Degenerative Scoliosis Surgery

1. What is it? Any common name for this procedure?

Degenerative Scoliosis Surgery (also known as Adult-Onset Scoliosis Surgery) is a corrective procedure for a side-to-side curvature of the spine that develops in adulthood. Unlike adolescent scoliosis, which is often idiopathic, degenerative scoliosis is caused by the "wear and tear" of spinal discs and facet joints.

As the discs collapse unevenly, the spine begins to tilt and twist, often resulting in a "leaning" posture. The surgery usually involves a combination of decompression (clearing space for nerves) and stabilization (using rods, screws, and cages to straighten and fuse the spine).

Common Names:

• Adult Spinal Deformity (ASD) Surgery
• Long-Segment Spinal Fusion
• Complex Spinal Reconstruction

2. Common Indications: When is it Recommended?

Surgery is typically considered the last resort when the deformity significantly impacts quality of life.

• Neurogenic Claudication: Severe leg pain or heaviness when walking, caused by narrowed nerve tunnels (stenosis).
• Progressive Deformity: The curve is visibly worsening (e.g., more than 5 degrees per year).
• Sagittal Imbalance: The patient is leaning so far forward or to the side that they cannot stand upright without bending their knees.
• Intractable Pain: Chronic back and leg pain that no longer responds to injections, bracing, or physical therapy.

3. List of Associated Risks and Conditions

• Proximal Junctional Kyphosis (PJK): A common complication where the spine develops a new "hunch" or fracture just above the top of the metal rods.
• Pseudarthrosis: When the bones fail to fuse together, which can eventually lead to the metal rods breaking.
• Flatback Syndrome: Loss of the natural curve in the lower back, making it hard to stand straight.
• Nerve Injury: Due to the complexity of straightening a twisted spine, there is a risk of temporary or permanent nerve irritation.

4. List of Screening Tests and Assessment Tools

5. Am I Eligible for This Evaluation?

• Failed Conservative Care: You have completed at least 6 months of physical therapy and pain management without success.
• Medical Clearance: Because this is a major surgery, you must have your heart, lungs, and bone density cleared by specialists.
• Non-Smoker: Most surgeons will not perform this surgery unless you have been nicotine-free for at least 6 weeks, as smoking prevents bone fusion.
• Functional Limitation: You have significant difficulty walking more than a block or standing for more than 10–15 minutes.

6. Common Surgical Techniques

• Decompression Only: For patients with leg pain but a stable curve (rarely done for scoliosis alone).
• Posterior Instrumented Fusion: Using screws and rods from the back to pull the spine into alignment.
• Interbody Fusion (XLIF/OLIF/ALIF): Using cages from the front or side to "jack up" collapsed discs and restore height before the rods are placed.
• Osteotomy: In severe cases, the surgeon may need to remove a wedge of bone to "break" a stiff curve and realign the spine.

7. Days Required for Hospitalization

• Surgical Time: 4 to 10 hours (sometimes performed in two stages over two different days).
• In-Hospital Stay: 3 to 7 Days.
• Rehabilitation: Many patients go to a rehab facility for 1–2 weeks after hospital discharge to regain strength.
• Full Recovery: It takes 6 to 12 months for the long fusion to solidify.

Hospitalization: 3–7 Days.

8. Benefits of Degenerative Scoliosis Surgery

• Improved Posture: Patients can stand up straight again, which reduces muscle fatigue and "leaning."
• Leg Pain Relief: Decompressing the nerves significantly improves the ability to walk and stand.
• Prevention of Decline: It prevents the curve from progressing to the point of total disability or paralysis.
• Restored Balance: Proper alignment reduces the risk of falls and improves the overall mechanical efficiency of the body.