Severe Scoliosis: Surgical Options and Risks Explained

Regarding severe scoliosis?

My girlfriend has a scoliosis of about 55 degrees, in an S-shape, which was discovered approximately five years ago.
During this time, the recommendations from Western medicine have indicated that surgery is the only solution.
She has also tried various alternative therapies, including traditional Chinese medicine, acupuncture, cupping, and spinal adjustments, and has explored these options throughout Taiwan.
Additionally, she has been practicing yoga regularly, which is said to be beneficial, but there has been no improvement to date.

According to Western medical advice, the X-ray results from five years ago to now show that the curvature has neither worsened nor improved, meaning the angle is approximately the same.
Therefore, surgery is an option, but there is no urgency to proceed, as spinal surgery carries risks.
Based on my research, a curvature of 55 degrees is unlikely to respond to physical therapy, and surgery appears to be the only viable option.
However, spinal surgery is considered a significant procedure, and the potential for complications is considerable.
Doctors do not guarantee that surgery will lead to improvement; there is a possibility that the curvature may recur after surgery.
I would like to inquire about the success rate of the surgery expressed as a percentage.
What are the risks associated with the procedure, such as paralysis or death? What are the potential complications? Is there a high likelihood of the curvature returning post-surgery? From my research, I understand that spinal surgery can be performed from the front or the back; what factors determine which approach is chosen, and which is preferable? How large would the scar be?
I have also come across a KTT sound wave therapy (http://www.kkt-center.net) that claims to be non-invasive and drug-free.
Reports have circulated about it, and it seems to be gaining popularity online.
I inquired about the cost, which is approximately 50,000 TWD for a complete treatment of 16 sessions.
What is the credibility of this therapy? Are there any medical foundations or clinical success cases supporting it? If it is genuinely effective, I would consider it a worthwhile investment, regardless of the cost.
She mentioned that doctors generally advise against pregnancy for individuals with a curvature above 50 degrees, as the spine may not be able to bear the strain.
Is this true? Given that she has a 55-degree curvature and an S-shape, the physical manifestations are quite apparent, with her right scapula noticeably protruding, uneven pelvic height, atrophy of the left lumbar muscles, and visible discrepancies in leg length when lying down.
She was diagnosed while still in middle school, and now as a university student, this condition has affected her self-esteem and personality, leading to feelings of insecurity and even suicidal thoughts.
Her parents oppose surgery due to the significant risks involved and the uncertainty of post-operative improvement.
Currently, she only visits a traditional Chinese medicine practitioner for spinal adjustments once a month and goes to a major hospital for X-ray follow-ups every six months.
It is widely understood that physical therapy is unlikely to resolve her condition; it seems more like a form of self-comfort and struggle.
I support her decision to undergo surgery, and if it is the only path forward, I will advocate for it to her parents.

Youxia, 20~29 year old female. Ask Date: 2005/09/21

Dr. Shi Guozheng reply Orthopedics

A curvature angle of 55 degrees is considered moderate, and it can typically be corrected with a success rate of about 50-60%.
The only significant risk is that excessive correction may potentially injure the nerves.
Surgery is usually performed from the posterior approach, but if the spine is very rigid, a combined anterior and posterior approach may be considered.
Other methods lack evidence to prove their effectiveness.

Reply Date: 2005/09/21

More Info

Understanding severe scoliosis, particularly when it presents at a curvature of approximately 55 degrees, is crucial for determining the best course of action for treatment. Scoliosis can lead to various complications, including chronic pain, respiratory issues, and psychological effects due to physical appearance. Given your girlfriend's situation, let's explore the surgical options, risks, and potential outcomes.

Surgical Options
When it comes to treating severe scoliosis, especially with a curvature of 55 degrees, surgery is often considered the most effective option. The primary surgical procedure for scoliosis is spinal fusion, where the surgeon connects two or more vertebrae to stabilize the spine and prevent further curvature. The surgery can be performed through two main approaches:
1. Posterior Approach: This is the most common method, where the surgeon accesses the spine from the back. It allows for direct visualization of the spine and the placement of rods and screws to correct the curvature.

2. Anterior Approach: In some cases, the surgeon may opt to approach the spine from the front. This method can be beneficial for certain types of curves and allows for a different angle of correction.

The choice between these approaches depends on the specific characteristics of the scoliosis, the age of the patient, and the surgeon's expertise.

Risks and Success Rates
Surgery for scoliosis is not without risks. The potential complications include:
- Infection: As with any surgical procedure, there is a risk of infection at the surgical site.

- Nerve Damage: There is a small risk of nerve injury during surgery, which could lead to numbness, weakness, or paralysis.

- Blood Loss: Significant blood loss can occur during surgery, necessitating transfusions.

- Failure to Correct Curvature: In some cases, the surgery may not achieve the desired correction, or the curvature may recur over time.

- Anesthesia Risks: General anesthesia carries its own risks, especially in patients with underlying health conditions.

The success rate for scoliosis surgery is generally high, with many studies reporting improvement in curvature and reduction in pain. However, the exact percentage can vary based on individual circumstances. A rough estimate suggests that the success rate can be around 70-90% for achieving a significant reduction in curvature and improvement in quality of life.

Postoperative Considerations
Post-surgery, patients may experience some level of discomfort and will need to undergo rehabilitation. Physical therapy is crucial for recovery, helping to strengthen the back muscles and improve flexibility. While some patients may experience a return of curvature over time, the likelihood of significant regression is generally low if the surgery is successful.

Alternative Treatments
You mentioned exploring various non-surgical treatments, including traditional Chinese medicine and physical therapy. While these methods can provide symptomatic relief, they are unlikely to correct a severe curvature like 55 degrees. The KTT sound wave therapy you referenced is a newer treatment modality, but its efficacy for severe scoliosis lacks substantial clinical evidence. It is essential to approach such treatments with caution and consult healthcare professionals about their validity.

Psychological Impact
The psychological effects of scoliosis, particularly in young women, can be profound. Body image issues and self-esteem challenges are common. If surgery is deemed necessary, it may not only improve physical health but also enhance mental well-being by alleviating the distress associated with the condition.

Conclusion
In summary, while surgery for scoliosis carries risks, it is often the most effective treatment for severe cases. Given your girlfriend's situation, it is essential to have an open discussion with her parents and healthcare providers about the potential benefits and risks of surgery. If surgery is pursued, selecting a skilled surgeon with experience in scoliosis correction is crucial. Ultimately, the decision should prioritize her health, well-being, and quality of life.

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