At what degree of curvature is scoliosis surgery recommended for a child?

From the Guidelines

Surgery for scoliosis in children is typically recommended when the spinal curvature reaches or exceeds 50 degrees, as indicated by the Cobb angle, to prevent further progression and potential long-term morbidity. This decision, however, is multifaceted and considers various factors including the child's age, skeletal maturity, rate of curve progression, location of the curve, and overall health 1. For instance, skeletally immature individuals with a Cobb angle of more than 20° have a high likelihood of curve progression, exceeding 70% 1.

Key Considerations for Surgical Decision

• The Cobb angle plays a crucial role in the surgical decision-making process, with higher angles indicating a greater need for surgical intervention 1.
• The flexibility of the curves, assessed through radiographic techniques such as side bending or push prone radiographs, also influences surgical planning 1.
• The SOSORT guidelines suggest limiting spine radiographs to monitor progression, unless there are clinical changes, highlighting the importance of selective imaging in management 1.

Management Approach

• For curves between 25 and 45 degrees in growing children, bracing is often the initial treatment approach to prevent progression 1.
• Surgery is considered when bracing fails to control the curve or if the curve is severe at diagnosis, with the primary goal of stopping curve progression and correcting deformity.
• The most common surgical approach involves spinal fusion with instrumentation, aiming to straighten and stabilize the spine, thereby improving quality of life and reducing the risk of long-term complications such as respiratory problems and chronic back pain.

Recovery and Outcomes

• Recovery from scoliosis surgery typically takes several months, with most children resuming full activities within 6-12 months after surgery.
• The decision for surgery should always prioritize minimizing morbidity, mortality, and maximizing quality of life, considering the potential risks and benefits of surgical intervention in the context of the child's overall health and prognosis 1.

From the Research

Scoliosis Surgery in Children

• Scoliosis surgery is typically recommended for children with curvatures exceeding 40 to 50 degrees to prevent further progression and achieve better trunk balance and cosmesis 2.
• The decision to perform surgery depends on the degree of curvature, the child's age, and the risk of progression 3, 4.
• For children with mild scoliosis (Cobb angle less than 20 degrees), observation and non-surgical interventions such as bracing and scoliosis-specific exercises are usually recommended 4, 5.
• Bracing is typically indicated for children with progressive curves between 20° and 45°, and can stop curve progression in most cases if properly designed and adapted 4.
• Surgery is usually reserved for severe cases (Cobb angle of 40 degrees or more) where there is a high risk of curve progression, physical pain, cosmetic deformity, psychosocial distress, or pulmonary disorders 2, 5.

Key Considerations

• The natural history of scoliosis and the risk of progression should be taken into account when deciding on treatment options 2, 3.
• A thorough evaluation, including patient history, physical examination, and radiographs, is critical in determining the appropriate treatment plan 3.
• Newer technologies, such as growing rods and intervertebral body stapling, are being developed for the treatment of scoliosis in growing children 6.