The most common operation for scoliosis is a posterior spinal fusion with instrumentation. It stops the curve getting worse and corrects it as far as is safe. In selected growing children, vertebral body tethering is an alternative that keeps more movement. This page explains both operations, how your child is protected, the risks, and what the day of surgery is like.
Reviewed by Dr. Kshitij Chaudhary — Last reviewed October 2026
What does the operation involve?
The most common operation is a posterior spinal fusion with instrumentation. "Posterior" means it's done through the back, "fusion" means joining vertebrae into one solid piece, and "instrumentation" means the metal implants. It's done under general anaesthesia, and it can treat all curve patterns.
- A cut is made along the back, over the curved section
- Screws (sometimes hooks) are placed into the vertebrae
- Rods are attached to the screws. These straighten the spine as much as is safe, and hold it in position
- Bone graft is laid along the spine so the vertebrae grow together into one solid column
The rods work as an internal brace while the bone fuses. This takes about 6 to 12 months. After that, the fusion itself holds the correction.
The levels that are fused depend on the curve pattern, and we'll explain our plan for your child.
(Image to add: before and after X-rays of a posterior spinal fusion, front and side views)
Is there an operation that avoids fusion?
In selected children, yes. We offer vertebral body tethering in appropriate cases. It is done for children who are still growing, usually through small cuts in the chest wall. Screws are placed on the outer side of the curve and joined by a strong, flexible cord. As your child keeps growing, the tension in the cord helps the spine to straighten gradually. Because the bones aren't fused, more spinal movement is kept.
It isn't right for everyone. It depends on the child's age, how much growth is left, the size and stiffness of the curve and its pattern. The cord can sometimes stretch or break, and some children need a further operation. We'll tell you whether it's an option for your child, and what the trade-offs are compared with fusion.
(Image to add: simple diagram of vertebral body tethering)
What are the implants made of, and do they stay in?
Implants are made of stainless steel, titanium or cobalt chrome. There is a wide variety available, and surgeons have their own preferences, which we'll discuss with you. Titanium and cobalt chrome allow an MRI scan later if you ever need one.
Implants normally stay in for life, apart from uncommon problems such as infection or discomfort. After the bones fuse, the fusion itself holds the correction, so the implants don't really have a job. Taking them out is a major operation, and it isn't needed in most cases.
How do the bones fuse?
Bone graft is used to fuse the spine in its corrected position. It can come from a variety of sources. These depend on the operation, and usually include bone removed from the spine during surgery plus extra bone products.
How does a fusion affect growth and movement?
A fusion stops growth in the section that is fused. Most teenagers don't notice, because they gain some height when the spine is straightened. Each vertebra grows only about 1 millimetre a year, and the height lost is generally balanced by the height gained from the correction.
The fused section is no longer flexible. In the chest, the spine moves very little anyway, so you barely notice. The lower back moves more, so a fusion there limits some movement, and the discs next to it have to do more work. This is why we fuse as few lower-back vertebrae as possible. Overall, the loss of flexibility is modest, and it affects day-to-day activity very little.
How is the spinal cord protected during surgery?
The spinal cord and nerves control movement, sensation, and bladder and bowel function. Throughout the operation, a trained specialist uses a computer system to check the signals travelling along the spinal cord and nerves, and the brain's responses. If anything changes, the surgical team knows straight away and can act. This monitoring significantly lowers the risk of spinal cord problems after surgery.
What are the risks of surgery?
Every operation has risks, and there are risks and benefits with every kind of scoliosis surgery. Your surgeon should talk them through with you in plain terms. The main ones are:
- Infection
- Bleeding
- Injury to the nerves or spinal cord, which is rare, and which monitoring helps to guard against
- Bone that doesn't fuse properly (called pseudarthrosis)
- Problems with the implants
- Needing another operation, which is more likely in younger children who still have growing to do
In experienced hands, the risk of serious complications is low, and further surgery is uncommon. We'll go through your child's own risks at the consultation.
What happens before the operation?
You meet the surgeon and team again to go through the plan. Your child may need more X-rays at this visit. This is a good time for questions, but do call the office at any time if something is worrying you. Our team will help with admission and paperwork, and arrange blood to be available for the operation. Many families find it helps to speak to another family who has been through it, so ask us about that.
What happens on the day of surgery?
Expect:
- More paperwork
- Meeting the anaesthetist (the doctor who puts your child to sleep), the surgeons and their assistants
- Repetition, with a lot of different people asking the same questions. That's for safety
- A chance to ask questions before surgery
- A long day, with minutes passing like hours for parents and like seconds for your child
- Great relief when you meet the surgeon after the operation, and even greater relief when you're reunited with your child
This information is for general education and does not replace a consultation with your doctor.