When is Scoliosis Surgery Necessary in Children?

Dear Parents,

Determining the right timing for surgery for your child diagnosed with scoliosis is one of the most difficult decisions. As an orthopedic specialist, I understand the anxiety you experience during this process. I would like to share with you, based on my professional experience, the objective criteria upon which the decision for surgery is based.

My goal is to inform you, reduce your concerns, and strengthen your communication with your doctor.

Not Just a Number: A Holistic Assessment

Families often expect a specific number as an answer to the question, "At how many degrees is surgery necessary?" However, real life isn't that simple. While the 40-50 degree range is generally the critical threshold where we consider surgery, we do not base our decision solely on this number. The decision for surgery is made by evaluating four fundamental factors that come together like pieces of a puzzle:

1. Cobb Angle (Degree of Curvature):

  • Between 25-45 Degrees: Typically, if the child has growth potential, the goal is monitoring with brace treatment to stop progression.

  • 40-50 Degrees and Above: This threshold is one of the most important indicators for surgery. Especially if the child is still growing, the risk of progression for curvatures of this degree is very high. Surgery stops this progression and corrects the existing curvature.

  • Above 50 Degrees: Scientific studies show that even in individuals who have reached skeletal maturity, curvatures above 50 degrees can continue to progress throughout life by about 0.5-1 degree per year. Therefore, for curvatures of this degree, surgery is considered to prevent future problems.

2. Child's Growth Potential (Bone Age and Risser Sign):
This can be a factor even more critical than the degree itself. We ask the question: "How much growth does the child have left?" The more growth remaining, the faster the curvature can progress. We assess this using bone age and the Risser sign (a growth area in the hip bone, usually graded from 0 to 5). A child with a Risser stage of 0-1 and a curvature above 40 degrees is among the strongest candidates for surgery.

3. Rate of Curvature Progression:
During follow-up, observing an increase of 5 degrees or more in the curvature between two control X-rays is a significant warning sign that requires us to change the treatment plan. If the curvature is progressing rapidly despite brace treatment, surgery should be considered.

4. Cosmetic Appearance and Quality of Life:
Scoliosis is not just an X-ray finding; it is a condition that affects the child's life. If a noticeable back hump (rib hump), shoulder and hip asymmetry are affecting the child's self-confidence, causing difficulty wearing clothes, and leading to social withdrawal, these factors play an important role in the surgical decision.

What are the Risks of Saying "Let's Wait"?

Sometimes families may want to postpone surgery or turn completely to alternative methods. This is understandable. However, waiting when a curvature requires surgery can carry the following risks:

  • The curvature increasing further, making the surgery technically more difficult.

  • A relatively lower correction rate in advanced curvatures.

  • Increased stiffness and reduced flexibility in the spine.

In Lieu of a Final Word: A Shared Decision-Making Journey

Remember, the most correct timing for your child is specific to their individual situation. The surgical decision may differ for a growing child with a 45-degree, rapidly progressing curvature and noticeable deformity, compared to a young adult with a 55-degree curvature who has reached skeletal maturity and whose progression has stopped.

We, as physicians, map out a path for you using scientific data, our clinical experience, and radiological findings. The final decision, however, is a shared one that must be made together with you, the families, equipped with this information, always keeping your child's best interests at heart.

Important Note: This article does not replace an orthopedic specialist's examination and consultation. Please consult your child's physician for all decisions regarding diagnosis, monitoring, and treatment. Every child is unique, and their treatment should be personalized.