Surgery for AIS.


The Canadian Scoliosis Screening Coalition


Contact us at: CSSC@scoliosiscanada.ca          Added May 11, 2025. Revised July 10, Sept 9, 2025

Links to Pre-operative procedures: Halo Gravity Traction (HGT)

A curated list. Note: when children are late-diagnosed with Scoliosis and/or forced to WAIT TOO long for spine surgery with unacceptable, dangerous, long wait times in Canadian Children's hospitals and their Scoliosis curves have progressed to an extremely severe magnitude, to avoid impending neurological and pulmonary complications, further invasive treatments are necessary (and consequently longer hospitalizations). One such preoperative treatment to fusion surgery is 'Halo Gravity Traction' treatment which includes halo surgery (where pins are drilled into the child's skull & attached to a metal halo aka ring) and subsequent gravity traction with weights (weights attached to the halo) for a few weeks or more is required before the final corrective fusion surgery (which is also more complicated and longer surgery for extremely severe curves with a reduced percentage of correction success due to the increased curve magnitude and spinal deformities). Some common minor complications are pin site dislocations, infection, pin site pain, nausea, dizzyness, headaches and neck pain. (This is a potentially traumatizing and definitely an extremely stressful invasive process for families and children to experience. And while not to be confused, conjures up mediavel torture scenes from historical movies. However, most children adapt very well to the procedure and the treatment importantly saves patients from paralysis.)

  1. Popescu MB, Marie H, Ulici A, Ionescu SN, Ionescu A, Popescu IA, Herdea A. Impact of Preoperative Halo Traction on Cobb Angle Reduction in Adolescent Idiopathic Scoliosis: A Retrospective Analysis. Children (Basel). 2025 Aug 9;12(8):1045. doi: 10.3390/children12081045. PMID: 40868497; PMCID: PMC12384220."... Halo traction, a technique that involves the application of gradual axial traction through a halo device attached to the skull, has been shown to reduce Cobb angles, improve pulmonary function, and enhance spinal flexibility in patients with severe scoliosis... and assist surgical correction...it is a well-established preoperative method that facilitates safer and more effective surgical outcomes by gradually improving spinal flexibility and reducing curve severity..."
  2. Bauer JM, Yang S, Yaszay B, Mackenzie WGS. Pediatric Halo Use: Indications, Application, and Potential Complications. J Pediatr Soc North Am. 2024 Oct 11;9:100129. doi: 10.1016/j.jposna.2024.100129. PMID: 40432689; PMCID: PMC12088272.
    Warning graphic disturbing photographs. Please view Figure 3, procedure to insert pins in child's skull and Figure 9, a pin site infection.
  3. Grabala P, Gregorczyk J, Fani N, Galgano MA, Grabala M. Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies. Journal of Clinical Medicine. 2024; 13(16):4824. https://doi.org/10.3390/jcm13164824
    Please view Figure 1. example of a patient undergoing Halo Gravity Traction.
  4. Rocos B, Reda L, Lebel DE, Dodds MK, Zeller R. The Use of Halo Gravity Traction in Severe, Stiff Scoliosis. J Pediatr Orthop. 2021 Jul 1;41(6):338-343. doi: 10.1097/BPO.0000000000001830. PMID: 33826561. "...Conclusion: HGT is a safe treatment for severe, stiff scoliosis because it can respond to early signs of impending neurological impairment. The first 3 weeks of treatment, reaching 50% of body weight as a traction force accounts for 80% of correction, with the remaining 20% in the following 2 weeks. At least 4 weeks of traction is recommended when following this protocol."
  5. Han X, Sun W, Qiu Y, Xu L, Sha S, Shi B, Yan H, Liu Z, Zhu Z. Halo Gravity Traction Is Associated with Reduced Bone Mineral Density of Patients with Severe Kyphoscoliosis. Biomed Res Int. 2016;2016:8056273. doi: 10.1155/2016/8056273. Epub 2016 Nov 8. PMID: 27896274; PMCID: PMC5118551.

Links to Paediatric Spinal Deformity Surgery (for AIS) (aka complex spine surgery) :

Below is just a curated list of publications. The primary goal of surgery for AIS treatment is to prevent curve progression and correct the deformity.

  1. Matamalas A, Bagó J, Pellisé F. Responsiveness of trunk asymmetry measurements in clinical photographs after adolescent idiopathic scoliosis surgery. Eur Spine J. 2025 Jul;34(7):2781-2787. doi: 10.1007/s00586-025-08918-6. Epub 2025 May 15. PMID: 40372456.
  2. Lott C, Capraro A, Qiu C, Talwar D, Gordon J, Flynn JM, Anari JB, Cahill PJ. How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial. Clin Orthop Relat Res. 2025 Jun 19. doi: 10.1097/CORR.0000000000003575. Epub ahead of print. PMID: 40537949."...Background: Recently, there has been an increased interest in alternative surgical options for treating idiopathic scoliosis. For instance, anterior vertebral body tethering (AVBT) is an emerging surgical solution used in lieu of posterior spinal fusion (PSF). This technology has been gaining in popularity because of its potential benefits of preservation of spinal growth, motion, and functional activity.... Results: Scoliosis curves were reduced to < 50°, without unplanned return to the operating room, at 2 years in 70% (14 of 20) of patients who underwent AVBT and 100% (21 of 21) of patients who had PSF (p < 0.001). No patients who had PSF underwent revisions....Conclusion: Pediatric orthopaedic spine surgeons should carefully consider discussing the use of vertebral body tethering with their patients who have adolescent idiopathic scoliosis, as this evidence points to the more established technique of PSF leading to better outcomes. Additional research supporting AVBT as noninferior to PSF in radiographic and safety measures is needed before the procedure becomes widely available to patients and their families." Level of evidence: Level III, therapeutic study.
  3. Stamiris S, Sofos C, Sarridimitriou A, Kakoulidis P, Christidis P, Stamiris D, Anestiadou E, Cheva A, Chatzianestiadou C, Christodoulou P, Karampalis C. Comparative meta-analysis of vertebral body tethering and posterior spinal fusion in patients with idiopathic scoliosis. Evaluation of radiographic, perioperative, clinical, patient-reported outcomes, and complication rates. Spine Deform. 2025 Jun 8. doi: 10.1007/s43390-025-01113-z. Epub ahead of print. PMID: 40484922.
  4. Zhao Y, Du Y, Yang Y, Zhang H, Li C, Sun D, Li Z, Zhang J, Wang S. What Are the Medium-term Reciprocal Changes in Cervical Sagittal Alignment After Posterior Correction for Lenke 5C Adolescent Idiopathic Scoliosis? Clin Orthop Relat Res. 2025 Mar 21;483(9):1746-1758. doi: 10.1097/CORR.0000000000003448. PMID: 40117516; PMCID: PMC12373072.
  5. Al-Naseem AO, Al-Naseem A, Al Balushi B, Marwan Y, Leong J, Shafafy R. Posterior spinal fusion versus vertebral body tethering for paediatric scoliosis: a meta-analysis of comparative studies. Spine Deform. 2025 May;13(3):681-694. doi: 10.1007/s43390-025-01050-x. Epub 2025 Feb 4. PMID: 39904840.
  6. Todderud J, Milbrandt T, Baroncini A, Petcharaporn M, Marks M, Hoernschemeyer D, Newton P, Parent S, Alanay A, Miyanji F, Lonner B, Neal K, Yaszay B, Blakemore L, Shah S, Haber L, Samdani A, Larson AN. Outcomes and complications of vertebral body tethering by patient gender. Spine Deform. 2025 Jan 15. doi: 10.1007/s43390-024-01035-2. Epub ahead of print. PMID: 39812990. “...Conclusion: Our study found that boys on average had higher body weight than girls and also higher rates of tether cord breakage and loss of correction. Despite these differences, curve correction, modulation, and reoperation rates were similar in both groups...”
  7. Larson AN, Todderud JE, Mathew SE, Nassr A, Sebastian AS, Potter DD, Milbrandt TA. Vertebral Body Tethering in Skeletally Immature Patients: Results of a Prospective U.S. FDA Investigational Device Exemption Study. J Bone Joint Surg Am. 2024 Dec 24. doi: 10.2106/JBJS.24.00033. Epub ahead of print. PMID: 39719007."...Conclusions: In skeletally immature patients treated in the U.S. under a prospective Investigational Device Exemption, there was a 75% rate of successful outcomes at 2 years....”
  8. Todderud J, Larson AN, Haft G, El-Hawary R, Price N, Anderson JT, Fitzgerald R, Chan G, Lonner B, Albert M, Hoernschemeyer D, Milbrandt TA. Matched comparison of non-fusion surgeries for adolescent idiopathic scoliosis: posterior dynamic distraction device and vertebral body tethering. Spine Deform. 2024 Oct 8. doi: 10.1007/s43390 024-00982-0. Epub ahead of print. PMID: 39377901. “Conclusion: Early results show PDDD demonstrates better index correction, reduced operative time, less blood loss, and shorter length of stay but higher rates of revision compared to a matched cohort of VBT patients at two-year follow-up.” Level of evidence: Level II, prospective cohort matched comparative study.
  9. Jalloh, Hulaimatu BA*; Andras, Lindsay M. MD*; Redding, Greg MD†; Villamor, Gabriela A. BS*; Yang, Joshua BA*; Skaggs, David L. MD, MMM‡. In-office Maximal Voluntary Ventilation Testing Demonstrates Pulmonary Improvement Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Journal of Pediatric Orthopaedics 44(8):p 497-501, September 2024. | DOI: 10.1097/BPO.0000000000002694 “...This is the first study using office-based spirometry in an orthopaedic clinic showing improved pulmonary function with posterior spinal fusion and growth in patients with AIS” Level of Evidence: Level II.
  10. Whitaker, Colin M. MDa; Miyanji, Firoz MDb; Samdani, Amer F. MDc; Pahys, Joshua M. MDc; Sponseller, Paul D. MDd; Bryan, Tracey P. MAe; Newton, Peter O. MDe; Harms Study Group; Hwang, Steven W. MDc. Prospectively Collected Comparison of Outcomes Between Surgically and Conservatively Treated Patients With Adolescent Idiopathic Scoliosis. Spine 49(17):p 1210-1218, September 1, 2024. | DOI: 10.1097/BRS.0000000000004948 “Conclusions.Surgically treated patients with AIS have improved HRQOL outcomes in several domains compared with age-matched and curve magnitude-matched nonoperatively treated patients at two-year follow-up.”
  11. Stencel-Allemand M, Marie-Hardy L, Khalife M, Happiette A, Moreau PE, Ilharreborde B, Ferrero E. A comparison of idiopathic scoliosis surgery between teenage years and adulthood. Eur Spine J. 2024 Jul;33(7):2688-2695. doi: 10.1007/s00586-024-08211-y. Epub 2024 Apr 9. PMID: 38592487.
  12. Irianto KA, Firas NR, Binti CGS, Tinduh D, Sakti YM, De Vega B. The impact of spinal fusion of adolescent idiopathic scoliosis in Salah (Islamic Prayer) movement: a retrospective case-control study. F1000Res. 2024 Jun 24;11:1054. doi: 10.12688/f1000research.124255.2. PMID: 38765242; PMCID: PMC11099510.
  13. Alvi MA, Kwon BK, Hejrati N, Tetreault LA, Evaniew N, Skelly AC, Fehlings MG. Accuracy of Intraoperative Neuromonitoring in the Diagnosis of Intraoperative Neurological Decline in the Setting of Spinal Surgery-A Systematic Review and Meta-Analysis. Global Spine J. 2024 Mar;14(3_suppl):105S-149S. doi: 10.1177/21925682231196514. PMID: 38632716; PMCID: PMC10964897.
  14. Stone, Lauren E. MDa; Ames, Christopher P. MDb; Pellise, Ferran MDc; Newton, Peter O. MDd; Upasani, Vidyadhar V MDd; Harms Study Group; Kelly, Michael P. MDd. Scoliosis Research Society-22r and Ceiling Effects: Limited Capabilities for Precision-Medicine with Adolescent Idiopathic Scoliosis. Spine ():10.1097/BRS.0000000000004993, March 19, 2024. | DOI: 10.1097/BRS.0000000000004993
  15. Tsirikos AI, Ahuja K, Khan M. Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review. J Clin Med. 2024 Mar 29;13(7):2013. doi: 10.3390/jcm13072013. PMID: 38610778; PMCID: PMC11012693.
  16. Daroszewski P, Huber J, Kaczmarek K, Janusz P, Główka P, Tomaszewski M, Kotwicki T. Real-Time Neuromonitoring" Increases the Safety and Non-Invasiveness and Shortens the Duration of Idiopathic Scoliosis Surgery. J Clin Med. 2024 Mar 5;13(5):1497. doi: 10.3390/jcm13051497. PMID: 38592334; PMCID: PMC10934752.
  17. Orellana, Kevin J. BS*; Lee, Julianna BA*; Yang, Daniel MS*; Hauth, Lucas BS*; Flynn, John M. MD*,†. Impact of Social Determinants of Health on Adolescent Idiopathic Scoliosis Curve Severity. Journal of Pediatric Orthopaedics 44(2):p e168-e173, February 2024. | DOI: 10.1097/BPO.0000000000002529 “Conclusion: Socioeconomic status plays a significant role in the severity of AIS. Specifically, patients with lower COI tend to present with curve magnitudes beyond what is responsive to nonsurgical treatment, leading to larger curves at the time of surgery. Future work should focus on addressing social inequalities to optimize the treatment and outcomes of AIS patients.” Level of Evidence: Level III- Retrospective Comparative Study.
  18. Gorijala VK, Reddy RP, Anetakis KM, Balzer J, Crammond DJ, Shandal V, Shaw JD, Christie MR, Thirumala PD. Diagnostic utility of different types of somatosensory evoked potential changes in pediatric idiopathic scoliosis correction surgery. Eur Spine J. 2024 Apr;33(4):1644-1656. doi: 10.1007/s00586-023-08063-y. Epub 2024 Jan 29. PMID: 38285275. “Conclusion Intraoperative SSEP monitoring can predict perioperative neurological injury and improve surgical outcomes in pediatric scoliosis fusion surgery.” Level of Evidence: Level 2
  19. Oeding JF, Siu J, O'Donnell J, Wu HH, Allahabadi S, Saggi S, Flores M, Brown K, Baldwin A, Diab M. Combined Anterior Thoracic Vertebral Body Tethering and Posterior Lumbar Tethering Results in Quicker Return to Sport and Activity Compared to Posterior Spinal Instrumented Fusion in Patients with Adolescent Idiopathic Scoliosis. Global Spine J. 2023 Dec 14:21925682231222887. doi: 10.1177/21925682231222887. Epub ahead of print. PMID: 38097271.
  20. Alamrani, Samia PT, MSca,b; Gardner, Adrian BM, PhD, MRCS, FRCSc; Rushton, Alison B. EdDd; Falla, Deborah PhDa; Heneghan, Nicola R. PhDa. Predictors of Relevant Changes in Pain and Function for Adolescents With Idiopathic Scoliosis Following Surgery. Spine 48(16):p 1166 1173, August 15, 2023. | DOI: 10.1097/BRS.0000000000004705
  21. Lebel DE, Machida M, Koucheki R, Campbell F, Bath N, Koyle M, Ruskin D, Levin D, Brennenstuhl S, Stinson J. Utilization of individual components of enhanced recovery after surgery (ERAS) protocol improves post-operative outcomes in adolescent idiopathic scoliosis: a blueprint for progressive adoption of ERAS. Spine Deform. 2023 Sep;11(5):1117-1125. doi: 10.1007/s43390-023-00706-w. Epub 2023 May 26. PMID: 37233951; PMCID: PMC10425294.”Conclusion Based on our cohort, a modified ERAS (Enhanced recovery after surgery) intervention for AIS patients results in significantly shorter LOS (Length of Stay) after surgery, reduced pain, and lower opioid consumption. The use of intrathecal morphine, NSAIDs, early removal of urinary catheter, and early ambulation when combined contributed to shorter LOS...”
  22. Beling, Alexandra MD*; Hresko, M. Timothy MD*; Verhofste, Bram MD*; Miller, Patricia E. MS*; Pitts, Sarah A. MD†; Glotzbecker, Michael P. MD‡. Do Adolescent Idiopathic Scoliosis Patients With Vitamin D Deficiency Have Worse Spine Fusion Outcomes?. Journal of Pediatric Orthopaedics 43(3):p e209-e214, March 2023. | DOI: 10.1097/BPO.0000000000002308 “Conclusion: AIS patients with vitamin D deficiency (<20 ng/mL) are more likely to be younger age at time of surgery, and report lower Function, Self-image, and Total SRS-30 scores postoperatively. Further work is needed to determine whether vitamin D supplementation alters curve progression and patient outcomes...." Level of Evidence: Level II—prognostic study
  23. Newton PO, Parent S, Miyanji F, Alanay A, Lonner BS, Neal KM, Hoernschemeyer DG, Yaszay B, Blakemore LC, Shah SA, Bastrom TP; Harms Study Group. Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves: A Retrospective Comparison by the Harms Study Group. J Bone Joint Surg Am. 2022 Dec 21;104(24):2170-2177. doi: 10.2106/JBJS.22.00127. Epub 2022 Oct 20. PMID: 37010479. Level of Evidence: Therapeutic Level III
  24. Mariscal G, Morales J, Pérez S, Rubio Belmar PA, Bovea-Marco M, Bas JL, Bas P, Bas T. Meta-analysis on the efficacy and safety of anterior vertebral body tethering in adolescent idiopathic scoliosis. Eur Spine J. 2023 Jan;32(1):140-148. doi: 10.1007/s00586-022-07448-9. Epub 2022 Nov 29. PMID: 36443510.
  25. Tetreault T, Darland H, Vu A, Carry P, Garg S. Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: a prospective cohort study. Spine Deform. 2023 Mar;11(2):383-390. doi: 10.1007/s43390-022-00592-8. Epub 2022 Oct 5.PMID: 36197603.
  26. Pahys JM, Samdani AF, Hwang SW, Warshauer S, Gaughan JP, Chafetz RS. Trunk Range of Motion and Patient Outcomes After Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: Comparison Using Computerized 3D Motion Capture Technology. J Bone Joint Surg Am. 2022 Sep 7;104(17):1563-1572. doi: 10.2106/JBJS.21.00992. Epub 2022 Jun 28. PMID: 35766407.
  27. Mens RH, Bisseling P, de Kleuver M, van Hooff ML. Relevant impact of surgery on quality of life for adolescent idiopathic scoliosis : a registry-based two-year follow-up cohort study. Bone Joint J. 2022 Feb;104-B(2):265-273. doi: 10.1302/0301 620X.104B2.BJJ-2021-1179.R1. PMID: 35094577. “Conclusion: Relevant improvement in functioning, condition-specific and health-related QoL, self-image, and a relevant decrease in pain is shown at two-year follow-up after fusion surgery for AIS, with few adverse events.”
  28. Kurra, S., DeMercurio, P. & Lavelle, W.F. Comparison of operative implications between adolescent and young adult idiopathic scoliosis patients from scoliosis research society mortality and morbidity database. Spine Deform 10, 1133–1138 (2022). https://doi.org/10.1007/s43390-022-00515-7 “Conclusions The operative implications observed with young adult idiopathic scoliosis patients may potentially result in more complex surgical procedures and operative-associated complications than their adolescent counterparts. Further studies are required and should include a larger number of cases, be prospective in nature and verifiable data.” Level of evidence II.
  29. Sarwahi, Vishal MDa; Galina, Jesse BSa; Atlas, Aaron BSa; Gecelter, Rachel BSa; Hasan, Sayyida BSa; Amaral, Terry D. MDa; Maguire, Kathleen MDb; Lo, Yungtai PhDc; Kalantre, Sarika MDd. Scoliosis Surgery Normalizes Cardiac Function in Adolescent Idiopathic Scoliosis Patients. SPINE 46(21):p E1161-E1167, November 01, 2021. | DOI: 10.1097/BRS.0000000000004060
  30. Johnson, Mitchell A. BSE; Flynn, John M. MD; Anari, Jason B. MD; Gohel, Shivani BS; Cahill, Patrick J. MD; Winell, Jennifer J. MD; Baldwin, Keith D. MD, MPH, MSPT. Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity. Journal of Pediatric Orthopaedics 41(9):p 543-548, October 2021. | DOI: 10.1097/BPO.0000000000001929 “Conclusions: Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient’s risk of progression and ultimate surgical risk.”
  31. Ho D, Du JY, Erkilinc M, Glotzbecker MP, Mistovich RJ. Getting Them Back in the Game: When Can Athletes With Adolescent Idiopathic Scoliosis Safely Return to Sports? A Mixed-effects Study of the Pediatric Orthopaedic Association of North America. J Pediatr Orthop. 2021 Oct 1;41(9):e717-e721. doi: 10.1097/BPO.0000000000001902. PMID: 34267153
  32. Lonner BS, Brochin R, Lewis R, Vig KS, Kassin G, Castillo A, Ren Y.< a href="https://pubmed.ncbi.nlm.nih.gov/31495474/"> Body Image Disturbance Improvement After Operative Correction of Adolescent Idiopathic Scoliosis. Spine Deform. 2019 Sep;7(5):741-745. doi: 10.1016/j.jspd.2018.12.005. PMID: 31495474.
  33. Fernandes P, Soares Do Brito J, Flores I, Monteiro J. Impact of Surgery on the Quality of Life of Adolescent Idiopathic Scoliosis. Iowa Orthop J. 2019;39(2):66-72. PMID: 32577110; PMCID: PMC7047296. Level of evidence: III
  34. Duramaz A, Yılmaz S, Ziroğlu N, Bursal Duramaz B, Kara T. The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis. Eur Spine J. 2018 Sep;27(9):2233-2240. doi: 10.1007/s00586 018-5639-4. Epub 2018 May 25. PMID: 29802465. “...41 consecutive patients who underwent surgery for AIS were compared with the control group of 52 healthy patients regarding the changes in the pre- and postoperative quality of life and psychiatric status of patients with deformity correction..Surgical correction of deformity in AIS provided significant improvements regarding quality of life and psychiatric condition. Spinal surgeons should be aware of the possible psychological problems of AIS patients and should keep in mind that deformity correction not only improves physical health but also improves mental health”
  35. Fletcher ND, Marks MC, Asghar JK, Hwang SW, Sponseller PD; Harms Study Group; Newton PO. Development of Consensus Based Best Practice Guidelines for Perioperative Management of Blood Loss in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Spine Deform. 2018 Jul-Aug;6(4):424-429. doi: 10.1016/j.jspd.2018.01.001. PMID: 29886914.
  36. Ohrt-Nissen, S., Hallager, D.W., Karbo, T. et al. Radiographic and Functional Outcome in Adolescent Idiopathic Scoliosis Operated With Hook/Hybrid Versus All-Pedicle Screw Instrumentation—A Retrospective Study in 149 Patients. Spine Deform 5, 401–408 (2017). https://doi.org/10.1016/j.jspd.2017.05.002 “Conclusions In a large consecutive cohort of AIS patients followed for a minimum of two years, we found a significantly better curve correction and less loss of correction with PS instrumentation compared to H/H. There was no significant difference in SRS-22r scores at final follow-up.” Level of Evidence: 3
  37. Jeans KA, Lovejoy JF, Karol LA, McClung AM. How Is Pulmonary Function and Exercise Tolerance Affected in Patients With AIS Who Have Undergone Spinal Fusion? Spine Deform. 2017 Nov;5(6):416-423. doi: 10.1016/j.jspd.2017.04.001. PMID: 29050719.
  38. Youn MS, Shin JK, Goh TS, Kang SS, Jeon WK, Lee JS. Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J. 2016 Oct;25(10):3114-3119. doi: 10.1007/s00586 016-4488-2. Epub 2016 Mar 10. PMID: 26963762.
  39. Lehman RA Jr, Kang DG, Lenke LG, Sucato DJ, Bevevino AJ; Spinal Deformity Study Group. Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group. Spine J. 2015 May 1;15(5):951-8. doi: 10.1016/j.spinee.2013.06.035. Epub 2013 Oct 5. PMID: 24099682.
  40. Pellegrino LN, Avanzi O. Prospective evaluation of quality of life in adolescent idiopathic scoliosis before and after surgery. J Spinal Disord Tech. 2014 Dec;27(8):409-14. doi: 10.1097/BSD.0b013e3182797a5e. PMID: 23096129.
  41. Bettany-Saltikov J, Weiss HR, Chockalingam N, Taranu R, Srinivas S, Hogg J, Whittaker V, Kalyan RV, Arnell T. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev. 2015 Apr 24;2015(4):CD010663. doi: 10.1002/14651858.CD010663.pub2. PMID: 25908428; PMCID: PMC11167694. “...Objectives To examine the impact of surgical versus non‐surgical interventions in people with AIS who have severe curves of over 45 degrees, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short term (a few months) and the long term (over 20 years)....There is currently no randomised or non‐randomised trial‐based evidence from prospective studies with a control group comparing the effectiveness of surgical to non‐surgical interventions for people with AIS with severe curves of over 45 degrees....”
  42. Duramaz A, Yılmaz S, Ziroğlu N, Bursal Duramaz B, Kara T. The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis. Eur Spine J. 2018 Sep;27(9):2233-2240. doi: 10.1007/s00586 018-5639-4. Epub 2018 May 25. PMID: 29802465. “...41 consecutive patients who underwent surgery for AIS were compared with the control group of 52 healthy patients regarding the changes in the pre- and postoperative quality of life and psychiatric status of patients with deformity correction..Surgical correction of deformity in AIS provided significant improvements regarding quality of life and psychiatric condition. Spinal surgeons should be aware of the possible psychological problems of AIS patients and should keep in mind that deformity correction not only improves physical health but also improves mental health”
  43. Han J, Xu Q, Yang Y, Yao Z, Zhang C. Evaluation of quality of life and risk factors affecting quality of life in adolescent idiopathic scoliosis. Intractable Rare Dis Res. 2015 Feb;4(1):12-6. doi: 10.5582/irdr.2014.01032. PMID: 25674383; PMCID: PMC4322590.
  44. Tarrant RC, OʼLoughlin PF, Lynch S, Queally JM, Sheeran P, Moore DP, Kiely PJ. Timing and predictors of return to short-term functional activity in adolescent idiopathic scoliosis after posterior spinal fusion: a prospective study. Spine (Phila Pa 1976). 2014 Aug 15;39(18):1471-8. doi: 10.1097/BRS.0000000000000452. PMID: 24875955. “Conclusion. The majority of patients with AIS can expect to return to school/college full-time by 16 weeks and unrestricted physical activity by 52 weeks after PSF. Preoperative curves greater than 70°, postoperative weight loss greater than 5 kg, and minor perioperative respiratory complication incidence independently predicted a delayed return to school/college full-time. These findings add to the current knowledge base regarding actual versus anticipated timing of return to short-term functional outcomes in this population.” Level of Evidence: 3
  45. Rushton PR, Grevitt MP. What is the effect of surgery on the quality of life of the adolescent with adolescent idiopathic scoliosis? A review and statistical analysis of the literature. Spine (Phila Pa 1976). 2013 Apr 20;38(9):786-94. doi: 10.1097/BRS.0b013e3182837c95. PMID: 24477054.
  46. Carreon LY, Sanders JO, Diab M, Sucato DJ, Sturm PF, Glassman SD; Spinal Deformity Study Group. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010 Nov 1;35(23):2079-83. doi: 10.1097/BRS.0b013e3181c61fd7. PMID: 20395881.
  47. Merola, Andrew A. MD*†; Haher, Thomas R. MD†; Brkaric, Mario MD*; Panagopoulos, Georgia PhD‡; Mathur, Samir MD*; Kohani, Omid MS III*; Lowe, Thomas G. MD§; Lenke, Larry G. MD ; Wenger, Dennis R. MD¶; Newton, Peter O. MD#; Clements, David H. III, MD**; Betz, Randal R. MD††. A Multicenter Study of the Outcomes of the Surgical Treatment Of Adolescent Idiopathic Scoliosis Using the Scoliosis Research Society (SRS) Outcome Instrument. Spine 27(18):p 2046-2051, September 15, 2002.
  48. Evaniew, N., Devji, T., Drew, B. et al. The surgical management of scoliosis: a scoping review of the literature. Scoliosis 10, 1 (2015). https://doi.org/10.1186/s13013-014-0026-3
  49. Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976). 2003 Jan 1;28(1):63-9. doi: 10.1097/00007632-200301010-00015. PMID: 12544958.

Long-term Studies after Paediatric Spinal Deformity Surgery (for AIS)

(aka complex spine surgery)

A curated list. Revised July 7, Aug 2 2025

  1. Antonia Matamalas, Juan Bagó, Franciso Javier Sánchez, Pérez‑Grueso, Lucía Moreno‑Manzano, Javier Pizones, Carlos Villanueva1, Susana Núñez‑Pereira, Sleiman Haddad, Ferrán Pellisé Thirty years later: the lingering effects of adolescent idiopathic scoliosis surgery with third‑generation implants on quality of life Received: 3 September 2024 / Accepted: 21 December 2024 / Published online: 16 January 2025 © The Author(s), under exclusive licence to Scoliosis Research Society "...Conclusions Thirty years after surgery, AIS patients have more pain and worse physical functioning than their peers. However, the differences are not clinically relevant except for pain and physical activity. Further, on average, the former are in good clinical condition, although surgery has not normalized their lives...."
  2. Hoernschemeyer DG, Hawkins SD, Tweedy NM, Boeyer ME. Anterior Vertebral Body Tethering: A Single-Center Cohort with 4.3 to 7.4 Years of Follow-up. J Bone Joint Surg Am. 2024 Oct 16;106(20):1857-1865. doi: 10.2106/JBJS.23.01229. Epub 2024 Jul 5. PMID: 38968364. “With >5 years of follow-up, we observed a decrease in postoperative success, as progression of the deformity was observed in most subgroups, and an increase in the revision and suspected broken tether rates. No additional patients had conversion to a posterior spinal fusion, which may indicate long-term survivorship.” Level of Evidence: Therapeutic Level III
  3. Friedman, A.S., Koneru, M., Gentile, P. et al. Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees. Spine Deform (Oct 2024). https://doi.org/10.1007/s43390-024-00984-y
  4. Kim HJ, Chang DG, Lenke LG, Pizones J, Castelein R, Trobisch PD, Watanabe K, Yang JH, Suh SW, Suk SI. Rotational Changes Following Use of Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: A Long-Term Radiographic and Computed Tomography Evaluation. Spine (Phila Pa 1976). 2024 Aug 1;49(15):1059-1068. doi: 10.1097/BRS.0000000000004869. Epub 2023 Nov 7. PMID: 37937448. “Conclusions.The rotation regression phenomenon in AV and rotation maintenance in distal EV were observed after DVR over an average 10-year follow-up. These findings suggest that the DVR in the surgical treatment of AIS has a positive long-term effect on the stabilization of distal EV from the point of view of axial rotation.” Level of Evidence. 4.
  5. Gouzoulis MJ, Joo PY, Jeong S, Jabbouri SS, Moran J, Zhu JR, Grauer JN. A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are "one and done"? Spine Deform. 2024 Jul;12(4):903-908. doi: 10.1007/s43390-024-00858-3. Epub 2024 Mar 31. PMID: 38555557. “Conclusions: The current study of a large national AIS PSF population found 9.6% to undergo reoperation in the 10 years following their index operation....”
  6. Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T, Minato K, Sato M, Kawashima H. Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion. Eur Spine J. 2024 Jun;33(6):2522-2529. doi: 10.1007/s00586-024-08233-6. Epub 2024 Apr 4. PMID: 38573384.
  7. Akazawa T, Kotani T, Sakuma T, Iijima Y, Torii Y, Ueno J, Yoshida A, Eguchi Y, Inage K, Matsuura Y, Suzuki T, Niki H, Ohtori S, Minami S. Long-term changes in bone mineral density following adolescent idiopathic scoliosis surgery: a minimum 34-year follow-up. Eur J Orthop Surg Traumatol. 2024 Jan;34(1):425-431. doi: 10.1007/s00590-023-03678-9. Epub 2023 Aug 11. PMID: 37566138. "Conclusion: Significant reductions in BMD and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population.(note: this could be true of all patients with AIS, fused or not)
  8. Çetinkaya İ, Kuru Çolak T, Korkmaz MF, Aydoğan M. The effect of spinal range of motion on functional balance, quality of life, and perception of appearance in adolescent idiopathic scoliosis after posterior spinal fusion surgery. Ir J Med Sci. 2024 Jun;193(3):1307-1312. doi: 10.1007/s11845-023-03563-8. Epub 2023 Nov 9. PMID: 37943401. ”...Postoperative spinal limitation of motion adversely affected functional balance, quality of life, and perception of appearance. We believe that comprehensive rehabilitation approaches that improve postoperative range of motion and increase functionality are important for optimal postoperative recovery.”
  9. Tsirikos AI, García-Martínez S. Long Term Health-Related Quality of Life (QOL) after Paediatric Spinal Deformity Surgery and Comparison with the General Population. J Clin Med. 2023 Nov 17;12(22):7142. doi: 10.3390/jcm12227142. PMID: 38002754; PMCID: PMC10672074. “Patients with AIS, syndromic/secondary scoliosis and low/high-grade spondylolisthesis had reduced SRS-22r total/domain and EQ-5D (index/VAS) scores and higher VAS back/leg pain scores compared to the 20 29 year group but comparable scores to the 30-39 year group. Patients with spinal deformity reported improved QOL and high satisfaction after surgery which was maintained at >10 years of follow-up.”
  10. Stone, Lauren E. MDa; Upasani, Vidyadhar V. MDb; Pahys, Joshua M. MDc; Fletcher, Nicholas D. MDd; George, Stephen G. MDe; Shah, Suken A. MDf; Bastrom, Tracey P. MAb; Bartley, Carrie E. MAb; Lenke, Lawrence G. MDg; Newton, Peter O. MDb; Kelly, Michael P. MD, MSb; Harms Study Group. SRS-22r Self-Image After Surgery for Adolescent Idiopathic Scoliosis at 10 year Follow-up. Spine 48(10):p 683-687, May 15, 2023. | DOI: 10.1097/BRS.0000000000004620
  11. Jakkepally S, Viswanathan VK, Shetty AP, Hajare S, Kanna RM, Rajasekaran S. The analysis of progression of disc degeneration in distal unfused segments and evaluation of long-term functional outcome in adolescent idiopathic scoliosis patients undergoing long-segment instrumented fusion. Spine Deform. 2022 Mar;10(2):343-350. doi: 10.1007/s43390-021-00428-x. Epub 2021 Oct 20. PMID: 34669167.
  12. Helenius L, Diarbakerli E, Grauers A, Lastikka M, Oksanen H, Pajulo O, Löyttyniemi E, Manner T, Gerdhem P, Helenius I. Back Pain and Quality of Life After Surgical Treatment for Adolescent Idiopathic Scoliosis at 5-Year Follow-up: Comparison with Healthy Controls and Patients with Untreated Idiopathic Scoliosis. J Bone Joint Surg Am. 2019 Aug 21;101(16):1460 1466. doi: 10.2106/JBJS.18.01370. Erratum in: J Bone Joint Surg Am. 2021 Feb 3;103(3):e13. doi: 10.2106/JBJS.ER.18.01370. PMID: 31436653. ”Conclusions: Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower.”
  13. Louer, Craig Jr. MD; Yaszay, Burt MD; Cross, Madeline MPH; Bartley, Carrie E. MA; Bastrom, Tracey P. MA; Shah, Suken A. MD; Lonner, Baron MD; Cahill, Patrick J. MD; Samdani, Amer MD; Upasani, Vidyadhar V. MD; Newton, Peter O. MD. Ten-Year Outcomes of Selective Fusions for Adolescent Idiopathic Scoliosis. The Journal of Bone and Joint Surgery 101(9):p 761-770, May 1, 2019. | DOI: 10.2106/JBJS.18.01013
  14. Ghandhari H, Ameri E, Nikouei F, Haji Agha Bozorgi M, Majdi S, Salehpour M. Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis. Scoliosis Spinal Disord. 2018 Aug 2;13:14. doi: 10.1186/s13013-018-0157-z. PMID: 30123840; PMCID: PMC6090875.
  15. Akazawa T, Kotani T, Sakuma T, Minami S, Torii Y, Orita S, Inage K, Fujimoto K, Shiga Y, Inoue G, Miyagi M, Saito W, Ohtori S, Niki H. Midlife changes of health-related quality of life in adolescent idiopathic scoliosis patients who underwent spinal fusion during adolescence. Eur J Orthop Surg Traumatol. 2018 Feb;28(2):177-181. doi: 10.1007/s00590-017-2027-4. Epub 2017 Aug 10. PMID: 28798984.
  16. Zacharia B, Subramaniyam D, Padinharepeediyekkal S. A retrospective analysis of health-related quality of life in adolescent idiopathic scoliosis children treated by anterior instrumentation and fusion. Scoliosis Spinal Disord. 2018 Aug 30;13:15. doi: 10.1186/s13013-018-0162-2. PMID: 30182063; PMCID: PMC6116550.
  17. Simony A, Hansen EJ, Carreon LY, Christensen SB, Andersen MO. Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment. Scoliosis. 2015 Jul 16;10:22. doi: 10.1186/s13013-015-0045-8. PMID: 26180541; PMCID: PMC4502518. “Conclusion Health related quality of life, as measured by the SRS22R and SF-36, of adult AIS patients treated with Boston brace or surgery during adolescence were similar to the general population. No clinical progression of the deformity has been detected during the 25-year follow up period.”
  18. Vigneswaran HT, Grabel ZJ, Eberson CP, Palumbo MA, Daniels AH. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr. 2015 Sep;16(3):322-8. doi: 10.3171/2015.3.PEDS14649. Epub 2015 Jun 26. PMID: 26114991.
  19. Iida T, Suzuki N, Kono K, Ohyama Y, Imura J, Ato A, Ozeki S, Nohara Y. Minimum 20 Years Long-term Clinical Outcome After Spinal Fusion and Instrumentation for Scoliosis: Comparison of the SRS-22 Patient Questionnaire With That in Nonscoliosis Group. Spine (Phila Pa 1976). 2015 Aug 15;40(16):E922-8. doi: 10.1097/BRS.0000000000000991. PMID: 25996533.
  20. Falick-Michaeli T, Schroeder JE, Barzilay Y, Luria M, Itzchayek E, Kaplan L. Adolescent Idiopathic Scoliosis and Pregnancy: An Unsolved Paradigm. Global Spine J. 2015 Jun;5(3):179-84. doi: 10.1055/s-0035-1552987. Erratum in: Global Spine J. 2016 Sep;6(6):626. doi: 10.1055/s-0036-1586242. PMID: 26131384; PMCID: PMC4472295. “Conclusion Women who underwent scoliosis correction suffered from long-term back pain after pregnancy and had decreased satisfaction with surgery. In addition, anesthesiologists refused epidurals in a large number of these patients. A larger study is needed on the topic. “
  21. Vigneswaran HT, Grabel ZJ, Eberson CP, Palumbo MA, Daniels AH. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr. 2015 Sep;16(3):322-8. doi: 10.3171/2015.3.PEDS14649. Epub 2015 Jun 26. PMID: 26114991.
  22. Lykissas MG, Jain VV, Nathan ST, Pawar V, Eismann EA, Sturm PF, Crawford AH. Mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine (Phila Pa 1976). 2013 Jan 15;38(2):E113-9. doi: 10.1097/BRS.0b013e31827ae3d0. PMID: 23124268.
  23. Akazawa T, Minami S, Kotani T, Nemoto T, Koshi T, Takahashi K. Health-related quality of life and low back pain of patients surgically treated for scoliosis after 21 years or more of follow-up: comparison among nonidiopathic scoliosis, idiopathic scoliosis, and healthy subjects. Spine (Phila Pa 1976). 2012 Oct 15;37(22):1899-903. doi: 10.1097/BRS.0b013e31825a22c2. PMID: 22531470. “Conclusion. The patients with non-IS and IS had similar health-related quality of life and low back pain. The patients with non-IS were found to have lower function and self-image in the SRS-22 questionnaire and more severe low back pain in the RDQ than healthy subjects. The patients with non-IS had a significantly lower marriage rate than the other 2 groups.”
  24. Akazawa T, Minami S, Kotani T, Nemoto T, Koshi T, Takahashi K. Long-term clinical outcomes of surgery for adolescent idiopathic scoliosis 21 to 41 years later. Spine (Phila Pa 1976). 2012 Mar 1;37(5):402-5. doi: 10.1097/BRS.0b013e31823d2b06. PMID: 22037534. “Surgery had no demonstrable adverse effects on pain or mental health in these middle-aged AIS patients 21-41 years after surgery, although the AIS patients did have significantly lower function and lower self-image than the controls. “
  25. Danielsson AJ, Nachemson AL. Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine (Phila Pa 1976). 2003 Sep 15;28(18):E373-83. doi: 10.1097/01.BRS.0000084267.41183.75. PMID: 14501939. “Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls...”
  26. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL. Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001 Aug;10(4):278-88. doi: 10.1007/s005860100309. PMID: 11563612; PMCID: PMC3611508. “Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.”

Risks and Complications of Paediatric Spinal Deformity Surgery for AIS (aka complex spine surgery)

A curated list.

  1. Reviewed by SickKids Staff, Immediate risks of scoliosis surgery. Hospital for Sick Children, last updated June 1st 2008 “...Key Points: Possible complications after scoliosis surgery include complications from blood transfusions, neurologic complications, infection, lung complications, intestinal blockage, blood clots in the thighs or leg, pain where the bone chips are removed.The risk of most of these complications is between 1 % to 2%. Immediate risks of surgery are those risks that can occur within the few weeks after surgery....”
  2. Braun JT, Federico SC, Lawlor DM, Grottkau BE. Outcomes in patients with tether rupture after anterior vertebral tethering for adolescent idiopathic scoliosis: the good, the bad, and the ugly. Spine Deform. 2025 Mar 28. doi: 10.1007/s43390-025-01077-0. Epub ahead of print. PMID: 40153146. “Conclusion: This study demonstrated an early tether rupture rate of 9% and late tether rupture rate of 26% in a large series of patients treated with AVT for AIS over 14 years. While the majority of patients had inconsequential tether rupture (67%), with 7.2° loss of correction, a final curve < 40°, and no pain, a number of patients had consequential (13%) or problematic tether rupture (16%). These adversely affected patients had a final curve ≥ 40°, convex back pain, or required revision surgery. Additionally, a small number of patients (4%) actually benefitted from tether rupture by improvement in an area of impending overcorrection. “ Level of Evidence: IV
  3. Tetreault TA, Phan TN, Wren TAL, Heffernan MJ, Welborn MC, Smith JT, El-Hawary R, Cheung K, Illingworth KD, Skaggs DL, Andras LM; Pediatric Spine Study Group. The Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage? Spine (Phila Pa 1976). 2025 Mar 15;50(6):405-411. doi: 10.1097/BRS.0000000000005072. Epub 2024 Jun 12. PMID: 38864265. “...skeletally immature patients with curves ≥35 degrees at time of rupture are most likely to undergo additional surgery. Most patients can expect progression at least 5 degrees in the first 2 years after tether breakage, though longer term behavior remains unknown." Level of Evidence: Level III
  4. Zale C, Fene E, Bonnyman C, Klinkerman L, McIntosh AL. Aborted AIS spinal fusion due to persistent loss of IONM: which patients are at greatest risk? Spine Deform. 2024 May;12(3):681-687. doi: 10.1007/s43390-024-00831-0. Epub 2024 Mar 5. PMID: 38441871.
  5. Cahill, Patrick J. MD*,†; Miyanji, Firoz MD‡; Lullo, Brett R. MD§; Samdani, Amer F. MD∥; Lonner, Baron S. MD¶; Pahys, Joshua M. MD§; Hwang, Steven W. MD§; Haber, Lawrence L. MD#; Alanay, Ahmet MD**; Shah, Suken A. MD††; Parent, Stefan MD‡‡; Blakemore, Laurel C. MD§§; Hoernschemeyer, Daniel G. MD∥∥; Neal, Kevin M. MD††;  Harms Study Group; Newton, Peter O. MD¶¶. Incidence of Tether Breakage in Anterior Vertebral Body Tethering. Journal of Pediatric Orthopaedics 44(4):p e323-e328, April 2024. | DOI: 10.1097/BPO.0000000000002619
  6. Burgos J, Hevia E, Sanpera I, García V, de Santos Moreno MT, Mariscal G, Barrios C. Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis. Eur Spine J. 2024 Apr;33(4):1624-1636. doi: 10.1007/s00586 024-08165-1. Epub 2024 Feb 19. PMID: 38372794.
  7. Benes, Gregory BS*; Shufflebarger, Harry L. MD†; Shah, Suken A. MD‡; Yaszay, Burt MD§; Marks, Michelle C. MS, PT ; Newton, Peter O. MD§; Sponseller, Paul D. MD, MBA*. ∥ Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal. Journal of Pediatric Orthopaedics 43(7):p e525-e530, August 2023. | DOI: 10.1097/BPO.0000000000002440
  8. Mehta NN, Talwar D; Harms Study Group; Flynn JM. Unplanned return to the operating room (UPROR) after surgery for adolescent idiopathic scoliosis. Spine Deform. 2021 Jul;9(4):1035-1040. doi: 10.1007/s43390-021-00284-9. Epub 2021 Mar 11. PMID: 33704688.
  9. Kwan KYH, Koh HY, Blanke KM, Cheung KMC. Complications following surgery for adolescent idiopathic scoliosis over a 13-year period. Bone Joint J. 2020 Apr;102-B(4):519-523. doi: 10.1302/0301-620X.102B4.BJJ-2019-1371.R1. PMID: 32228070.
  10. Mignemi M, Tran D, Ramo B, Richards BS. Repeat Surgical Interventions Following "Definitive" Instrumentation and Fusion for Idiopathic Scoliosis: 25-Year Update. Spine Deform. 2018 Jul-Aug;6(4):409-416. doi: 10.1016/j.jspd.2017.12.006. PMID: 29886912.
  11. How NE, Street JT, Dvorak MF, Fisher CG, Kwon BK, Paquette S, Smith JS, Shaffrey CI, Ailon T. Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev. 2019 Jun;42(2):319-336. doi: 10.1007/s10143-018-0951-3. Epub 2018 Feb 6. PMID: 29411177.
  12. Shillingford JN, Laratta JL, Sarpong NO, Alrabaa RG, Cerpa MK, Lehman RA, Lenke LG, Fischer CR. Instrumentation complication rates following spine surgery: a report from the Scoliosis Research Society (SRS) morbidity and mortality database. J Spine Surg. 2019 Mar;5(1):110-115. doi: 10.21037/jss.2018.12.09. PMID: 31032445; PMCID: PMC6465472.
  13. Baron S. Lonner, Yuan Ren, Vidyadhar V. Upasani, Michelle M. Marks, Peter O. Newton, Amer F. Samdani, Karen Chen, Harry L. Shufflebarger, Suken A. Shah, Daniel R. Lefton, Hussein Nasser, Colin T. Dabrowski, Randal R. Betz, Disc Degeneration in Unfused Caudal Motion Segments Ten Years Following Surgery for Adolescent Idiopathic Scoliosis, Spine Deformity, Volume 6, Issue 6, 2018, Pages 684 690, ISSN 2212-134X, ”...Conclusion In the first study of its kind, we found that only 7.3% of patients had significant DD 10 years after surgical correction of AIS. Rates of DD increased over time. Our data provide evidence to support recommendations to save as many caudal motion segments as possible, to avoid fusing to L4, and maintain the LIV tilt angle below 5° and LIV translation less than 2 cm.”
  14. Divecha HM, Siddique I, Breakwell LM, Millner PA; British Scoliosis Society Members. Complications in spinal deformity surgery in the United Kingdom: 5-year results of the annual British Scoliosis Society National Audit of Morbidity and Mortality. Eur Spine J. 2014 Apr;23 Suppl 1(Suppl 1):S55-60. doi: 10.1007/s00586-014-3197-y. Epub 2014 Jan 24. PMID: 24458937; PMCID: PMC3946093.

Risk of Radiation Exposure and Cancer rates in AIS patients:

A curated list. One of the major complaints raised against school screening has been the issue of radiation exposure to children. However, with newer EOS® stereoradiography systems, the radiation of the microdose protocol is 45 times less than that of conventional radiography. Many major childrens hospitals in Canada now have this 3D imaging device and it should be the standard.

  1. Striano BM, Crawford AM, Verhofste BP, Hresko AM, Hedequist DJ, Schoenfeld AJ, Simpson AK. Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J. 2024 Jun;24(6):1087-1094. doi: 10.1016/j.spinee.2024.01.007. Epub 2024 Jan 21. PMID: 38262498. "...Conclusions: Ours is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies.
  2. Farivar D, Skaggs DL, Gabriel K, Illingworth KD. Breast Cancer Incidence, Mortality, and Cost in Adolescent Idiopathic Scoliosis Patients and the Role of Low Dose Biplanar Radiography. J Am Acad Orthop Surg. 2023 Sep 1;31(17):e633-e637. doi: 10.5435/JAAOS-D-23-00062. Epub 2023 Jul 10. PMID: 37432975.
  3. Cool J, Streekstra GJ, van Schuppen J, Stadhouder A, van den Noort JC, van Royen BJ. Estimated cumulative radiation exposure in patients treated for adolescent idiopathic scoliosis. Eur Spine J. 2023 May;32(5):1777 1786. doi: 10.1007/s00586-023-07651-2. Epub 2023 Mar 21. PMID: 36943485."...Conclusion The estimated cumulative effective radiation exposure in the clinical treatment of AIS patients, as calculated in this study, was relatively low, given the ample number of radiological examinations conducted and the cumulative radiation dose reported elsewhere in the literature. However, any amount of additional radiation exposed to as a result of medical imaging represents potential harm, especially so in the adolescent patient and should therefore be kept to a minimum. In surgically treated patients, the recently introduced combination of preoperative low-dose CT scans and patient-specific intraoperative drill guides for accurate pedicle screw insertion increased the average cumulative effective radiation dose compared to the use of intraoperative 2D fluoroscopy, which was caused by the significantly higher radiation dose of the preoperative low-dose CT scan.
  4. Duke A, Marchese R, Komatsu DE, Barsi J. Radiation in Adolescent Idiopathic Scoliosis Management: Estimated Cumulative Pre-Operative, Intra-Operative, and Post-Operative Exposure. Orthop Res Rev. 2022 Dec 30;14:487-493. doi: 10.2147/ORR.S387369. PMID: 36606065; PMCID: PMC9809375. “Conclusion The two-year cumulative radiation exposure is below the recommended exposure by Nuclear Regulatory Commission and OSHA. As expected, CT exposure presents the largest radiation exposure to patients with AIS throughout their operative management.”

Diagnostic Imaging for Monitoring AIS

A curated list.

  1. Kumar S, Awadhiya B, Ratnakumar R, Thalengala A, Areeckal AS, Nanjappa Y. A Review of 3D Modalities Used for the Diagnosis of Scoliosis. Tomography. 2024 Aug 2;10(8):1192-1204. doi: 10.3390/tomography10080090. PMID: 39195725; PMCID: PMC11360202.
  2. Rose LD, Williams R, Ajayi B, Abdalla M, Bernard J, Bishop T, Papadakos N, Lui DF. Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard. Spine Deform. 2023 Jul;11(4):847-851. doi: 10.1007/s43390-023-00653-6. Epub 2023 Mar 22. PMID: 36947393; PMCID: PMC10261215. “Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality....Standard plain film imaging of the whole spine requires in excess of 5 times higher doses of radiation compared to dual planar EOS scans."





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