Scoliosis that progresses beyond a certain point may require surgical treatment to prevent further curvature, improve spinal alignment, and protect lung function. While many children and adults can manage scoliosis with bracing and physical therapy, curves that reach 45–50 degrees typically require scoliosis surgery to stop progression and correct deformity.

This guide covers everything families need to know about scoliosis surgery, including spinal fusion, vertebral body tethering (VBT), fusionless options, recovery, risks, and what to expect before and after treatment.

When Is Surgical Treatment for Scoliosis Needed?

Most scoliosis specialists agree that surgery should be considered when:

✔ Curves exceed 45–50 degrees

Research shows these curves usually worsen even after growth stops. Surgery prevents progression and improves appearance.

✔ Curves between 40–50 degrees show rapid progression

Young patients still growing may need surgery sooner to prevent severe deformity.

✔ The curve affects breathing or lung function

Severe thoracic curves can limit rib cage expansion.

✔ Back pain is significant or worsening

While many mild curves don’t cause pain, severe scoliosis can lead to chronic discomfort.

Types of Scoliosis Surgery

1. Spinal Fusion for Scoliosis (Gold Standard Treatment)

The most common scoliosis surgery is posterior spinal fusion, which uses rods, screws, hooks, or wires to straighten the spine. A bone graft is then placed to fuse the affected vertebrae into a single solid bone.

How spinal fusion works

Curved vertebrae are repositioned and stabilized
Metal implants hold the spine in the corrected position
Bone grafts encourage healing and fusion
Over several months, the fused section becomes solid and can no longer curve

Why fusion is effective

Stops curve progression permanently
Significantly improves alignment
Proven long-term results

Fusion eliminates movement in the fused area, but most patients retain normal mobility because the rest of the spine compensates.

2. Vertebral Body Tethering (VBT) – Fusionless Scoliosis Surgery

A newer option for children and adolescents still growing is vertebral body tethering (VBT). This fusionless surgery uses screws and a flexible tether to guide spinal growth.

How VBT works

Screws are placed along the curved side of the spine
A flexible cord (tether) is connected between them
Gentle tension partially corrects the curve at surgery
As the child grows, the tether slowly straightens the spine

Benefits of VBT

Preserves spinal flexibility
Small incisions
Faster recovery compared to fusion
Allows continued spinal growth

Ideal candidates

Children still growing
Curves between 35–65 degrees
Flexible curves based on bending X-rays

VBT is promising, but long-term research is still emerging. Tether breakage remains a known risk.

3. Anterior vs Posterior Scoliosis Surgery Techniques

Posterior approach (most common)

Incision down the back
Rods and screws placed to straighten the spine
Typically used for thoracic and lumbar curves

Anterior approach

Incision through the side or chest
A section of rib may be removed
Discs between vertebrae may be removed to improve correction
Lung must be temporarily deflated

Anterior surgery is less common today but still used for certain curve patterns.

Combined anterior/posterior surgery

Used for very stiff or severe curves requiring maximum correction.

X-Rays: Before and After Scoliosis Surgery

Modern surgical techniques often reduce large curves to under 25 degrees, with significant cosmetic improvement.

Common Questions About Scoliosis Surgery

How straight will my spine be after surgery?

Your spine will be corrected as far as safely possible. Flexibility on bending X-rays helps determine how much correction is achievable.

Will surgery relieve my back pain?

Most patients experience less back pain one year after surgery. Post-operative pain gradually decreases over 3–12 weeks.

Will I ever have a completely straight spine?

Some residual curve usually remains, but it is typically mild and not noticeable.

Bone Grafts Used in Scoliosis Surgery

Bone grafts help the vertebrae fuse.

Types of bone grafts

Autograft (patient’s own bone) — best for healing but requires an additional incision
Allograft (donor bone) — commonly used, avoids extra surgical site
Synthetic bone grafts — used alongside other graft materials

How Long Does Scoliosis Surgery Take?

Most spinal fusions last 4 to 8 hours, depending on:

Curve size
Number of vertebrae fused
Surgical approach

Preparation, anesthesia, and positioning also add time.

Pain After Scoliosis Surgery

Pain varies by patient but generally follows this timeline:

Days 1–3: Most uncomfortable
Day 3–4: Begin walking and moving
Weeks 2–3: Pain greatly decreases
Weeks 4–6: Most teens return to school
3–6 months: Mild soreness may linger

Pain control may include:

PCA pump
IV pain medication
Oral pain medication
Transition off opioids as soon as possible

Do Rods Stay in the Spine Forever?

Yes. Spinal implants are typically left in place permanently. Removal is only needed in rare cases such as:

Infection
Hardware breakage
Persistent pain

Will Fusion Make My Back Stiff?

Only the fused part of the spine becomes stiff. Most patients maintain normal movement and return to:

School
Work
Sports
Activities of daily living

Contact sports usually resume once the fusion is fully healed (6–12 months).

Fusionless Scoliosis Surgery: Is It an Option?

Fusion-less options such as VBT or growth modulation are available only for:

Skeletally immature patients
Moderate curves
Flexible spines

Fusion is still the gold standard for long-term stability and prevention of curve progression.

Scoliosis Surgery Recovery Timeline

Hospital Stay: 3–4 days

Return to School: 4–6 weeks

Activities & Sports: 2–6 months

Full Fusion: 6–12 months

Patients may need:

Physical therapy
A back brace (depending on the surgeon)
Regular follow-up X-rays

After Surgery: What to Expect

Patients may experience:

Temporary bowel slowdown
Chest tube placement (for anterior surgery)
Bladder catheter for 1–2 days
IV fluids and medication
A brace or cast, depending on technique used

Your surgeon will provide detailed instructions for home care.

Scoliosis Surgery for Children

In children with scoliosis, surgery may be needed when:

Curves exceed 40–45 degrees
Bracing no longer prevents progression
Curves worsen rapidly during growth spurts
Severe curves impact appearance, pain, or breathing

Child scoliosis surgery may involve:

Posterior spinal fusion
Anterior fusion
Thoracotomy (chest incision)
Video-Assisted Thoracoscopic Surgery (VATS)
VBT for growing children

Children often recover faster than adults and typically resume normal life within months.

Risks of Scoliosis Surgery

While scoliosis surgery is safe, risks include:

Bleeding or transfusion
Infection
Nerve injury (very rare — approx. 1 in 300 cases)
Lung issues (temporary)
Pseudarthrosis (incomplete fusion)
Hardware irritation
Future curve progression (mainly in young children)

Surgeons use real-time nerve monitoring throughout the procedure to protect the spinal cord.

Before Surgery: What Families Should Do

Complete a full medical evaluation
Learn breathing exercises
Practice safe movement techniques (log rolling)
Stop certain medications before surgery
Avoid nicotine exposure
Bank autologous blood if recommended
Report any illness before surgery

After Surgery: Home Care & Follow-Up

Keep incision clean and dry
Limit bending and lifting
Follow your surgeon’s pain management plan
Wear a brace if recommended
Return for routine X-rays
Watch for signs of infection

Most children and teens feel significantly better after 2–3 weeks.

Outlook & Long-Term Results

Scoliosis surgery has an excellent success rate. After treatment:

The spine is significantly straighter
Most curves improve to under 25 degrees
Cosmetic appearance improves dramatically
Lung function is preserved
Back pain often decreases
Spinal fusion is permanent and prevents future curve progression

Children typically gain height from both growth and spinal straightening.

Get Help With Scoliosis Treatment

If you or your child has a curve over 40 degrees or has a curve that is worsening, speak with a scoliosis specialist immediately. Early evaluation leads to better outcomes — and a safer, more effective recovery.