Surgery for scoliosis

Is surgery right for scoliosis?

Most people with scoliosis do not need surgery. Many curves stay stable, or can be managed with monitoring, bracing, and exercise-based care.^{1 2}

Surgery may be worth discussing when the curve is more likely to keep getting worse, or when symptoms are clearly limiting day-to-day life.

A spine specialist may consider surgery when:

• A teen’s curve is getting larger during growth, especially when there is a lot of growth left and the curve is already moderate to large.^{2 3}
• The curve is approaching a range where progression is more likely, commonly discussed around 45 to 50 degrees for adolescent idiopathic scoliosis, depending on curve type and overall alignment.^{1 4}
• An adult has scoliosis plus nerve-related symptoms, such as leg pain, numbness, tingling, or reduced walking tolerance from spinal narrowing (stenosis).^{5 6}
• Pain and function are not improving with non-surgical care, and the person has meaningful imbalance or disability.^{5 6}

Surgery is not the “automatic next step.” It is a shared decision that should consider your symptoms, curve behavior, overall health, and what matters most to you.^{2 5}

Common surgical options for scoliosis

A surgeon may bring up different procedures depending on age, curve type, symptoms, and whether the spine is still growing.

1. Posterior spinal fusion with metal bars and screws. Often used for adolescent idiopathic scoliosis, and sometimes in adults. The goal is to stop the curve from progressing and improve alignment by fusing selected vertebrae and using implants for stability.^{1 4}
2. Decompression with or without fusion (more common in adults). If leg symptoms come from spinal narrowing, surgery may focus on relieving pressure on nerves. Fusion may be added to support stability and alignment, especially when there is deformity or instability.^{5 6}
3. Vertebrae osteotomies and fusion (in adults). If the deformity causes imbalance, surgery may need to include bone cuts (osteotomies) to correct and improve alignment. It's necessary to use metal implants for stability.
4. Fusionless or growth-modulating procedures (selected children and teens). In certain peadiatric cases, surgeons may consider approaches designed to correct the curve while preserving growth or avoiding a full fusion (metal devices that grow with the spine). National Institute for Health and Care Excellence (NICE) has evaluated minimally invasive fusionless approaches for idiopathic scoliosis in children and young people.⁷

What to expect during recovery

Recovery looks different for everyone, and it depends on the procedure, the number of spinal levels involved, your age, and your overall health. In general, it helps to plan for recovery in phases.^{1 5}

Early recovery

• Pain and stiffness are common early on, and activity is usually increased gradually under your surgical team’s guidance.¹
• You may need support with daily tasks for a period of time, especially in the first stretch of healing.¹

Building strength and return to life

• Many people work on walking tolerance, strength, and confidence with movement over time. Adults may need a longer rebuild, particularly when surgery is more complex or when there is significant imbalance before surgery.^{5 6}

Possible challenges

• Fatigue and slower-than-expected progress can happen, especially if you were less active before surgery or if the procedure was extensive.⁵

Risks to understand

All surgery has risks. With scoliosis surgery, risks can include infection, blood loss, nerve injury, hardware issues (broken metal devices, pull-out of a screw), incomplete symptom relief, ongoing pain, or the need for additional surgery. Adult scoliosis surgery generally carries higher risk than adolescent surgery, so careful patient selection is important^{5 6.}

Can surgery be avoided?

Often, yes.

For teens, the key goal is reducing the chance a curve progresses into a surgical range. Bracing has strong evidence for lowering progression risk in growing adolescents with moderate curves, and more brace wear time is linked with better results.⁴

For teens and adults, exercise-based care and education can support posture, trunk control, function, and quality of life, although curve-angle changes from exercises alone are often modest and vary across studies.^{2 8}

For adults, scoliosis symptoms are frequently driven by degeneration, stiffness, and sometimes nerve compression, so a plan that focuses on strength, endurance, and symptom management can meaningfully improve daily function even if the curve does not fully change.^{5 6}

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

The SOSORT guidelines emphasize matching treatment to curve size, risk of progression, and growth remaining. They support bracing for certain moderate curves during growth, and include scoliosis-specific exercises within conservative care.²