Scoliosis, a spinal deformity characterized by abnormal sideways curvature of the spine, is estimated to affect approximately 2 to 3% of the U.S. population or 7 million Americans. Frequently diagnosed in late childhood or early adolescence, the condition can range from mild to severe, often progressing/worsening over time without treatment.
The majority of scoliosis cases respond well to conservative treatment options, but surgery may be recommended if symptoms are serious, unresponsive to non-surgical approaches, and affecting quality of life. Multiple factors come into play when determining the best age for scoliosis surgery, including the type, scope, and location of the spinal curvature, how rapidly it is progressing, and the severity of symptoms the patient is experiencing.
At the New Jersey Spine Institute, our board-certified spine specialists have extensive experience diagnosing and treating scoliosis in patients of all ages. We understand that the decision to undergo scoliosis surgery is never an easy one and are dedicated to working closely with patients and families to develop personalized treatment plans that reflect the unique circumstances of each case. If, after careful evaluation and analysis, surgery is determined to be the best path forward, our team will be there to offer expert support and guidance every step of the way. Below, we’ll explore scoliosis in more depth along with the considerations that go into determining if and when surgery is the right treatment option.
To learn more about scoliosis treatment at the New Jersey Spine Institute, schedule an appointment at our state-of-the-art clinic today!
What Is Scoliosis?
Scoliosis is an abnormal sideways curvature of the spine that can impact the upper back, mid back, and/or lower back. Often characterized by a spinal curve shaped like the letter “S” or “C”, the condition is most commonly diagnosed between the ages of 10 to 15, but can affect individuals of any age.
Many people with scoliosis experience only mild, manageable symptoms, or may not even realize they have the condition at all, but in severe cases, scoliosis can cause intense pain and have a major impact on posture, mobility, comfort, breathing, and overall quality of life. Most cases of scoliosis respond well to conservative treatment approaches such as bracing and physical therapy, but surgery may be recommended if symptoms are serious, persistent, and/or progressive.
By far the most common form of scoliosis is idiopathic scoliosis—specifically, adolescent idiopathic scoliosis (AIP), which develops between the ages of 10 and skeletal maturity. By definition, idiopathic conditions have no known cause, but other forms of scoliosis may be present at birth (congenital scoliosis) or stem from known causes such as an accident or traumatic injury, underlying neuromuscular conditions (neuromuscular scoliosis), or age-related wear and tear (degenerative scoliosis).
Scoliosis Symptoms
The symptoms of scoliosis can vary from individual to individual depending on a variety of factors, but often include one or more of the following:
- “C” or “S”-shaped curvature of the spine when viewed from behind
- Uneven shoulders, ribs, hips, and or leg length
- One shoulder blade that protrudes further than the other
- Back/leg/hip pain, numbness, and/or weakness
- Twisting of the spine and/or the formation of a hump on the back
- Abnormal gait
- Limited range of motion in the spine
- Difficulty standing up straight
- Bowel, bladder, or motor issues (severe cases)
- Breathing problems (severe cases)
Determining The Severity Of Scoliosis
One of the major indicators in determining the severity of scoliosis is the Cobb angle, a measurement of the degree of spinal curvature. The number of degrees in the Cobb angle corresponds to the severity of the condition as follows:
- 1-10 degrees – A Cobb angle of less than 10 degrees is considered normal.
- 10-20 degrees – A Cobb angle in this range indicates mild scoliosis.
- 20-30 degrees – In this range, scoliosis is considered to be moderate.
- More than 40 degrees – A spinal curve greater than 40 degrees is indicative of severe scoliosis.
Scoliosis In Children And Adolescents
Although scoliosis can affect individuals of any age, from infants to seniors, it is most commonly diagnosed during early adolescence, between the ages of 10 to 15. Some young people living with the condition experience very few symptoms (or even none at all), while others may suffer from ongoing pain, postural imbalances, and/or mobility issues. In the most severe cases, scoliosis can put pressure on the thoracic cavity, resulting in difficulty breathing.
Aside from the physical symptoms associated with scoliosis, the condition can also impact the mental and emotional health of children and adolescents. Young patients may experience anxiety about undergoing treatment or feel shyness/embarrassment about their physical appearance or inability to participate in certain types of activities. Providing comprehensive support to children and teens as they navigate the physical, mental, social, and emotional complexities of a scoliosis diagnosis is critical.
The Importance Of Early Detection
The sooner scoliosis is diagnosed, the sooner it can be addressed. In mild cases, nothing more may be necessary than scheduling regular check-up appointments to monitor the progression of the condition. Ongoing examinations, X-rays, and spine measurements can help ensure that any evolution in spinal curvature is noted in a timely manner so that treatment can be initiated.
Depending on the circumstances, conservative treatments such as bracing and/or physical therapy may be recommended immediately upon the diagnosis of scoliosis. Starting treatment right away at the youngest age possible, while the spine is still flexible and before further complications have developed, can help prevent curve progression and reduce the likelihood that surgery will be necessary in the future.
The spine becomes more rigid and less responsive to treatment over time, which is one reason why surgery may be considered at a young age to address severe scoliosis. No matter the exact age of the patient or the type/severity of the condition, early diagnosis and intervention are vital to giving children and youth the best chances of minimizing the symptoms and impacts of scoliosis.
Non-Surgical Treatment Options
The vast majority of scoliosis cases can be effectively managed without surgery. Even severe cases may be highly responsive to conservative treatment approaches, which focus on preventing the progression of the condition. At the New Jersey Spine Institute, we rarely recommend surgical treatment for young patients before implementing a conservative treatment plan that includes one or more of the following:
Bracing
Bracing with a rigid or flexible brace is usually recommended as a treatment option for moderate to severe cases of scoliosis in the thoracic (middle) or lumbar (lower) back. It is most effective in individuals who are still growing. The goal of bracing is to prevent further progression of the spinal curve while also working to correct it. The brace applies pressure to the outer part of the spinal curve, slowing down its growth and forcing it to straighten.
Physical Therapy
Physical therapy aims to reduce pain, improve spinal alignment, increase strength and range of motion in the spine and core, improve posture, and ultimately prevent further progression of the spinal curve. It is often recommended in combination with other conservative treatment options, such as bracing.
During physical therapy sessions, young patients receive hands-on treatments as well as learn specific exercises and techniques to do at home. These may focus on improving strength, flexibility, balance, and/or posture.
Other Conservative Treatment Options
Other conservative treatment options for scoliosis may include pain management and activity modification as well as complementary therapies such as chiropractic care, massage therapy, acupuncture, and targeted exercise.
Surgical Treatment
Surgical treatment for scoliosis may be considered in cases where the condition is severe, progressive, and/or unresponsive to conservative treatment approaches. While surgical techniques can help to actively relieve serious symptoms at any age, the primary reason for performing scoliosis surgery at an early age is to prevent further progression of the spinal curve over time.
Determining The Need For Surgical Intervention
Surgical intervention is often considered in scoliosis cases where the spinal curve measures greater than 40 degrees. Young people living with scoliosis tend to experience increases in spinal curvature during periods of growth, so if spinal curvature is already within or close to the severe range prior to an expected growth spurt, the need for surgical intervention may be evaluated as higher. This is often the case for patients with severe scoliosis who are approaching puberty and its associated growth spurt(s).
At the New Jersey Spine Institute, our highly qualified and experienced doctors are aware that the decision to undergo scoliosis surgery is never a simple one. Whether you are considering the procedure for yourself or your child, we will take the time to answer all of your questions and help you thoroughly understand its potential benefits and risks so that you can make the most informed decision possible. Every patient’s circumstances are unique, and we are dedicated to tailoring treatment to the specifics of each case.
Factors That Influence The Best Age For Scoliosis Surgery
A broad spectrum of factors comes into play when considering the best age for scoliosis surgery. These can include:
- Type, Scope, and Location of the Condition – Surgery is more often recommended in cases where the curve is severe or multiple curves exist in different areas of the spine. Cases of neuromuscular scoliosis may be more likely to be treated surgically than other forms of the condition.
- Severity of the Curve – Surgery is generally considered in cases where the Cobb angle is greater than 40 degrees.
- Curve Progression – When the spinal curve is progressively worsening or is projected to worsen during an upcoming growth spurt, surgery is often considered.
- Response to Conservative Treatments – If the condition is severe and unresponsive to non-surgical interventions, surgery may be the next step.
- Symptom Severity – Patients experiencing breathing problems and/or major limitations on daily activities and quality of life due to scoliosis are often prioritized for surgery no matter their age.
- Skeletal Maturity/Growth Patterns – Your surgeon will carefully analyze your child’s skeletal maturity and growth patterns before recommending the optimal timing for scoliosis surgery.
Impacts And Benefits Of Surgery At Different Ages
There is no one-size-fits-all answer to the question, when is the best age for scoliosis surgery?
The decision to take a surgical approach to scoliosis treatment is based much more on the severity and progression of the condition than it is on a particular biological age. Scoliosis surgery can greatly improve spine health and quality of life over the long term but like any surgical intervention, also comes with the potential for risks and complications at various ages.
Benefits associated with scoliosis surgery at a young age may include a quicker recovery time and a higher degree of resiliency due to the flexibility of the still-growing spine. Risks may include further spinal changes as spinal growth continues over time and the inherent potential for complications associated with surgery.
Types Of Scoliosis Surgery
At the New Jersey Spine Institute, we will work closely with you to determine the best type of surgical intervention based on the specifics of your case or your child’s case. The two scoliosis surgeries we most commonly perform are:
- Spinal Fusion – Two or more vertebrae are fused together in order to stabilize the spine and stop curve progression. This surgery is usually most effective in older children/adolescents or adult patients.
- Growing Rod Surgery – This technique may be recommended for young children with severe scoliosis. Expandable rods are attached to the spine to hold it in proper alignment and extended progressively as the child’s spine grows over time.
Minimally Invasive Options
At the New Jersey Spine Institute, we are committed to using minimally invasive surgical techniques to reduce the risk of complications and speed recovery times whenever possible. Speak with us directly to learn more about the surgical approach we believe will be most effective based on your particular needs, goals, and circumstances.
Preparing Your Child For Surgery
If the decision is made to move forward with scoliosis surgery for your child, our dedicated team at the New Jersey Spine Institute will provide detailed information and instructions to help your family prepare. Supporting your child physically and emotionally at every stage is vital, and we will be there to answer all of your questions and help you ensure the smoothest experience and best outcomes possible.
What To Expect During Surgery And Recovery
Every patient and procedure is unique, so it’s best to consult directly with your surgeon for an accurate estimate of what to expect during and following scoliosis surgery. Generally speaking, most patients will spend a few days in the hospital after the surgery has been completed before being discharged for 3 to 4 weeks of at-home recovery. Most children can return to school approximately a month after scoliosis surgery and gradually return to more physically demanding activities over the course of 3 to 6 months.
Risks And Complications
As with any surgical procedure, scoliosis surgery comes with the potential for various risks and complications including:
- Infection
- Bleeding
- Nerve damage
- Hardware failure
- Failure of the bones to fuse properly
Speak directly with your surgical team for further information about potential risks and complications based on the specifics of your case.
Consult With The Board-Certified Surgeons At The New Jersey Spine Institute
No matter your age or the age of your child, the New Jersey Spine Institute is your trusted provider of state-of-the-art scoliosis treatment in New Jersey. Schedule an initial consultation with our board-certified surgeons today to receive a personalized treatment plan and take your first steps on the road to recovery. We look forward to working with you!