Scoliosis Bracing/Surgery

Scoliosis bracing or surgery is a treatment for scoliosis (an abnormal sideways curve of the spine), aimed at stopping the curve from getting worse or correcting it so that it causes less pain and better posture.

The spine normally runs straight down the back. In scoliosis, it curves to one side — sometimes also twisting like a corkscrew. In children and teenagers who are still growing, a brace (a firm outer jacket worn around the torso) can be fitted to hold the spine in a straighter position and slow or stop the curve from progressing. When the curve is already large, is getting worse quickly, or causes significant problems, surgery may be recommended. The most common operation is spinal fusion (joining two or more vertebrae — the individual bones of the spine — together with rods, screws, and bone graft) so the curved section is held permanently straight.

This treatment is used for scoliosis in children, adolescents, and sometimes adults. The choice between bracing and surgery — and the urgency of treatment — depends on how large the curve is, how fast it is progressing, and how much skeletal growth remains.

• Idiopathic scoliosis (cause unknown — the most common type) in children and teenagers with a moderate-to-large spinal curve
• Congenital scoliosis (a curve present from birth due to abnormally formed vertebrae)
• Neuromuscular scoliosis (a curve caused by conditions such as cerebral palsy, muscular dystrophy, or spina bifida that affect the muscles and nerves supporting the spine)
• A curve that is worsening rapidly during a growth spurt
• Significant back or rib pain linked to the curve
• Breathing difficulties caused by the chest wall being distorted by the curve
• Adults with a progressive curve causing pain or nerve-related symptoms such as numbness or leg weakness

Bracing or surgery is usually not recommended in certain situations.

• A very small curve that is stable and causing no symptoms — regular monitoring may be all that is needed
• A patient whose skeleton has finished growing and whose curve is mild and not causing pain or organ problems
• Serious medical conditions that make general anaesthesia (being fully asleep during the operation) too dangerous — your doctor will assess this carefully

Bracing alone carries very few risks; surgery carries more significant ones because it is a major spinal operation performed under general anaesthesia. Your surgical team will discuss all risks with you before any decision is made.

• Skin irritation or pressure sores from brace wear — the most common issue with bracing
• Discomfort and reduced confidence in teenagers who find wearing a brace difficult socially or emotionally
• Failure of the brace to stop the curve progressing, especially if not worn as directed
• Surgical infection at the wound site or around the metal implants (rods and screws)
• Significant blood loss during a spinal fusion operation, sometimes requiring a blood transfusion
• Nerve injury causing temporary or, rarely, permanent weakness, numbness, or changes in bladder and bowel control
• Implant problems — rods or screws can loosen, break, or irritate surrounding tissue over time
• Pseudarthrosis (incomplete fusion — where the vertebrae do not fully join), which may require further surgery
• Adjacent segment degeneration (wear-and-tear changes in the vertebrae above or below the fused section) years after surgery
• Reactions to general anaesthesia, including breathing difficulties or, very rarely, serious allergic responses
• Deep vein thrombosis (a blood clot in a leg vein) or pulmonary embolism (a clot that travels to the lungs) — standard precautions are taken to reduce this risk

Preparation for bracing is straightforward — mainly involving measurements and a fitting appointment. Preparation for surgery is more involved and usually begins several weeks beforehand.

If surgery is planned, patients are usually asked to stop smoking and limit or stop alcohol, because both impair healing and increase anaesthetic risk. Certain medications — including blood thinners and some anti-inflammatory painkillers — are typically paused before surgery. The medical team will give specific guidance on this. Patients are usually asked to fast (no food or drink) for several hours before going to the operating theatre; the exact fasting window will be confirmed in advance.

Tests that are typically carried out before surgery include:

• Full-length standing X-rays of the spine to measure the Cobb angle (the standard measurement of how far the spine curves)
• MRI (magnetic resonance imaging) or CT scan to see the detail of the vertebrae, spinal cord, and surrounding structures
• Lung-function tests if the curve is affecting breathing
• Blood tests to check general health, clotting ability, and blood type
• Heart assessment with an EKG (electrocardiogram — a recording of the heart's electrical activity) if needed
• A pre-operative consultation with the anaesthetist (the doctor who manages anaesthesia and pain during the operation)

The surgical procedure itself generally follows these steps, though the exact sequence varies depending on the technique used and the patient's anatomy:

• 1. The patient is given general anaesthesia and positioned carefully on the operating table, usually face-down.
• 2. The surgeon makes one or more incisions (cuts) along the back, or sometimes through the side or chest.
• 3. The muscles are carefully moved aside to expose the affected vertebrae.
• 4. Screws are placed into selected vertebrae on both sides of the curve.
• 5. Pre-shaped metal rods are attached to the screws and gradually tightened to bring the spine into a more upright position.
• 6. Bone graft (small pieces of bone, taken from the patient's own pelvis, from a bone bank, or from synthetic material) is placed between the vertebrae to encourage them to fuse together over the coming months.
• 7. Spinal cord monitoring — using electrical signals to check that the nerves are undisturbed — is carried out throughout the operation.
• 8. The incision is closed in layers and a sterile dressing is applied.
• 9. The patient is woken from anaesthesia and moved to a recovery area.

Recovery from bracing is mainly about adjusting to wearing the brace consistently and keeping the skin underneath healthy. Recovery from spinal fusion surgery is a longer process that takes place in hospital first, then at home over several months. Your care team will tailor the plan to your child's or your own specific surgery and health.

• Hospital stay: After spinal fusion, most patients spend several days on the ward, where pain is managed with intravenous (into a vein) medication that is then switched to oral tablets as comfort improves.
• Early movement: Physiotherapists (movement specialists) usually help the patient sit up and take short walks within the first day or two after surgery — early gentle movement reduces the risk of complications.
• Wound care: The surgical wound needs to be kept clean and dry; dressings are changed according to the hospital's protocol, and the team will advise on showering restrictions.
• Brace after surgery: Some patients are given a post-operative brace to wear during the healing phase — your surgeon will specify whether this applies.
• Activity restrictions: Lifting, bending, twisting, and vigorous sports are usually avoided for several months; your surgeon will give a staged timeline for returning to each activity.
• Return to school or work: Many children return to school within weeks, but contact sports and heavy physical activity are restricted for much longer — usually at least several months.
• Follow-up appointments: Regular clinic visits with repeat X-rays are needed — often at intervals of weeks, then months, then yearly — to confirm the fusion is progressing well and the correction is holding.
• Long-term implants: The rods and screws are usually left in permanently unless they cause problems. Removal surgery is only considered if there is a specific reason.
• Lifestyle: Swimming and low-impact exercise are often encouraged once healing is confirmed. Maintaining a healthy body weight and avoiding smoking support long-term spinal health.
• For brace wearers: Follow-up visits monitor the curve with X-rays, and the brace is adjusted or replaced as the child grows. Skin checks at every visit help catch pressure areas early.