Scoliosis operation: in which cases is surgery indicated?

If nearly 4% of the population is affected by scoliosis, only a small part of them will have recourse to surgery. In what cases is it offered? How does the intervention take place? What are the consequences? The answers of Dr Arvieu, orthopedic surgeon at the Parisian Spine Institute.

What is scoliosis?

We speak of scoliosis when the Cobb angle, formed by the two most inclined vertebrae at the extremities of the scoliotic curvature, is greater than 10 degrees. “This three-dimensional deformation of the spine is secondary to a rotation of the vertebrae relative to each other”, describes Dr. Arvieu. It can occur in childhood, adolescence but also in adulthood, and can be isolated or associated with a disease.

Symptoms of scoliosis: how do you know if you have scoliosis?

Most of the time, in children and adolescents, scoliosis does not cause particular spinal pain and is therefore asymptomatic. The main symptom is a more or less significant and visible spinal deformity. Scoliosis should be routinely screened for in children and adolescents. The doctor performs a clinical examination, where he asks the child to stand up and bare-chested, and to lean forward to touch his toes: he then looks for a possible hump either at the level of the lumbar spine (bottom) or at the level of the dorsal spine (behind the thorax) depending on the location of the deformity. He will also look for an asymmetry of the shoulders and/or pelvis, flanks, or a tendency to leave to the left or to the right.

In adults, the diagnosis is also clinical.

This diagnosis will be confirmed by x-rays of the entire spine from the front and from the side. An MRI and CT scan of the spine may be requested, especially in case of pain in the legs or problems walking.

Scoliosis treatment: when to have surgery?

The only curative treatment for scoliosis is surgery, however, it is rarely justified. The other treatments for scoliosis aim to stop its progression during growth and allow the patient to live with it. In adulthood, non-surgical therapies will mainly have an analgesic objectives.

Arthrodesis: how to straighten adult or adolescent scoliosis through surgery?

The operation for scoliosis is called arthrodesis, and aims to fuse several adjacent vertebrae together in order to limit any mobility of the spine. “The general principles of this surgery are correction and fusion,” explains Dr. Arvieu.

The correction of the deformity aims to correct the sagital imbalances – namely from front to back – and frontal, from right to left. The surgeon uses specific rods and cages between the vertebrae to reduce the deviation. These act as tutors accompanied by hooks and screws implanted on the vertebrae. “The idea is, ultimately, to obtain an overall balance with the head aligned in the middle of the coccyx, the shoulders and with a symmetrical pelvis”, indicates the surgeon.

As for the fusion, it corresponds to the result of the bone graft carried out during the surgical procedure, which thus makes it possible to obtain a maintenance of the correction in a lasting way.

Arthrodesis is an intervention that is performed under general anesthesia and lasts between 3 and 7 hours on average. The approach can be conventional or more recently – and in some cases only – minimally invasive. It generally requires hospitalization for 5 to 7 days.