There is more than one way to treat scoliosis, and fortunately, many cases can be treated non-surgically. While spinal fusion can make a crooked spine straighter, there are no guarantees that it will be successful at stopping progression, and how the spine is straightened can cause some long-term side effects.
The traditional scoliosis treatment approach funnels patients towards spinal fusion surgery, while a modern conservative approach uses proactive treatment to prevent the need for surgery. Long-term effects will vary, but commonly include a loss of spinal flexibility and decreased range of motion.
Before getting to the specifics of spinal fusion, let’s talk generally about the condition for a clearer understanding of how scoliosis, and different forms of treatment, can affect the spine’s long-term function and health.
A healthy spine will appear straight if viewed from the front and/or back, and will have an ‘S’ shape when viewed from either side; this is due to the spine’s natural and healthy curves in each of the spine’s main sections.
The spine has three main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
The spine’s natural curves make it stronger, more flexible, and better able to absorb stress: like a coiled spring.
When the spine loses one or more of its healthy curves, they’re replaced by bad curves, and this introduces a lot of uneven forces to the body, disrupting the biomechanics of the entire spine.
A scoliotic spine has an unnatural sideways spinal curve, with rotation, and a Cobb angle measurement of 10 degrees; a patient’s Cobb angle is taken during X-ray by drawing intersecting lines from the tops and bottoms of the most-tilted vertebrae at the curve’s apex.
The resulting angle is expressed in degrees and tells me how far out of alignment a scoliotic spine is, while classifying condition severity:
As you can see, scoliosis ranges widely in severity, and as a progressive condition, where scoliosis is at the time of diagnosis is not indicative of where it will stay.
A case of mild scoliosis can easily progress to moderate or severe, especially if left untreated, or not treated proactively.
Proactive treatment can help prevent progression, escalating symptoms, and the need for invasive treatment in the future, like spinal fusion.
For those on the path of traditional scoliosis treatment, spinal fusion is commonly recommended once progression has continued past the severe classification, increasing the likelihood of continued progression.
While there are different types of spinal fusion surgery, it commonly involves fusing the curve’s most-tilted vertebrae together into one solid bone.
The goal of spinal fusion surgery is not to correct scoliosis, but to prevent it from getting worse (progressing).
Rods are commonly attached to the spine with screws to hold it in place while the vertebrae continue to heal, and the hardware used is permanently attached to the spine.
When successful, the fusing of the vertebrae eliminates movement in the area, and related progression, but there is no guarantee that it will do so, and spinal fusion, like all surgeries, comes with its share of risks and potential long-term side effects.
Just as scoliosis is a highly-variable condition ranging from mild to severe, the way patients respond to spinal fusion can be equally varied.
Important patient/condition variables such as age and overall health, condition type, severity, fusion location, whether or not there were complications, and the number of vertebrae fused all factor into how a patient is likely to respond to the surgery.
When it comes to spinal fusion, there are both short- and long-term risks associated with the procedure, and while not every patient will experience these side effects, the risk is there so should be considered carefully.
Risks associated with the procedure itself can include:
In addition to the potential short-term effects of spinal fusion, there are some commonly reported long-term side effects, but there is also a large gap in the research/data on what happens to a fused spine long term, so there could still be some long-term effects we’re simply unaware of.
For example, hardware longevity has to be a factor, and considering the age group most commonly diagnosed with scoliosis (adolescents), the hardware has to last a long time.
If a rod, screw, or hook is to fail, the only recourse is more surgery, and facing all the associated risks again; just like most surgical procedures, they get riskier with age.
The most common complaint of patients post-spinal fusion is a loss in spinal flexibility and range of motion.
As movement in the fused section of the spine is eliminated, this means it’s not functioning properly (the very design of the spine is based on movement).
In addition to the spine’s rigidity causing mobility issues, and pain in many cases, its surrounding muscles can also be affected by the fusion, becoming strained and tight.
A fused spine is more vulnerable to injury, and a loss in spinal flexibility and range of motion means some patients have unexpected post-surgical activity restrictions after scoliosis surgery.
In addition, there is the very real psychological effect of living with a fused spine; some patients have reported that being aware of their increased risk of spinal injury has made them fearful of trying new things and affected their overall quality of life.
Under a conservative chiropractic-centered scoliosis treatment approach, proactive treatment is applied as close to the time of diagnosis as possible, with the goal of preventing progression past the surgical-level threshold.
A conservative approach is integrative, combining multiple condition-specific treatment disciplines so treatment plans can be fully customized to impact the condition on every level.
As a CLEAR-certified scoliosis chiropractor, I provide patients with a non-surgical alternative to traditional treatment through the combination of chiropractic care, in-office therapy, corrective bracing, and custom-prescribed home exercises.
The end goal of conservative treatment is achieving corrective results so surgery can be avoided and as much of the spine’s natural function as possible can be preserved.
I apply manual adjustments and a variety of chiropractic techniques to work towards repositioning the most-tilted vertebrae back into alignment with the rest of the spine.
Through a variety of in-office therapies, I can help patients increase their core strength so spines are optimally supported by their surrounding muscles.
Corrective bracing, like the ScoliBrace, can augment corrective results achieved through other forms of treatment by pushing the spine into a corrective position and addressing the condition’s true 3-dimensional nature.
Custom-prescribed home exercises are part of a home-rehabilitation program that’s key to further stabilizing the spine for sustainable long-term results, and in addition, certain scoliosis-specific exercises (SSEs) are known to activate specific areas of the brain for postural remodeling, improved brain-body communication, and more-natural body positioning.
Remember, a spine that’s held in place through artificial means (spinal fusion) is not the same as actually correcting scoliosis on a structural level.
When it comes to the long-term side effects of spinal fusion surgery, they will vary from one patient to the next, but among the most-commonly reported are a loss in spinal flexibility and range of motion.
Due to the increased spinal rigidity and loss of motion in the fused section of the spine, pain at the fusion site can also be a long-term effect.
However, it’s also important to understand that in addition to the aforementioned known potential side effects, there is a gap in the research/data on the long-term effects of life with a fused spine 20, 30, 40+ years down the road.
How long does the hardware last? It’s bound to fail at some point, and the younger the patient, the longer it has to last. More surgery is the usual recourse when there is a hardware-related issue.
There is also the psychological effect of living with a fused spine and knowing it’s more vulnerable to injury.
What I want patients, and their families, to understand is that there is more than just one treatment option available, and not all scoliosis journeys have to end in surgery.
In fact, a proactive conservative treatment approach can take degrees off a curve while increasing core strength so the spine is optimally supported and as much of the spine's natural function as possible is preserved.
For those who choose to forgo a surgical recommendation, or want to try a less-invasive treatment option first, the potential long-term side effects of spinal fusion surgery can be avoided through chiropractic-centered treatment that can offer corrective results.
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