🎧 Listen to this guideAudio version coming soon. Narrated in Mr Sadek’s voice using AI voice technology, from a script he has reviewed.
Key points
- Surgery for adult degenerative scoliosis aims to take pressure off trapped nerves and hold the spine steady with screws, rods and bone graft.
- It is only offered when non-surgical treatment no longer helps, and your overall health matters more than your age.
- BASS describes it as carrying the highest potential risks of any spinal operation currently performed. About 8 in 10 people have some complication and about 3 in 10 have a major one.
- BASS reports good relief of leg symptoms in about 7 in 10 people. Back pain relief is much less predictable.
- Expect a night or two in intensive or high dependency care, a hospital stay of a week or more, and a recovery that runs over many months.
What is adult degenerative scoliosis?
Degenerative scoliosis is a sideways curve of the spine that develops in adulthood as the discs and facet joints wear. When the wear is worse on one side, the spine can gradually tip over. It is diagnosed when the curve measures at least 10 degrees on standing, full-length X-rays, a measurement known as the Cobb angle.[1]
Most people with symptoms are 60 or older. Typical problems are back pain, stiffness and pain in the buttocks and thighs. If the curve narrows the spinal canal or stretches the nerves, you may also get sciatica-like leg pain, pins and needles or numbness, usually brought on by standing or walking and eased by sitting or bending forward.[1] Our guide to scoliosis explains the condition itself.
What the operation aims to do
There are two main goals. The first is decompression, which means removing bone and thickened tissue to free the trapped nerves. The second is stabilisation, where screws and rods hold the spine in a better position while bone graft fuses the vertebrae together so they no longer move.[1] Because the operation can be very long, it is often split into two stages, sometimes weeks apart.
Surgery is not a cure. The aim is a worthwhile improvement in some of your symptoms, especially leg pain.[1]
The parts of the operation
- Decompression through the back, by removing the roof of the spinal canal (laminectomy) or making a smaller window in it (laminotomy).
- Pedicle screws and rods, which act like internal scaffolding while the bone heals. Screws can also go into the pelvis for a firmer anchor.
- Bone graft. Fusion is a biological process that takes 6 to 12 months.
- Interbody cages, small spacers placed where a worn disc has been removed to restore height and improve alignment. They can go in from the back, side or front, and occasionally through the chest (thoracotomy).
BASS notes that expected outcomes are broadly similar between techniques, so your surgeon chooses based on your symptoms, previous surgery, build and fitness.[1] You can read more about lumbar decompression and lumbar spinal fusion in our other guides.
Who is it for?
Most people are treated without surgery, using exercise and physiotherapy, medication and lifestyle changes. NICE does not recommend spinal injections for back pain, or epidural injections for leg pain caused by narrowing of the central spinal canal, although an epidural may be considered for severe sciatica of recent onset.[15] Major corrective surgery is only considered once these no longer help, and after a careful look at heart, lung and other health problems.[1] Age on its own is not a reason to rule it out. For someone who is frail, a shorter operation to decompress the nerves without correcting the curve may be the safer option.
Before surgery
- Stop smoking and all nicotine, ideally 2 to 3 months beforehand. Nicotine is the factor that most harms fusion, and your operation may be postponed if you are still smoking.[1]
- Diabetes, obesity, poor nutrition, osteoporosis and long-term steroid use can also affect fusion, so your team may want to optimise these first.[1]
- Tell your team about blood thinners and anti-inflammatory painkillers, which usually need stopping.[1]
- Women taking oestrogen, such as the combined pill or HRT, are advised to stop four weeks before surgery to lower the risk of blood clots.[1]
In hospital
Because the operation is long, you are likely to spend the first night or two in an intensive therapy or high dependency unit. A wound drain, if used, usually comes out the next day. A physiotherapist will help you out of bed, teach you how to move safely and practise stairs with you. Most people go home a week or more after surgery.[1]
Recovery at home
- Leg pain may come and go while nerve swelling settles, which can take eight weeks or longer. Feeling and strength in the legs often improve slowly over a year or so.[1]
- You can usually shower after 48 hours, keeping the dressing dry, but avoid baths for two weeks.[1]
- Expect not to drive for at least four weeks, and only restart when you could do an emergency stop.[1]
- Walk regularly and get up at least every 20 minutes or so when sitting. Avoid heavy lifting for the first few weeks, possibly up to three months.[1]
- Advice on sport varies: BASS suggests activities such as swimming or golf may be possible from six weeks to three months,[1] while some NHS spinal units advise avoiding golf, contact sports, mountain biking and skiing for at least 12 months.[5] Your surgeon may suggest no flying for six weeks, and no long-haul travel for up to three months.[1]
- Most people need about 6 weeks off work, and 8 weeks or more for a physical job.[1]
- Don’t stop nerve pain medicines or strong painkillers suddenly. Your GP can help you reduce them.
Recovery: what to expect
Recovery from this operation is measured in months, it varies a great deal between people, and your own team’s advice comes first. This guide draws mainly on the BASS booklet on degenerative scoliosis surgery.[1]
| Time after | What to expect |
|---|---|
| First 24 hours | You are likely to spend the first night or two in intensive care or a high dependency unit. A drain, if used, usually comes out the next day.[1] |
| First 2 weeks | A physiotherapist helps you out of bed and practises stairs with you. Most people go home a week or more after surgery; in one large study the average stay was about 8 days.[1][9] |
| 2 to 6 weeks | Leg pain may come and go while the nerves settle, which can take 8 weeks or longer. Aching around the spine and tiredness are normal and can last several months.[1][5] |
| 6 to 12 weeks | Most people are off work for around the first 6 weeks. Some NHS units arrange a physiotherapy review about 6 weeks after surgery.[1][5] |
| 3 to 12 months | Feeling and strength in the legs often improve slowly over a year or so. Bone fusion takes 6 to 12 months.[1] |
Getting back to everyday life
- Walking and activity: sitting for more than about 20 minutes causes stiffness, so get up and walk about regularly. Avoid repeated bending or twisting for the first few weeks, and heavy lifting for possibly up to 3 months.[1] Some people need a stick or walking poles for a while.[5]
- Wound care: you may shower after 48 hours if the dressing stays fairly dry, but avoid baths for two weeks.[1]
- Driving: BASS advises not driving for at least 4 weeks, and only once you could do an emergency stop.[1] Some NHS units advise at least 6 weeks, sometimes up to 12.[5] Check with your doctor before driving again.[6] If you are still unable to drive 3 months after the operation, you must tell the DVLA.[7] Tell your car insurer about the operation.[5]
- Work: office work may be possible before 6 weeks if you can keep moving, while a physical job may need 8 weeks or more. A phased return with shorter hours or lighter duties can help.[1][5]
- Flying: your surgeon may advise no flying for 6 weeks and no long-haul flights for up to 3 months, because of the risk of clots.[1] Tell your travel insurer about the surgery.[5]
- Sport: advice varies. BASS says swimming or golf may be possible from 6 weeks to 3 months, while one NHS unit advises avoiding golf, skiing and contact sports for at least 12 months. Ask your own team.[1][5]
How the evidence helps set expectations
In a study of 188 working adults after spinal deformity surgery, 15% were back at full-time work at 6 weeks, 70% at 6 months and 83% at 1 year.[8] In a large multicentre database of 521 people followed for 2 years, back and leg pain fell by about half on average and about 65% felt their activity level had improved.[9] These studies included younger people and other types of curve, so your own recovery may be slower or quicker.
Contact your team or seek urgent help if you notice:
- New numbness around your bottom or genitals, loss of bladder or bowel control, or new or rapidly worsening weakness in your legs: go to A&E or call 999.
- A painful, swollen calf, or sudden chest pain or breathlessness: call 999.
- Redness or leakage at the wound, clear fluid leaking with headaches, or a high temperature: contact your hospital team or GP, or call NHS 111.
Risks and complications
BASS reports that around 8 in 10 people have a complication related to their surgery and about 3 in 10 have a major one. It also reports that 13 in 100 need further surgery within a year because of complications, rising to 25 in 100 within three years.[1] Many complications, such as a urine infection or brief confusion, are treatable and temporary.
| Risk | Approximate frequency (BASS) |
|---|---|
| Delirium (temporary confusion) | 13 in 100 |
| Urine infection | About 10 in 100 |
| Tear in the lining around the nerves (dural tear) | Fewer than 10 in 100 |
| Pneumonia | 8 in 100 |
| Deep wound infection | 7 in 100 |
| Nerve pain from scarring or nerve damage | 7 in 100 |
| Non-union (bones fail to fuse) | Up to 5 in 100 |
| Worsening of spinal cord or nerve function | 3 in 100 |
| Nerve root damage | Fewer than 2 in 100 (first operation); up to 10 in 100 (repeat surgery) |
| Blood loss over two litres | 2 in 100 |
| Misplaced screw | 2 in 100 |
| Cage movement | Up to 2 in 100 (1 in 100 needs another operation) |
| Blood clot in the leg or lung | Fewer than 1 in 700 |
| Death from damage to major blood vessels or organs | 2 in 10,000 |
| Fatal anaesthetic complication | 2 in 250,000 |
Some approaches add their own risks. With front or oblique approaches through the abdomen, BASS reports damage to the large blood vessels in up to 15 in 100 cases (less often with experienced surgeons), a temporarily sleepy bowel in 11 in 100 and retrograde ejaculation in fewer than 1 in 100 men. The side approach can cause thigh pain, numbness or weakness bending the hip. After a thoracotomy, long-lasting pain at the chest wound is reported in 1 in 10.[1]
What the evidence shows
BASS reports good relief of leg symptoms in about 7 in 10 people, often building over several months. Results for back pain are much less reliable, and numbness or weakness can persist if the nerves were badly affected beforehand.[1]
Larger reviews tell a similar story. Sciubba and colleagues pooled 93 studies covering 11,692 patients and found an overall complication rate of 55%, with major complications around the time of surgery in 18.5% and long-term complications in 20.5%.[2] An earlier systematic review by Yadla and colleagues, of 49 studies and 3,299 patients, found that surgery improved disability and quality of life scores at two years or more, but with complications in about 41% and failed fusion in about 13%.[3] Figures differ between sources because patients, operations and definitions differ.
The most useful long-term data come from the North American ASLS-1 study of 286 adults aged 40 to 80 with lumbar scoliosis. Those who had surgery had clearly better disability and quality of life scores than those treated without it at 2, 5 and 8 years, with no sign of the benefit fading. Serious treatment-related problems were common, particularly in the first two years, yet patients who had one still did better on average than the non-surgical group.[4]
When to seek help
Contact the hospital or your GP if your wound becomes red, starts leaking or you develop a high temperature.[1]
Seek urgent medical help (A&E or 999) if you have:
- New numbness around your bottom or genitals, or loss of control of your bladder or bowels
- New or rapidly worsening weakness in your legs
- Chest pain or sudden breathlessness
- A painful, swollen, warm calf
Frequently asked questions
Is surgery for adult scoliosis worth it?
For carefully chosen people it often is, but it is a big decision. In the ASLS-1 study, adults who had surgery had clearly better disability and quality of life scores than those treated without it at 2, 5 and 8 years, despite frequent complications.[4] In a large database of 521 people, back and leg pain roughly halved on average at two years and about 65% felt more active, while about 4% felt worse and 6.5% would not choose surgery again.[9] BASS reports good relief of leg symptoms in about 7 in 10, with back pain much less predictable.[1]
Am I too old for scoliosis surgery?
Age alone is not usually the deciding factor; overall health matters more. BASS points out that most people with symptoms are 60 or older, so age by itself is not a reason to rule surgery out, but frailty or health problems that raise the risk of complications such as a stroke or heart attack may favour a shorter operation just to free the nerves.[1] One American centre found similar results and complication rates in people aged 75 and over compared with those aged 65 to 74 with similar health problems, although this was a single, look-back study.[10]
Will my scoliosis get worse if I don’t have surgery?
It may, but usually slowly, and there is little good research. In a small American study of 24 people with milder curves, the curve increased by about 2 degrees a year on average, faster in those over 69, and progression was not always steady.[11] In a Japanese community study that followed older adults for 15 years, new curves stayed mild, all under 30 degrees.[12] Ask your specialist how often your curve and symptoms should be reviewed.
Will I be able to bend down and put my socks on after a long spinal fusion?
Most people manage, though some tasks can feel harder. In a study of 103 people with fusions of the whole lower back, stiffness did not substantially increase disability at two years and did not affect satisfaction.[13] A smaller Korean study of 44 people fused to the pelvis found everyday tasks were more limited after surgery, especially when the fusion extended higher up the spine.[14] Early on, an occupational therapist can provide long-handled aids for dressing, and you will be taught to bend at your hips and knees rather than your back.[5]
Will I be taller or straighter after scoliosis surgery?
A little straighter, but not much taller. In a large database of people having long fusions for spinal deformity, height increased by about 1.1 cm on average, and more than 70% felt their appearance had improved at two years.[9] For degenerative scoliosis, though, the main aims are to free trapped nerves and hold the spine steady, not to create a perfectly straight back, and BASS stresses that surgery is not a cure.[1]
Will I need more operations after scoliosis surgery?
Quite possibly; further surgery is common after these operations. BASS reports that 13 in 100 people need another operation within a year because of complications, rising to 25 in 100 within three years.[1] In a large North American database, 25% had a further operation within two years.[9] Reasons include deep wound infection, bones failing to fuse, and screws or cages moving out of place.[1] Ask your surgeon which problems are most likely in your case.
When can I have sex after scoliosis surgery?
When you feel comfortable. One NHS spinal unit advises that you can resume sex as and when you feel ready, that talking with your partner can ease worries about causing pain, and that different positions and pillows to support your back can help.[5] The same unit advises avoiding heavy lifting and extremes of movement, especially twisting, for at least 12 weeks.[5] The Outsiders charity offers advice on sex and physical difficulties.[5] Men who had part of the operation through the abdomen should mention any change in ejaculation, a rare complication.[1]
When should I get urgent help after scoliosis surgery?
Go to A&E or call 999 if you develop numbness around your bottom or genitals, loss of bladder or bowel control, or new or rapidly worsening weakness in your legs.[1] Call 999 for chest pain or sudden breathlessness, and seek urgent help for a painful, swollen, warm calf.[1] Contact your hospital team, GP or NHS 111 if the wound becomes red or starts leaking, clear fluid leaks with headaches, or you have a high temperature; deep wound infection affects about 7 in 100 people after this surgery.[1] Brief confusion in the first days is common and usually temporary.[1]
Further reading
References
- British Association of Spine Surgeons. Degenerative scoliosis: surgical options (patient booklet, issue 2). BASS; 2022. Link
- Sciubba DM, et al. A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform. 2015;3(6):575-94. Link
- Yadla S, et al. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus. 2010;28(3):E3. Link
- Smith JS, et al. Operative vs nonoperative treatment for adult symptomatic lumbar scoliosis at 8-year follow-up: a nonrandomized clinical trial. JAMA Surg. 2025;160(6):634-44. Link
- Lancashire Teaching Hospitals NHS Foundation Trust. Recovering from Scoliosis/Kyphosis Surgery (patient information). February 2025. Link
- Driver and Vehicle Licensing Agency. Spinal conditions, injuries or spinal surgery and driving. GOV.UK; updated 2025. Link
- Driver and Vehicle Licensing Agency. Surgery and driving. GOV.UK. Link
- Neuman BJ, Wang KY, Harris AB, et al. Return to work after adult spinal deformity surgery. Spine Deform. 2023;11(1):197-204. Link
- Ogura Y, Gum JL, Soroceanu A, et al. Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery. J Neurosurg Spine. 2021;34(2):218-227. Link
- Lovato ZR, Deckey DG, Chung AS, et al. Adult spine deformity surgery in elderly patients: are outcomes worse in patients 75 years and older? Spine Deform. 2020;8(6):1353-1359. Link
- Chin KR, Furey C, Bohlman HH. Risk of progression in de novo low-magnitude degenerative lumbar curves: natural history and literature review. Am J Orthop (Belle Mead NJ). 2009;38(8):404-9. Link
- Watanuki A, Yamada H, Tsutsui S, et al. Radiographic features and risk of curve progression of de-novo degenerative lumbar scoliosis in the elderly: a 15-year follow-up study in a community-based cohort. J Orthop Sci. 2012;17(5):526-31. Link
- Hart RA, Hiratzka J, Kane MS, et al. Stiffness after pan-lumbar arthrodesis for adult spinal deformity does not significantly impact patient functional status or satisfaction irrespective of proximal endpoint. Spine (Phila Pa 1976). 2017;42(15):1151-1157. Link
- Choi JH, Jang JS, Yoo KS, et al. Functional limitations due to stiffness after long-level spinal instrumented fusion surgery to correct lumbar degenerative flat back. Spine (Phila Pa 1976). 2018;43(15):1044-1051. Link
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Published 30 November 2016; last updated 29 July 2026. Link
This guide is general information and is not a substitute for advice about your own situation. Please discuss the benefits and risks of any procedure with your surgeon.
Leave a comment