What Happens If You Don’t Get Surgery For Scoliosis?

A diagnosis of scoliosis doesn't have to mean a life of limitation, nor does it have to mean surgical interventions will be needed. While some cases of scoliosis that are particularly severe and/or atypical require surgical intervention, typical cases of scoliosis are different; continue reading to find out why.

Most people have heard of scoliosis, and many think surgical treatment is the only recourse. The reality is that many cases of scoliosis don't need surgical treatment, particularly with early diagnosis and intervention.

There are many different types of scoliosis, and it's important to know the difference because it can mean understanding how different types of treatment will shape long-term spinal health.

Scoliosis and Surgery

Scoliosis causes the spine to bend unnaturally to the side and rotate, making it a 3-dimensional condition that can be complex to treat.

In addition, as a progressive condition, the nature of scoliosis is to become more severe over time, and it's growth that triggers progression.

Scoliosis progressing means the size of the unnatural spinal curve is increasing, symptoms are becoming more overt, and the more severe a condition gets, the closer that patient is moving towards the necessity of surgical intervention.

But in many cases, had proactive treatment been applied early on, the necessity of surgery could have been avoided.

Scoliosis progression can often be managed with a proactive treatment response, but condition type is an important factor when it comes to whether or not surgery is necessary.

Scoliosis surgery is invasive so should be considered carefully, and it's important that patients suffering from scoliosis understand there is also an effective non-surgical treatment option: conservative scoliosis treatment.

Condition severity and type are two determinants of a surgical recommendation, so let's start with how condition severity is determined.

Condition Severity

Condition severity is determined by the size of the unnatural spinal curve and the angle of trunk rotation (ATR).

The larger the unnatural spinal curvature, the more unnaturally-tilted its vertebrae are, the further out of alignment the spine is, and the more noticeable condition effects are going to be.

In addition, the more severe a patient's scoliosis, the more likely it is to continue progressing and becoming more severe.

Even scoliosis diagnosed initially as mild scoliosis can become moderate, severe, or very severe if left untreated, or not treated proactively.

A measurement known as Cobb angle is taken during X-ray and determines condition severity:

• Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40+ degrees
• Very-severe scoliosis: Cobb angle measurement of 80+ degrees

For patients on the path of traditional scoliosis treatment, surgery is commonly recommended for severe curves of 40+ degrees; patients who are unaware of other treatment options can be funneled towards surgery.

And it's important to understand that as traditional scoliosis treatment has no strategy for addressing scoliosis while mild, watching and waiting is a common diagnosis response; meanwhile, curves can be progressing unimpeded, particularly in children having growth spurts.

As progression occurs, the spine is becoming increasingly rigid and less responsive to treatment, hence the benefit of starting proactive treatment that works towards preventing progression.

In many cases of typical scoliosis, had treatment been applied early on, progression into the severe classification could have been avoided, along with the recommendation of a surgical response.

Different condition types and severity levels have different characteristics, including treatment needs.

Typical vs Atypical Types of Scoliosis

Most cases of scoliosis are classified as idiopathic, meaning not clearly associated with a single-known cause.

Approximately 80 percent of known diagnosed cases are idiopathic, and in typical cases of idiopathic scoliosis, the unnatural spinal curve bends to the right, away from the heart, but in atypical cases, curves can bend to the left, towards the heart.

When I see a left-bending curve on an X-ray, I know it's an atypical case that's likely severe, or going to become severe, and these types can be particularly complex to treat.

The remaining 20 percent of known cases have known causes, can be particularly severe, and are the most likely to require future surgical intervention: congenital scoliosis, degenerative scoliosis, and neuromuscular scoliosis.

Scoliosis with Known Causes

When I see a curve bend to the left on an X-ray, I know it's an atypical type of scoliosis that will likely be severe and can require scoliosis surgery in the future.

Congenital scoliosis is a rare type affecting 1 in 10,000 and is caused by a malformed spine that develops in utero: babies are born with it.

Degenerative scoliosis affects older adults and is caused by natural age-related spinal degeneration, and as progression occurs, the spine can become increasingly unbalanced, unstable, and put these patients at risk for serious injury from falls.

Neuromuscular scoliosis (NMS) patients are generally my most severe cases because the scoliosis is caused by the presence of a larger neuromuscular condition such as spina bifida, cerebral palsy, or muscular dystrophy.

In these cases, because there is a larger medical condition causing the scoliosis to develop as a complication, the neuromuscular condition has to be the focus of treatment.

Some NMS patients end up unable to walk on their own and are wheelchair bound.

So in atypical cases where surgery is necessary, not getting treatment can have severe consequences, but in typical cases of idiopathic scoliosis that are diagnosed early, scoliosis surgery isn't always necessary, and then the question becomes, what happens if I get unnecessary scoliosis surgery?

Spinal Fusion and Long-Term Spinal Health

So in some instances, surgical intervention can be necessary, but I want awareness that these aren't generally typical cases.

In many cases, particularly with early detection and intervention, scoliosis can be highly responsive to a proactive non-surgical treatment plan.

Spinal fusion often involves removing intervertebral discs that sit between adjacent vertebrae to be fused and fusing the curve's most-tilted vertebrae into one solid bone. Metal rods are attached to the spine to maintain its position and alignment.

When successful, scoliosis surgery can straighten a bent spine, but the way it does so is invasive and contrary to the spine's natural movement-based design, so it can come with a price: long-term spinal health and function.

A spine that's fused is one that's going to be less flexible, and reduced range of motion in the back can interfere with activities and quality of life.

In addition, a fused spine is also weaker and more vulnerable to injury, and pain at the fusion site is also common.

So cases of typical idiopathic scoliosis that are addressed unnecessarily with spinal fusion can mean living with a spine that's less functional, and that's a significant risk to take.

Conclusion

The worst treatment choice that can be made is to leave scoliosis untreated; untreated scoliosis can become increasingly severe and develop related complications such as digestive issues and breathing problems.

Scoliosis surgery isn't always the answer; in fact, in some cases, it can be the wrong answer, and the way to avoid a mistake is to be informed and fully aware of all treatment options available.

Understanding the difference between typical cases of idiopathic scoliosis and particularly severe and/or atypical condition types is key when determining if surgery is a necessity, or a choice.

Another factor I want patients aware of is that a primary motivation for a surgical response is often misunderstood.

Many scoliosis patients choose surgery because they think it will reverse postural changes and restore their pre-scoliosis bodies, but this isn't the case; in fact, for those cosmetically motivated, conservative treatment is far more effective at restoring a patient's posture and improving postural changes.

Spinal fusion only addresses the spine and how the condition affects it, but conservative treatment is multifaceted so impacts conditions on every level, including how the condition affects the spine's surroundings and the entire body.

An important facet of conservative treatment is physical therapy, applied to improve posture and postural changes.

So what happens if you don't get surgery for scoliosis will depend on a number of factors, and in some cases, not getting surgery, if it means committing to a proactive conservative treatment plan early on, can mean treatment success and a spine that's stronger and healthier than one that's fused.

For those recently diagnosed, I recommend getting guidance on the different treatment options available so an informed treatment choice can be made.

Here at the Scoliosis Reduction Center®, patients benefit from a proactive non-surgical treatment alternative with proven results.