Spinal surgery in scoliosis

When a child is told that “the scoliosis is progressing”, the first question is almost always the same: does exercising and wearing a brace still make sense, or is surgery coming? Dr. Kateřina Smíšková explains what the decision rests on — and why it is not one number, but several things at once.

The main indicator is the Cobb angle. The line around fifty degrees is where surgery is discussed seriously; but even a curve between forty and forty-five degrees can mean that conservative treatment has run its course — it depends on how fast the curve is growing and how much growth the child has left. And predicting growth is harder today than it used to be.

Three types of surgery and how they differ

The episode goes through three procedures by age and growth stage. In small children growing rods — rods that grow with the child. In adolescents classic instrumentation with fusion using rods and screws, the most stable solution, but at the cost of mobility in the operated section. And then AVBT tethering, which Dr. Smíšková calls the gold standard where it is possible: less impact on the tissue and, above all, preserved spinal mobility.

Why progression is harder to predict

Hypermobility comes into the decision, as does the fact that some curves keep worsening at sixteen or seventeen — an age at which older assumptions said they should be settled. That changes how long conservative work with a child continues.

Before surgery and after it

The practical part: how a rigid curve is prepared with manual techniques before the procedure, when exercise starts again afterwards, and what to watch out for with the scar. And one difference worth remembering — after stabilization with fusion the rules for rotation and forward bending are stricter than after tethering, because the operated section no longer moves.