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Adult Spinal Deformity Surgery
Degenerative Scoliosis Surgery
An in-depth, evidence-based explanation of surgery for degenerative (de novo) scoliosis — the adult-onset lumbar curve that develops from wear, often with trapped nerves.
Degenerative scoliosis, sometimes called de novo scoliosis, is a curve that develops for the first time in later adult life out of asymmetric wear of the discs and facet joints, with no childhood scoliosis behind it. The curves are usually smaller than the idiopathic ones seen in younger people, but they frequently come with narrowing of the nerve channels, so leg pain and walking difficulty are common. Surgery is considered when symptoms are significant and have not settled with non-operative care, and it is tailored — from a focused decompression to a longer realignment — according to the balance of the spine and the nerves involved. This page explains what the surgery involves and what the evidence shows.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
The problem it treats
In degenerative scoliosis, uneven wear tilts and rotates the lower spine over time. The main symptoms are usually back pain and, very often, leg symptoms — sciatica from a pinched nerve, or a cramping tiredness in the legs on walking (neurogenic claudication) from narrowing of the spinal canal that accompanies the curve. As in all adult deformity, what matters most is not the size of the curve but whether the spine is balanced, whether nerves are compressed, and how much the symptoms affect daily life.
How the surgery is chosen and what it involves
There is a spectrum of operations, and the aim is to do enough to relieve the problem without over-treating. Where the main issue is a trapped nerve in a reasonably balanced spine, a targeted decompression, sometimes with a short fusion at the affected level, can be enough. Where the curve is unbalanced, progressive or the wear is widespread, a longer fusion with pedicle screws and rods is used to realign and stabilise the spine, often with interbody cages to restore height, open the nerve channels and help the fusion knit. Frameworks such as the Silva-Lenke levels of treatment help match the extent of surgery to the severity of the deformity and symptoms.
What the evidence shows
The evidence guides how much surgery to do. Comparative studies of decompression alone, decompression with a limited fusion, and full-curve fusion for degenerative scoliosis show that each has a place: a limited approach can work well when balance is preserved and the problem is focal, while a broader correction is warranted for unbalanced or progressive curves. Sagittal balance again predicts outcome, and the evidence supports tailoring the operation to the individual rather than applying a single approach to every curve. The balanced view is that degenerative scoliosis surgery is effective when matched carefully to the pattern of deformity and the symptoms.
What to expect
The operation is carried out under general anaesthetic, with the hospital stay and recovery depending on the scale of surgery — shorter for a focused decompression, longer for a realignment. Leg symptoms often ease relatively quickly once the nerves are decompressed, while a fusion consolidates over the following months, supported by rehabilitation. As with any surgery there are risks, which are discussed fully beforehand, and the right operation for a given person is decided together.
The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 2010. (PMID 20192655)
- —Aebi M. The adult scoliosis. Eur Spine J 2005. (PMID 16328223)
- —Transfeldt EE, et al. Surgical outcomes of decompression, decompression with limited fusion, and full-curve fusion for degenerative scoliosis with radiculopathy. Spine 2010. (PMID 20802398)
- —Daubs MD, et al. Decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis in the elderly. Evid Based Spine Care J 2012. (PMID 23531707)
- —Glassman SD, et al. The impact of positive sagittal balance in adult spinal deformity. Spine 2005. (PMID 16166889)
- —Kobayashi T, et al. A prospective study of de novo scoliosis in a community-based cohort. Spine 2006. (PMID 16418637)
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