Pros of Having or Not Having Surgery

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.

Here is a table that lists the good points about having surgery and also about not having surgery.

Concern

Pros of having surgery

Pros of not having surgery

Lung function

If your teen has surgery on the back ( posterior) of her thoracic (mid-back) spine, she may have a temporary reduction in lung function.

Eventually, your teen will regain the lung function she had before surgery.

This recovery can take anywhere from three months to two years after surgery.

Your teen’s lung function may actually improve over what it was before surgery, depending on the size and location of the curve.

If your teen does not have scoliosis surgery, there will generally be no effect on lung function unless her curve becomes quite large.

If your teen’s curve is 80 degrees or more, she may have shortness of breath with everyday activities.

If your teen’s curve is 100 to 120 degrees, her lung capacity can be reduced by up to 50% and she will experience increasing shortness of breath with everyday activities.

Life span

Surgery has no impact on life span.

Teens who do not have scoliosis surgery are just as likely to live to 65 years of age as people without scoliosis.

Self image or physical appearance

If your teen has surgery, it can improve her physical appearance and result in a straighter spine. This will allow for better alignment of her head, ribcage and pelvis. She will have more balance in her hips and shoulders, and reduced rib prominence. She may also get a bit taller.

How much your teen improves in physical appearance depends on the type and size of her curve(s) and the surgical technique used. Make sure to discuss this with your teen’s surgeon before surgery.

Teens with small curves (up to 30 degrees) usually have a normal self image.

                                            

 

Pain

Most likely, your teen will find that the pain from surgery gradually goes away over several months.

If your teen was having pain before surgery, it is hard to say whether surgery will reduce or eliminate this pain.

In a 50-year follow-up study, people who didn’t have scoliosis surgery had more pain than people without scoliosis. However, the pain was generally rated as occasional. It did not interfere with working life or with daily activities.

Osteoarthritis in the lower (lumbar) spine

Fusion into the lumbar (lower) spine has its good and bad points.

If your teen’s lumbar (lower) spine is not fused, she will have more range of motion when doing everyday activities and recreational or athletic activities.

In a 40-year follow-up study, osteoarthritic changes in the spine were found in about 38% of scoliosis patients who didn’t have surgery .

The majority of these patients (67%) only had mild changes.

Osteoarthritic changes in the spine also commonly occur in people who don’t have scoliosis.

Everyday activities

About one to two years after surgery, all restrictions on your teen’s activities should be lifted. Then she can return to most activities.

Your teen will have stiffness and reduced range of motion in the areas of her spine that are fused.

Generally, this stiffness doesn’t interfere with  everyday activities.

Athletes who participate in a sport that requires significant flexibility in the spine (gymnasts, dancers, divers, etc.) should discuss this with their surgeon.

A long-term study that followed scoliosis patients for 22 years after diagnosis looked at whether low back pain caused problems in doing everyday activities. There was no difference in this between scoliosis patients who didn’t have surgery and people who did not have scoliosis.

After 50 years of follow-up, patients with scoliosis were just as able to do everyday activities as people without scoliosis.

Need for surgery in the future

 

 

 

 

There is usually no need for additional surgery in the future unless a complication occurs.

There is no need to have the hardware removed (rods, hooks, screws) unless a specific problem such as infection or broken hardware occurs.

A study looked at scoliosis patients under the age of 15 years with curves between 20 and 45 degrees. Twenty-three per cent of patients who received a brace went on to have surgery. Twenty-two per cent of patients who were followed for observation went on to have surgery.

Quality of life

A study found that 10 years after surgery, scoliosis patients had a more positive perception of self than others the same age.

Another study found that 20 years after surgery, scoliosis patients had the same health-related quality of life as the general population.

A study found that, two years following surgery, patients who had surgery had only a small increase in quality of life when compared to patients who didn’t have surgery.

After 50 years of follow-up, people with scoliosis who didn’t have surgery were no more depressed than people without scoliosis.

Marriage and childbirth

A 22-year study compared scoliosis surgery patients to those without scoliosis. It found that there was no difference in marital status, number of children, age at first pregnancy, or need for caesarean section at first pregnancy.

There was no difference in back pain. Any worsening of the curve was not related to number of pregnancies or age at first pregnancy.

After 50 years of follow-up, 90% of scoliosis patients who didn’t have surgery had been married at least once.

Of those who married, there was an average of three children per family.

The caesarean section rate of women with scoliosis who didn’t have surgery was 3% compared with 10% in women who didn’t have scoliosis.

Curve changes

Scoliosis surgery can correct your teen’s curve by at least 40% to 65%.

This depends on the flexibility of her spine, type of curve, size of curve, and her age.

In one study, curves treated with surgery only increased in size by 3.5 degrees over 22 years.

A study followed scoliosis patients who did not have surgery. After 50 years of follow-up, some curve types had only a small 20% to 25% increase in curve size.

 

Sandra Donaldson, BA

Andrew Howard, MD, MSc, FRCSC

James Wright, MD, MPH, FRCSC

6/1/2008


Notes: