Medical Health Encyclopedia

Candidates for Surgery. In general, pain is the most common reason for surgery in adult scoliosis. Surgery may be recommended in the following cases:

• Curvatures over 50 degrees with persistent pain.
• Surgery is almost always recommended for adults with curvatures over 60 degrees; those over 100 are life-threatening.
• Progressive mid and low back curve or low-back curve with persistent pain.
• Reduced heart and lung function. Most surgeons, however, will not operate on adults with severely impaired lung function and heart failure. Once this has occurred, most experts do not believe that surgery will help lung capacity and in fact, surgery can cause the condition to worsen, at least temporarily.
• Significant deformity is present. Adults should not expect to achieve a completely straight spine, however. There is a high risk for nerve damage if the spine is over-corrected, and adult spines are less flexible than children's are. Usually, however, the correction still achieves an acceptable cosmetic improvement.

Surgeons prefer to operate on adults under 50 years old, although surgery may be appropriate in some older people.

Standard Scoliosis Procedures in Adult Scoliosis. The procedures involve the following depending on whether the patient had been treated previously or not.

• In patients who have not had previous treatment and who have degenerative lumbar scoliosis, the procedure is often a discectomy (removal of the diseased discs) followed by scoliosis procedures (instrumentation and fusion).
• In patients with previously treated scoliosis, the only remedy is removal of the old instrumentation, extension of the fusion, and implementation of new instrumentation and bone grafts.

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Surgical procedures in adult scoliosis are complex and are undertaken only after careful consideration and all nonsurgical methods have been used. Adults have a much higher risk than children for complications, including pneumonia, infections, poor wound healing, and persistent pain. In addition, procedures in adults often involve fusion in lumbar and sacral areas (the low back), which can cause a number of complications. Some experts believe that the risks of operations in this area nearly always outweigh any benefits in adults and should not be performed. Most studies on adults have also reported low success rate.