Scoliosis Surgery - Are Some Patients Predisposed To Spinal Fusion?

"In view of the high rate of complications, the limited gains to be derived from spinal fusion (for idiopathic scoliosis) should be assessed and clearly explained to patients before the procedure is undertaken."

~Results of surgical treatment of adults with idiopathic scoliosis.
J Bone Joint Surg Am 1987 Jun;69(5):667-75
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.

Are some scoliosis patients simply doomed to "needing" scoliosis surgery? Are they genetically pre-programmed "scoliosis time bombs" that are just waiting until adolescences to go off and no one can diffuse them in time? According to Mark Spoonamore, MD, an orthopedic surgeon in the Keck School of Medicine of USC, "Less than 10 percent of scoliosis patients have surgery to correct severe curvatures". This statistic that doesn't include a large number of scoliosis patients whose scoliosis spine curvatures reach the mythical 40 degree scoliosis surgery threshold and chose not to under go scoliosis surgery "correction", so the TRUE number of patients whose spine curvatures reach severe levels is most likely well above 10% of all idiopathic cases.

Recent breakthroughs in the field of genetic testing for scoliosis (Scoliscore) have revealed a treasure trove of new information about the origins of idiopathic scoliosis and provides tremendous insight into the age old condition. According to the Scoliscore data, only 1% of ALL scoliosis patients diagnosed as idiopathic are considered "genetically high risk" for "needing" spinal fusion surgery; Which leads one to ask, If only 1% of idiopathic scoliosis patients are "genetically high risk" with a pre-disposition for developing severe scoliosis (requiring surgery), then why does at least 10 times that number of idiopathic scoliosis case under go scoliosis surgery. This is a question that should be asked by every patient that has been told they need surgery?

The answer to the question above actually isn't as difficult or complex as you might think once one understands that idiopathic scoliosis is a multi-factoral condition that is caused by both genetic pre-disposition and environmental influences. So basically...

Genetics + Environmental Influences = Idiopathic Scoliosis

So which factor (genetics or environment) is more important? Well, that depends on the individual case. A scoliosis patient with a "high genetic risk factor" may only require a very low amount of environmental influence to develop a severe scoliosis spine curve, where as a patient with a "low genetic risk factor" would require a very large amount of environmental influence before they developed a severe scoliosis spine curve. However, given that 99% of ALL idiopathic scoliosis spine cases are NOT genetically high risk for developing a severe scoliosis spine curvature, it becomes obvious that controlling the environmental influences is the true "key" to "severe scoliosis prevention".