Scoliosis Surgery: Correction and Instrumentation

Surgery is considered in the presence of pain that restricts daily activities and/or progressive neurological deficit that do not respond to conservative treatment (physical therapy, pain management, epidural injection).^1,2 The decision is made based not only on the angle, but also on the patient's functional status and quality of life.

Surgical Techniques

Decompression: In patients with nerve compression but no significant instability, laminectomy alone may be sufficient.

Fusion + Instrumentation: The curvature is corrected and the spine is stabilised with pedicle screws and rods. Short-segment (3-4 levels) or long-segment (down to the pelvis) fusion can be performed.

Osteotomies: In severe and rigid deformities, correction is achieved with a Smith-Petersen osteotomy (SPO) or pedicle subtraction osteotomy (PSO).^3,4

Lateral Interbody Fusion (LLIF/XLIF): The disc space is opened and lordosis is restored by entering from the side. It can be performed as a preliminary stage (staged surgery) in preparation for open posterior surgery.

Risks and Considerations

Adult scoliosis surgery is a major operation. Blood loss, infection, screw loosening, proximal junctional kyphosis (PJK), and pseudoarthrosis (non-union) are the main complications. Advanced age increases the risk of complications in scoliosis surgery.⁵ Therefore, patient selection and surgical planning are of critical importance.

Osteotomies: In severe and rigid deformities, correction is achieved with a Smith-Petersen osteotomy (SPO) or pedicle subtraction osteotomy (PSO).

Postoperative Process

Early mobilisation (standing up on the 1st postoperative day) is targeted. Brace use may last 3-6 months. Full recovery takes 6-12 months; heavy lifting is prohibited until the fusion is complete.

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