient. 

It’s essential to let your surgeon know about any prescribed medications, over-the-counter medications, supplements, vitamins, or recreational drugs you are using. Any chronic pain medications should also be discussed to ensure the surgical team can accurately prescribe postoperative pain medications that will more effectively treat pain.

What to Bring

It’s important to bring a photo identification and insurance card on the day of the surgery. You'll also want an overnight bag with any personal belongings (such as glasses, phone charger, books, or magazines) for the few days required for recovering in the hospital. Comfortable shoes will be needed to walk around the hospital and for discharge.

You will also need a support person to drive you home the day you are discharged from the hospital. You will not be able to drive due to pain medication and restrictions on mobility that would impair your driving ability. 

Pre-Op Lifestyle Changes

As with any surgery, it’s critical to stop smoking prior to surgery because it can cause delayed wound healing or lead to postoperative surgical site infections and other complications. It is recommended to stop smoking at least four weeks prior to surgery to mitigate complications.5

What to Expect on the Day of Surgery

On the day of the spinal fusion surgery, it’s important to give yourself extra time to find parking and to locate the surgery check-in area in the hospital. You should check in at the predetermined arrival time to give the pre-surgical teams ample time to prepare you for surgery. 

Before the Surgery

In the preoperative area on the day of the surgery, a nurse will assess your vital signs, weight, pregnancy status (if applicable), and blood sugar level (if applicable). Patients will remove their clothes and jewelry, and change into a surgical patient gown. Documents such as surgical and anesthesia consents will be reviewed and signed. 

The anesthesia team will complete another thorough assessment to determine any risks to undergoing general anesthesia. An IV (intravenous catheter) will be placed to provide any medications that will be needed during surgery.

Upon entering the operating room, it will be very cold and already set up with a special surgical bed, medical equipment and monitors, and numerous instruments and implants needed for the surgery. You will go to sleep on your back, and the surgical team will position you for surgery after the anesthesia team places the breathing tube (endotracheal tube) that is hooked up to the ventilator for breathing.

The surgical approach will determine whether you are positioned on your side for access to the spine or on your stomach with your back exposed. The surgical team will prep the skin of the surgical site with an antiseptic solution, and sterile drapes will be placed around the area to maintain a clean working area throughout the surgery.

During the Surgery

The steps of the procedure are as follows:3

• An incision is made over the area where the spinal bones will be worked on.

• The muscles are moved aside to expose the vertebrae of the spine.

• The vertebrae are roughened up to promote bone growth and fusion.

• Bone grafts may be placed between vertebrae to facilitate fusion between bones. These can be autografts (patient’s own bone), allografts (cadaver bones), or bone growth promoting tissues.

• Screws are placed into both sides of the vertebrae and connected with rods to hold the bones in correct alignment while the vertebrae fuse together to form a solid rigid bone over time.

• The surgeon moves the muscles back over the spine and closes the incision. Dressings are applied.

How Long Does Spinal Fusion Surgery Take?

The surgery typically takes four to eight hours, depending on the severity of the curve and how many spinal levels are being treated.1 This time frame also includes entering the operating room, preparing the patient for anesthesia, and waking up from anesthesia at the end of the procedure.

After the Surgery

The patient will be brought out of surgery to the post-anesthesia recovery unit, where they will recover for a few hours. As with any surgery, there will be pain following the surgery. Most patients will stay in the hospital for three to seven days, depending on how well the patient is feeling following the procedure and how much help they have when they return home.

Recovery

Most patients are very uncomfortable and experience varying amounts of pain for the first few days following surgery since this is a major procedure with manipulation of the muscles and bones of the spine.1 The pain will continue to improve little by little each day, and most people can get out of bed and walk around on day three or four after the surgery. 

Healing

The surgical wound will be covered with a dressing, but sponge baths will be the preferred method for bathing until the dressings naturally fall off around seven to 10 days after surgery. Surgical wounds should not be submerged under water until fully healed and closed to prevent infection.

The surgeon will provide postoperative instructions, depending on the dressing applied, about whether or not to shower and how to change the dressings. Some surgeons prefer for patients to wait until they are seen in the office for their first post-surgery visit before removing the dressings. 

Coping With Recovery

Pain control will vary depending on the surgeon and the hospital setting, but there will be different options. Some surgeons will order a patient-controlled pain pump to deliver limited amounts of pain medicine whenever the patient is in pain.

Strong pain medications will be given through the IV the first few days following the surgery, and then medications will be switched to oral pills. Opioids have known addictive qualities, so your surgeon may encourage you to switch to nonaddictive pain medications before returning home.1

For people who have been on pain medicine for longer periods of time prior to surgery, higher doses may be required to manage the pain, and they may be on stronger medications for longer periods of time than those who were not previously on a pain management regimen. Your surgeon will specify any limitations after surgery. This may include avoiding heavy lifting, driving, or bending forward for about six weeks.1

Long-Term Care

Physical therapists work with people to resume activities of daily living such as walking and moving from the bed to a chair. Goals for patients following surgery include moving from the bed to a chair on the first day, walking out of the room on the second day, and walking as tolerated by the third day following surgery.3

There will be several follow-up appointments with the surgeon, which can vary, but typically occur at two weeks, six months, and 12 months after surgery. At these appointments, the surgeon will take X-ray imaging to see how the fusion is healing, and assess the recovery through a physical exam.3

Possible Future Surgeries

Repeat surgery may be required for infection, failed fusion (pseudoarthrosis), or broken hardware in the spine. This is always on a case-by-case basis, and may require an additional surgery depending on the cause.

Lifestyle Adjustments

In the year following surgery, activities will return to normal as restrictions are steadily removed based on recovery. Most patients are discharged from the hospital after four days. Younger people may be out of school for four to six weeks, and most people can return to routine activities in two to six months.1 

During the first six months, you will not be able to perform strenuous activities, run, jump, or lift anything heavier than a dinner plate.3 Light activities with low impact, such as swimming, may be allowed at six to eight months and bicycling at around eight to 10 months.3 

Summary

Scoliosis surgery, also known as spinal fusion surgery, is performed to correct curvature of the spine of more than 25 to 30 degrees. It's usually recommended for people with scoliosis, where the spine curves to the side, if nonsurgical interventions fail to improve the condition. The goal of the surgery is to move the bones of the spine back into alignment and fuse them together to prevent the curve from getting worse.

Everyone who has scoliosis will not automatically be scheduled for surgery. For those who do need surgery, the majority of people are satisfied with the outcomes of their spinal fusion for correction of scoliosis. The surgery may treat symptoms such as pain, while also providing improvements in cosmetic appearance. Recovery from surgery can be extensive, but overall most people recover to normal function during the year following the procedure.

Sources

1.American Academy of Orthopaedic Surgeons. Surgical treatment for scoliosis.

2.Scoliosis and Spine Associates. Adult scoliosis treatment overview.

3.University of California San Francisco Health. Spinal fusion surgery for scoliosis.

4.Hyun SJ, Jung JM. Spinal Deformity Surgery : It Becomes an Essential Part of Neurosurgery. J Korean Neurosurg Soc. 2018 Nov;61(6):661-668. doi:10.3340/jkns.2018.0150

5.Sørensen LT. Wound Healing and Infection in Surgery: The Clinical Impact of Smoking and Smoking Cessation: A Systematic Review and Meta-analysis. Arch Surg. 2012;147(4):373–383. doi:10.1001/archsurg.2012.5

By Blyss Splane
Blyss Splane is a certified operating room nurse working as a freelance content writer and former travel nurse. She works as a freelance content writer for healthcare blogs when she's not spending time with her husband and dog.