Many patients are aware that their curves are slowly getting worse up until the time that they have surgery. Often they want to know how much their abnormal curve can be corrected at the time of surgery. It is important to remember that the goals of fusion surgery for scoliosis include both correcting the curve, and stopping it from getting worse later on. In many instances of adult scoliosis, stopping the curve from getting worse later on is a more important goal of surgery.
Correction of scoliosis in adults is very different than the correction of scoliosis in children. The causes of scoliosis are different in adults, and the flexibility of the spine is usually significantly decreased with age. As a result, adults who undergo spinal fusions can normally expect less than 50% correction of their original curve, whereas the same curve in a child may be 80% correctable. Complete correction of the curve is rarely possible in adults, especially when the curve is quite large originally.
Will the curve continue to progress after surgery?
It is not unusual for curves to get slightly worse after being corrected at the time of surgery. This is because the curve settles into a new position as the fusion is occurring. After six months, the fusion should be solid and the curve should not change significantly from that point on. However, even after a solid fusion has developed, slight curves at the top and the bottom of the major curve that are not included in the spinal fusion may get slightly worse.
If the curve continues to get significantly worse after surgery, this is often a sign that a fusion between the vertebral bodies has not occurred. As a result, there is still some motion between the vertebral segments that were meant to be fused together. A lack of fusion at one or more vertebral body levels is called a "pseudoarthrosis", which means a false joint. This can be a significant problem after spine surgery and may require further operations in order to correct the problem. One of the best things that patients can do in order to avoid the chance of developing a pseudoarthrosis is not to smoke before and after their surgery. Smoking cigarettes, chewing tobacco, or using a nicotine patch has been shown to interfere with the blood flow to the area that is trying to fuse together. This significantly decreases the chances of a solid fusion occurring.
It is important to discuss the potential risks, complications, and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
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