Scoliosis surgery in a child straightens and stabilizes a curve that would keep worsening, most often with posterior spinal fusion using screws and rods, or with growing rods and tethering in younger children who are still growing. Many curves are controlled with a brace and never need surgery. At Biruni Hospital in Istanbul, our pediatric spine surgeons operate with spinal cord monitoring and an enhanced recovery pathway that gets children walking the day after surgery.
About This Department
Pediatric Orthopedics
Most curved spines in children need watching or a brace. Surgery straightens and stops the curves that keep growing.
Scoliosis surgery in a child corrects a sideways and twisted curve of the spine that has reached a size where it will keep worsening into adulthood, at 45 to 50 degrees or more. For teenagers with idiopathic scoliosis surgeons use posterior spinal fusion with screws and rods as the standard operation, and for younger children with early onset scoliosis growth-friendly rods straighten the spine while it keeps growing. Many children never reach surgery. In the BrAIST trial of 242 adolescents, a brace worn as prescribed stopped high risk curves from reaching 50 degrees in 72 percent, against 48 percent with observation alone (Weinstein and colleagues, New England Journal of Medicine, 2013). When a child needs surgery, recovery comes faster than many families expect. An enhanced recovery pathway cut the average hospital stay after fusion from 6.3 to 3.5 days (Temby and colleagues, Spine Deformity, 2021). This page explains types of scoliosis, measurement, bracing, fusion, tethering, growing rods, safety, recovery, and how families from abroad arrange scoliosis surgery for a child at Biruni Hospital in Istanbul.
72
Percent of high risk curves kept below surgical range with a brace in a randomized trial
3.5
Days average hospital stay after spinal fusion with an enhanced recovery pathway
1,112
Patients in a meta-analysis comparing fusion with vertebral body tethering
Free
Review of your child's X-rays and MRI by our pediatric spine team
Scoliosis is a sideways curve of the spine combined with rotation of the vertebrae, which pushes the ribs backward on one side and creates a rib hump.
Two to three in a hundred adolescents have a curve over ten degrees, and only a small share of them need treatment. Girls have larger curves that progress more often than boys.
Scoliosis is not caused by posture, heavy school bags or sports. Parents did nothing to cause it.
Uneven shoulders, a prominent shoulder blade, an uneven waist or a hump when bending forward are the signs parents notice first.
Who treats scoliosis
Specialist
Role
When
Pediatric spine surgeon
Assessment, bracing decisions, surgery
Throughout
Orthotist
Making and adjusting the brace
During bracing
Physiotherapist
Scoliosis-specific exercises, recovery
Before and after surgery
Pediatric anesthetist and intensivist
Safe surgery and pain control
Around surgery
Types of scoliosis
Main types of scoliosis in children
Type
Cause
Typical age
Adolescent idiopathic
Unknown, runs in families
Ten years to maturity
Early onset
Idiopathic, congenital, syndromic or neuromuscular
Idiopathic scoliosis in adolescents is by far the most common form. Congenital and neuromuscular curves behave differently and are planned with other specialists.
An MRI for some children
Does every child with scoliosis need an MRI?
No. Typical adolescent curves need only X-rays. An MRI of the whole spine is done for curves before age ten, left-sided thoracic curves, pain, rapid progression or abnormal neurological findings, because these can point to a problem inside the spinal canal.
Measuring the curve
Measurements that guide treatment
Measurement
What it shows
How
Cobb angle
Size of the curve in degrees
Standing X-ray of the whole spine
Risser grade and hand X-ray
Growth remaining
X-ray of the pelvis or hand
Rib hump
Rotation
Forward bend test, scoliometer
Bending X-rays
Flexibility of the curve
Before surgery
Growth matters most
Curves grow fastest during the adolescent growth spurt. A 25 degree curve in a girl who has not started her periods carries a much higher risk of progression than the same curve two years after her periods began.
1
Low dose imaging
We use low dose X-ray techniques and limit repeat X-rays to the intervals the decision needs.
A change of five degrees or more between X-rays counts as real progression. Smaller changes fall within measurement error.
2
Surface scanning
Three-dimensional surface scans of the back between X-rays track the rib hump without radiation in selected children.
Each visit ends with a clear plan, the next X-ray date and the threshold that would change treatment.
Bracing
Bracing against observation in the BrAIST trial, 242 adolescents
Outcome
Brace
Observation
Curve stayed under 50 degrees, all patients
72 percent
48 percent
Randomized patients only
75 percent
42 percent
Effect of wear time
More hours, better result
Not applicable
A brace does not straighten a curve. It holds the spine during growth so that the curve does not reach the size where surgery is needed. The trial was stopped early because bracing worked, and success rose with the number of hours the brace was worn (Weinstein and colleagues, 2013).
Who benefits
1
The typical candidate
A growing child with a curve of 25 to 40 degrees, worn 18 hours or more a day until growth ends.
Living with a brace
Topic
Advice
Note
Hours
At least 18 a day, including nights
Sensors can record wear time
Sport
Allowed without the brace
Keeps muscles strong
Skin
Cotton vest underneath, daily checks
Adjust if red marks persist
When surgery is needed
The 50 degree line
1
Thresholds
Surgery is considered for curves above 45 to 50 degrees in adolescents, because these curves continue to grow by around one degree a year in adult life.
Larger thoracic curves also reduce lung capacity over time, and severe curves cause back pain and visible deformity in adulthood. Surgery aims to stop progression, correct the curve safely and balance the trunk and shoulders.
Can surgery wait until our child is older?
For a large curve in a growing child, waiting lets the curve get bigger and stiffer, which needs a longer and harder operation. After growth ends, curves around 50 degrees can sometimes be watched. We explain the trend in your child's X-rays and the cost of waiting in each case.
Choosing the right moment
Families choose the timing with us.
Once surgery is advised, families choose a date around school, examinations, sports seasons and travel, and a delay of a few months rarely changes the result for an adolescent near the end of growth, while a rapidly progressing curve in a younger child calls for an earlier date, so we show the growth stage, the speed of progression and the flexibility of the curve on the X-rays and agree a window rather than a fixed day. Summer holidays suit most teenagers. Psychological preparation matters too, and teenagers take part in every discussion.
Teenagers make this decision together with us.
Posterior spinal fusion
An incision runs down the middle of the back.
Screws are placed in the vertebrae of the curved segment.
Two rods, shaped to the corrected spine, are attached to the screws and rotated to straighten the curve.
Bone graft makes the instrumented vertebrae grow together into one solid segment.
The operation
A typical day of spinal fusion
Step
What happens
Time
Anesthesia and monitoring set-up
Nerve monitoring leads placed
One hour
Correction and fusion
Screws, rods, bone graft
Three to five hours
Waking
Neurological check in the operating room
Before leaving theater
Intensive care or high dependency
Pain control, monitoring
One night
Correction of 60 to 70 percent of the curve is typical, with a straighter trunk, level shoulders and a smaller rib hump. The fused segment no longer bends, while the levels above and below keep their movement.
The rods stay in place for life and do not set off airport security in most cases. Removal is rarely needed.
Safety during surgery
How we keep spinal surgery safe
Measure
Purpose
When
Spinal cord monitoring
Detects stress on the spinal cord in real time
Throughout surgery
Tranexamic acid and cell saver
Reduce blood loss and transfusion
During surgery
Navigation or careful screw checks
Accurate screw placement
During surgery
Antibiotics and wound protocol
Prevent infection
Before and after
Spinal cord injury is the most feared complication and remains rare in adolescent idiopathic scoliosis surgery. Electrical monitoring of the spinal cord pathways warns the surgeon within seconds if the correction stresses the cord, so the correction can be relaxed at once.
1
Other risks
Wound infection, blood loss, implant problems and, later, the need for further surgery in a small share. Each risk is explained in writing before consent.
Blood conservation
Most adolescents undergoing fusion avoid a blood transfusion with modern blood conservation. Iron levels are checked and corrected before surgery.
2
Pain control
Long-acting local anesthetic, intravenous pain medicines and early movement keep pain under control, and opioids are reduced within days.
Children with neuromuscular scoliosis carry higher risks, and their care is planned with neurologists, lung specialists and intensivists before surgery.
Vertebral body tethering
A non-fusion option
Fusion against tethering, 11 studies with 1,112 patients
Outcome
Posterior spinal fusion
Vertebral body tethering
Curve correction
Greater and more reliable
Less
Unplanned revision surgery
Lower odds
Higher, tether breakage in 13 to 23 percent
Pain and opioid use
More
Less
Return to sport, lumbar flexibility
Slower
Faster, more flexibility
Tethering places screws on the front of the spine through small chest incisions and connects them with a flexible cord that slows growth on the convex side, so the curve corrects as the child grows. It keeps movement but carries more unplanned operations (Al-Naseem and colleagues, Spine Deformity, 2025).
Who is a candidate
Is tethering right for our child?
It suits a few carefully selected children, those still growing with flexible thoracic curves of moderate size. For large or stiff curves, or after growth has ended, fusion gives a more predictable result. We discuss both options with the evidence for each.
Growing rods for young children
Growth-friendly surgery in 2,021 children with early onset scoliosis
Technique
Unplanned reoperations
Planned operations
Traditional growing rods
15 percent
Highest, 5.3 per child
Magnetically controlled growing rods
Higher than traditional rods
Lengthening in clinic with a magnet, no surgery
Shilla growth guidance
Comparable
Fewer
Fusing the spine of a young child stops chest growth and harms lung development. Growth-friendly techniques straighten the spine and let it grow.
Rods attached above and below the curve are lengthened every few months. Magnetically controlled rods are lengthened in the clinic with an external magnet, without anesthesia, while traditional rods need a short operation for each lengthening. The final fusion follows near the end of growth (Kim and colleagues, Journal of Neurosurgery Pediatrics, 2023).
Infants and toddlers with progressive curves start with serial casting under anesthesia, which straightens some curves completely.
Casting first
Serial plaster casts, changed every two to three months under anesthesia, delay or avoid surgery in many infants with idiopathic curves, and some curves resolve completely.
Congenital and neuromuscular scoliosis
Special planning
Congenital scoliosis comes from vertebrae that formed abnormally before birth, such as a hemivertebra. Removing a single hemivertebra early in childhood with a short fusion can prevent a severe curve later. Heart and kidney ultrasound look for associated differences.
Neuromuscular scoliosis
Condition
Goal of surgery
Special care
Cerebral palsy
Sitting balance, comfort, care
Fusion often to the pelvis
Duchenne muscular dystrophy
Sitting, breathing
Heart and lung assessment
Spinal muscular atrophy
Sitting, lung function
Growth-friendly rods in young children
1
Before surgery
Lung function tests, heart assessment, nutrition and bone health are optimized, and families meet the intensive care team.
For children who cannot walk, a straighter spine means more comfortable sitting, easier care and less pain.
Recovery
1
Enhanced recovery
Eating on the evening of surgery, sitting and walking on the first day, removal of drains and catheter early, and a planned day of discharge.
Enhanced recovery after spinal fusion, Australian study
Milestone
Enhanced recovery
Conventional care
Hospital stay
3.5 days on average
6.3 days
Switch to pain tablets
Two days earlier
Later
Hospital costs
Half
Full
2
At home
School after three to four weeks, light activity at once, swimming after six weeks and most sports after three to six months.
An enhanced recovery pathway cut hospital stay by 44 percent without increasing complications in an Australian children's hospital (Temby and colleagues, 2021). Our team uses the same principles, with physiotherapy from the first day.
Life after fusion
Teenagers go back to their lives.
After a fusion, adolescents return to school, sport, dance and most activities they enjoyed before, work in any career they choose and carry pregnancies later in life without special problems, while the fused segment no longer bends, which most young people barely notice when the fusion ends in the mid or lower back, and yearly X-rays for two years confirm that the fusion is solid. Long-term studies show good function decades after surgery.
A straight back, a full life.
For families from abroad
Send standing X-rays of the whole spine from the front and side, any bending X-rays and MRI, and photographs of the back standing and bending forward. Our spine team reviews them and proposes a plan before you travel.
Length of stay
1
Two to three weeks
Tests and preparation take two to three days, the hospital stay is three to five days, and a wound check and X-ray follow before fitness to fly.
Flying home
Long flights are possible ten to fourteen days after surgery, with walks in the aisle every hour.
2
After you return home
X-rays at six weeks, six months and one year can be done locally and reviewed by video and message.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Physiotherapy in hospital, X-ray before discharge, video follow-up
Braces, growing rod lengthening
The price depends on the number of levels fused, the type of implants and the complexity of the curve.
We send a written quote after reviewing X-rays and MRI, before you travel. Compare quotes for the same number of levels, implants and spinal cord monitoring.
Growing rods and staged care
For young children with growing rods, the quote lists the first operation, each lengthening and the final fusion separately, so families can plan for the years ahead.
References
Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-1521.
Al-Naseem AO, Al-Naseem A, Al Balushi B, et al. Posterior spinal fusion versus vertebral body tethering for paediatric scoliosis, a meta-analysis of comparative studies. Spine Deform. 2025;13(3):681-694.
Kim G, Sammak SE, Michalopoulos GD, et al. Comparison of surgical interventions for the treatment of early-onset scoliosis, a systematic review and meta-analysis. J Neurosurg Pediatr. 2023;31(4):342-357.
Temby SE, Palmer GM, Penrose SP, Peachey DM, Johnson MB. Implementation of an enhanced recovery pathway in Australia after posterior spinal fusion for adolescent idiopathic scoliosis delivers improved outcomes. Spine Deform. 2021;9(5):1371-1377.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Mustafa Atilla NURSOY, Pediatric Allergy and Immunology.
