By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 7 min read

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 physiotherapy, medication, injections and lifestyle changes. 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]
• Activities such as swimming or golf may be possible from six weeks to three months. 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.

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

Further reading

References

1. British Association of Spine Surgeons. Degenerative scoliosis: surgical options (patient booklet, issue 2). BASS; 2022. Link
2. 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
3. Yadla S, et al. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus. 2010;28(3):E3. Link
4. 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

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.