Typical routine
Surgical treatment

The decision as to whether surgery should be advised is always taken on an individual basis after discussion between parents, scoliosis specialist, and, most importantly, the patient. Teenagers in particular need to be involved in such a major decision so that they retain some control over their treatment, which helps to reduce their anxieties. The advice that surgery should be considered can come as a considerable shock for the patient and the family, which makes it difficult to think rationally at the time of the consultation with the specialist. Sometimes unanswered questions come to mind after that particular consultation. The best approach is to write down such questions so that at the next consultation the patient will remember to discuss these matters.

The good news is that for about 30 years successful surgery for scoliosis has been available. The breakthrough was the invention of the Harrington Rod by Paul Harrington of Texas, whose stainless-steel rod with a ratchet and a hook at each end allowed the safe placement, on the back of the spine, a metal strut, which could be lengthened to pull out a C-shaped curve to as near straight as possible. This procedure had to be accompanied by a spinal fusion—bone grafting—to solidify the spine in the straightened position. Without this fusion, constant movement would loosen the rod and it would either break or rattle free.

The principle of the Harrington Rod and spinal fusion is the basis of the far more sophisticated (and expensive) instrumentation systems that are available today. These systems, although complex, allow better fixation of the spine, which means a quicker recovery and return to normal. They also produce, to some extent, improved correction of the curvature in the longer term. However, the Harrington Rod remains a simple, quick and relatively complication-free gold standard against which to measure newer devices, and it is still sometimes used.

Scoliosis surgery is complex and should only be done by surgeons specialising in the subject who have appropriate training and infrastructure in their surgical units.

There are around 30 such surgeons in the UK and the Republic of Ireland who are all members of the British Scoliosis Society. They are all very conscious of the need to consider the patient as a whole and safety is a top priority. Scoliosis surgery undertaken by these experts in units used to carrying out this work is no longer a great ordeal. Furthermore, modern methods for anaesthesia and pain control, and specialised nursing care, keeps to a minimum the pain and stress. Almost all patients and their families find surgery a positive experience with a satisfactory outcome and return to normality.

The one major worry at present is the very long waiting list for scoliosis surgery on the NHS, which is generally many months. Sadly, this long wait is due to the absence of Government investment in spinal disorder services in general and scoliosis units in particular. It is unacceptable to those who care for scoliosis patients that curvatures in otherwise normal adolescents should increase significantly while they wait for hospital admission. 

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