Spinal flexibility and scoliosis is a topic that is rarely covered online. When it comes to scoliosis and spinal flexibility, it is usually in regard to its impact on the expected outcome of a scoliosis surgery. Spinal flexibility is determined by multiple lateral bending x-rays. X-rays are often taken preoperatively with the patient lying in the supine position and bending to the left and right to measure the flexibility of the thoracic and lumbar curves. This reveals spinal flexibility/rigidity as the Cobb angle can be measured in comparison to the standing scoliosis x-ray. The reason that surgeons order these studies is to make predictions about the outcome of fusion surgery.
It’s clear from our talks with families who have seen surgeons that many kids and their parents come away from these visits scared — and/or scarred. One concerned father reported being told that if his daughter—sixteen-years-old and nearly at bone maturity—did not have the spinal fusion surgery her spine would become rigid and she’d lose mobility. To me, that statement is almost laughable when you consider what rods, pedicle screws, and fused spinal segments do to a spine. (FYI – According to one study, 10-12 is the average number of fusions in one scoliosis surgery.)
What that doctor was most likely trying to imply is that the patient’s spine wouldn’t attain as much correction a year or two down the road compared to having surgery at a younger age. Spinal fusions do not induce spinal flexibility in any way shape or form. A pamphlet distributed by the North American Spine Society states that the definition of a spinal fusion is “a surgical technique in which one or more of the vertebrae of the spine are united together [‘fused’] so that motion no longer occurs between them.”
In fact when considering future spinal flexibility, a study entitled “The effect of scoliosis fusion on spinal motion” concluded that there was “overall 25% less total spinal motion in the surgical groups compared to the unfused group. Patients who had thoracic fusions had diminished thoracic motion, especially lateral bending, whereas those who had lumbar fusions had the least lumbar motion, particularly on forward bend and lateral bend maneuvers.”
At Scoliosis 3DC®, we take a very different approach to scoliosis treatment. Families of children with scoliosis, and adults, come to us for our Schroth intensive program and/or scoliosis bracing. We focus on helping patients learn to manage their scoliosis with Schroth three-dimensional correction exercises and highly corrective 3D bracing. Education on how to retain or improve spinal flexibility is key to our instruction protocols. When an adolescent can both improve their spinal flexibility and trunk muscle endurance, there is a far better chance of attaining halted progression or improving scoliosis.
When a child, any child, is first diagnosed with scoliosis, it may be a year, or two, or three years, or more, before a visit with a spinal orthopedic surgeon turns to the mention of surgery, and only if the scoliosis has progressed to where the surgeon considers it “necessary.” Based on our twenty years plus of experience and according to patient feedback, this is usually when a scoliosis reaches the 45°-50° Cobb angle range in an adolescent. That said, it does depend on the individual physician and their philosophy.
Doctors usually cite two reasons for recommending scoliosis surgery: an increased risk of scoliosis progression in adulthood and/or correction of the physical aspect of scoliosis. While it is true that spinal surgery for adolescents usually has better outcomes compared to adult scoliosis surgery, the greater question is, is such a serious surgery that subjects your child to significant risk warranted in the first place? What most doctors don’t share are the results of two independent natural history studies — published by surgeons — which concluded that kids (even with severe curves) can go on to lead long and healthy adult lives with scoliosis without ever having surgery.
Early treatment for scoliosis is paramount. Years ago, surgeons would not even mention the Schroth method to patients. As parents, we asked point-blank about scoliosis-specific exercises and were told there was nothing that would work. Today, many still don’t believe in taking proactive steps early on in a scoliosis diagnosis. Families who look outside the box and act early when given the opportunity to greatly improve their child’s odds of never having to hear those same words from a surgeon.
Clinically, we’ve seen that the potential for spinal and postural improvement in patients in the early stages of mild-to-moderate scoliosis can be significant. The reason for this is that most growing kids do have some spinal flexibility, some more than others. So, why is it that surgeons advise parents to ‘watch and wait’ when young children or adolescents are diagnosed and kids may have the potential to improve. It’s one of the great mysteries of scoliosis treatment over time, or lack thereof.
Viable scoliosis treatment alternatives do exist and are designed to take advantage of spinal flexibility. It is important and underrated when it comes to managing scoliosis conservatively. Our focus is on mobilization and stabilization to help patients improve flexibility, spinal configuration, and posture. In contrast, surgery limits mobility but certainly stabilizes, with hardware, at least where there are fusions. The question is, Which way would you rather address spinal flexibility?
References:
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003;289(5):559–567.
Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2.
Wilk B, Karol LA, Johnston CE II, Colby S, Haideri N. The effect of scoliosis fusion on spinal motion: a comparison of fused and nonfused patients with idiopathic scoliosis. Spine 2006;31:309–314.
Recommended reading:
Martha C. Hawes, Ph.D., published in Pediatric Rehabilitation, 2003: The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature. Martha is the author of Scoliosis and the Human Spine, available through the National Scoliosis Foundation.
Updated February 4, 2025
