Surgical and Non-surgical Treatments for Scoliosis

Dr. LUK Dip Kei, Keith

Honorary Consultant in Orthopaedic Surgery

Specialist in Orthopaedics & Traumatology

Adolescent idiopathic scoliosis refers to a condition in which the spine curves to the left or right and becomes C- or S-shaped. There is increasing evidence that it has a genetic cause. It mainly occurs and worsens during the growth spurt period between age 10 and 15. Incorporated into the local Student Health Service Programme in 1995, millions of scoliosis screenings have been conducted over the past decades. With international acclaim, this initiative has successfully achieved "early detection, early treatment".

If a spinal curvature of less than 20 degrees is detected in local school-aged children upon screening with no signs of worsening, it only requires regular monitoring until skeletal maturity (around 16 or 17 years old). However, if a curvature exceeding 20 degrees (but below 40 degrees) is detected during pre-pubertal period or early puberty and shows a tendency to worsening upon observation, a suitable brace should be worn as early as possible until maturity to prevent deterioration during the peak development period.

Today, orthotists can precisely capture a patient's posture and create custom-fitted rigid braces with computer-aided and 3D printing technology. These braces ensure even pressure distribution across the patient’s body, effectively supporting the spine. Before treatment, doctors will clarify the treatment goal to parents, i.e. to prevent the curvature from getting worse and NOT to "straighten" the spine. The longer the brace is worn, the better the corrective effect. It is generally recommended that patients wear the brace for 20 to 22 hours a day (except for bathing and exercise). Boys need to wear braces for about five years (10/11 to 16/17 years old), and it is four years for girls (10 to 14 and a half years old), depending on the time of diagnosis and growth.

With hand X-ray images, doctors can assess children’s bone age and determine skeletal maturity. And the brace time can be shortened based on these images.  Once it is confirmed that the curvature no longer worsens, patients can take off the braces and resume normal proper exercises to strengthen the muscles.

Thanks to years of successful screening and timely follow-up, less than 0.06% of local school children require surgical treatment. Surgery is recommended for those with severe curvature (over 45 degrees) at diagnosis or screening, or when bracing fails to prevent deterioration. Even if the bones are fully developed, scoliosis may continue to worsen due to gravity. In severe cases it may affect not only one’s appearance and balance, but also impair the heart and lung functions, leading to various complications that require proper management by an orthopedic specialist.

The purpose of surgery is to fuse and stabilise the affected spinal sections. The surgeon will first straighten the spine by implanting screws and rods to secure the corrected position. Fusion of the vertebrae, or allowing the bone to grow on the newly created "construct", will then be performed.

Intraoperative spinal cord monitoring is conducted to prevent any damage to the nearby spinal nerves during the procedure. With wires connected to the patient’s head and legs, the surgeon can monitor the signals of motor and sensory nerves in real time and immediately detect any adverse reactions. Patients can typically get out of bed and walk the day after surgery, and may be discharged within a few days if no complications occur. The "construct" needs not be removed unless specific complications occur.

While fusion surgery can effectively stop scoliosis progression, a larger surgical area means more spinal segments need to be fixed. It increases the risk of wear and degeneration of the remaining mobile segments. The procedure is also highly complex and carries a risk of paralysis, making it not advisable simply for cosmetic purposes. Patients are thus advised to discuss all the details with their doctors, weigh the benefits and risks, and thoroughly understand the potential surgical risks before making a decision.