Scoliosis Correction Surgery (Adult & Paediatric)

Scoliosis is a sideways curvature of the spine that is usually combined with rotation of the vertebrae, which makes it a three-dimensional deformity rather than a simple bend. Many curves are mild and need only observation, and in growing children a brace may be used to slow progression. When a curve becomes large, continues to worsen, or begins to affect balance, breathing, or nerve function, correction surgery may be advised. This page explains what that surgery involves in both children and adults.

What it is

Scoliosis correction surgery realigns the curved, rotated spine and holds it in a balanced position. In most operations the spine is straightened as far as is safe and stabilised with screws and rods, supported by bone graft so that the corrected segment fuses solidly over time.

Because scoliosis is three-dimensional, the goal is to improve the curve in every plane — side-to-side, front-to-back, and the rotation that often produces a visible rib or flank prominence. The right operation depends on the size of the curve, how rigid it is, its cause, and — crucially in children — whether the spine is still growing.

Who is a candidate? (Indications)

Surgical correction is considered for carefully selected patients, typically those with:

• A large curve, or a curve that is progressing despite bracing or non-surgical treatment
• A curve causing pain, imbalance, or a disabling deformity
• In children, a curve that threatens chest and lung development or trunk balance
• In adults, degenerative scoliosis with nerve compression, instability, or loss of balance
• Any curve associated with neurological symptoms, such as leg weakness or numbness

The patient’s age, the cause and flexibility of the curve, general health, and the balance of risk and benefit all inform the decision.

How it is performed

The operation is planned in detail beforehand, often with full-length standing X-rays, bending films to assess flexibility, and three-dimensional reconstruction of the anatomy. In broad terms:

1. The spine is exposed, most commonly through a posterior (back) approach.
2. Screws are placed into the vertebrae above and below the curve to provide secure anchors.
3. Contoured rods are used to derotate and realign the spine into a balanced position.
4. Where the curve is rigid, a measured wedge of bone (an osteotomy) — or, in the most severe cases, a whole segment of the spinal column — may be removed to allow correction.
5. The correction is held with the rods and screws, and bone graft is added to achieve a solid fusion.

Throughout, continuous spinal-cord monitoring gives early warning of any threat to neurological function so the surgical team can respond immediately.

Growth-friendly options in children

In a child who is still growing, fusing the whole spine early can limit the growth of the spine, chest, and lungs. Growth-friendly strategies aim to control the curve while allowing the spine to continue lengthening — for example with growing-rod systems that can be lengthened as the child grows, including magnetically-controlled rods that avoid repeated open lengthening operations. Definitive fusion is then usually carried out closer to skeletal maturity. The choice of strategy depends on the child’s age, the cause of the curve, and how it behaves over time.

Benefits and risks

The benefits of correction are a more balanced, upright spine, prevention of further progression, relief of pain caused by the deformity, and — where breathing or nerves are affected — protection of those functions. Against these must be weighed the real risks of major spinal surgery: injury to the spinal cord or nerves, significant blood loss, infection, implant problems, incomplete correction, and the possibility of further surgery, as well as the general risks of prolonged anaesthesia. These are discussed openly and individually so that the expected benefit clearly justifies the risk for that particular patient.

Alternatives

For milder or non-progressive curves, alternatives include observation with periodic imaging, physiotherapy, and — in growing children with certain curves — bracing. In adults with degenerative scoliosis, much can often be achieved with non-surgical measures or with a more limited operation aimed at the symptomatic level rather than the whole curve. A specialist assessment helps determine whether surgery is genuinely necessary, and if so, how extensive it needs to be.

Dr. Garg’s approach & experience

Dr. Garg is Principal Director & Head, Orthopaedics & Spine at Max Hospital, Delhi, and a former Professor at AIIMS New Delhi, with more than 325 peer-reviewed publications and a particular focus on spinal deformity. His work spans the full range of scoliosis, from growth-friendly surgery in young children to the correction of severe, rigid curves.

For early-onset scoliosis, Dr. Garg developed Active Apex Correction (APC), published in the Global Spine Journal in 2024 (where it received a Best Paper Award) and further reported in NASSJ in 2025. For the most severe and rigid deformities, his Modified Posterior Vertebral Column Resection (Modified PVCR) — published in The Spine Journal in 2020 — refines an exceptionally demanding operation with the aim of making it safer and more reproducible. This work sits alongside research into robotic, navigated, and 3D-printed patient-specific approaches to deformity correction.

When to seek a specialist opinion

A specialist assessment is appropriate for a curve that is large, visibly worsening, or causing pain or a noticeable asymmetry of the shoulders, waist, or rib cage. In children, a curve that appears early or progresses quickly warrants prompt review. Any scoliosis associated with leg weakness, numbness, balance problems, breathlessness, or changes in bladder or bowel function should be reviewed without delay.