Adult Scoliosis Surgery in New York City

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

Adult scoliosis is far more common than most people realize. It affects an estimated 8 to 68 percent of adults over the age of 60, and for many it is a significant source of back pain, leg pain, functional decline, and reduced quality of life. Unlike adolescent scoliosis, adult scoliosis is often accompanied by degenerative changes — arthritic joints, collapsed discs, stenosis, and nerve compression — that compound the deformity and its symptoms. Treatment is correspondingly more complex.

Dr. Sardar specializes in the full spectrum of adult scoliosis care, from non-surgical management of mild curves to complex multilevel reconstruction for severe deformity. As Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, he leads one of the highest-volume adult spinal deformity programs in New York and sees some of the most complex cases referred from across the country.

TYPES OF ADULT SCOLIOSIS

De Novo Degenerative Scoliosis

De novo degenerative scoliosis — the most common form of adult scoliosis — develops in adulthood as a result of asymmetric degeneration of the discs and facet joints of the lumbar spine. As the disc and joint structures degenerate unevenly, the spine begins to tilt and curve. This is not the same condition as adolescent scoliosis. It arises from a completely different process and requires a different treatment approach. It most commonly affects the lumbar spine and tends to progress slowly over time, particularly after menopause in women due to changes in bone density.

Adult Idiopathic Scoliosis (Curve from Adolescence)

Some adults carry a scoliosis curve from adolescence that was either never treated or treated with bracing rather than surgery. While many of these curves remain stable into adulthood, curves greater than 40-45 degrees at skeletal maturity tend to progress slowly over time — at a rate of approximately one degree per year. By middle age or later, what was a manageable 45-degree curve may have progressed to 65 or 70 degrees, now causing pain, functional limitation, and cosmetic concern that were not present earlier in life.

Iatrogenic or Postoperative Scoliosis

Scoliosis can develop or worsen as a consequence of prior spine surgery. Laminectomy without fusion, inadequate fusion constructs, adjacent segment failure, or the late effects of Harrington rod instrumentation can all result in progressive spinal deformity in adulthood. These iatrogenic deformities are among the most complex cases Dr. Sardar manages, and they represent a significant portion of his revision surgery practice.

HOW ADULT SCOLIOSIS DIFFERS FROM ADOLESCENT SCOLIOSIS

Adult and adolescent scoliosis share a common feature — abnormal lateral curvature of the spine — but they are fundamentally different conditions in almost every other respect.

Cause: Adolescent idiopathic scoliosis has no identified cause. Adult degenerative scoliosis results from asymmetric disc and joint degeneration.
Symptoms: Teenagers with scoliosis often have little or no pain. Adults typically present with back pain, leg pain, or both — often due to stenosis and nerve compression layered on top of the deformity.
Curve location: AIS most commonly involves the thoracic spine. Adult degenerative scoliosis predominantly involves the lumbar spine.
Surgical goals: In adolescents, the primary goal is curve correction and prevention of progression. In adults, the goals are pain relief, functional improvement, and restoration of sagittal balance — often as much as or more than curve correction per se.
Surgical complexity: Adult deformity surgery is generally more complex than adolescent surgery due to degenerative bone quality, the need for decompression as well as correction, and greater medical comorbidities.

SIGNS & SYMPTOMS

Adults with scoliosis typically present with one or more of the following:

Back pain — often axial (centered in the back) and worse with prolonged standing or activity; the most common presenting symptom
Leg pain, numbness, or weakness — caused by stenosis and nerve compression within the curved and degenerative segments; may mimic sciatica or peripheral vascular disease
Neurogenic claudication — leg pain or heaviness that worsens with walking and standing and improves with sitting or bending forward; a hallmark of lumbar stenosis within the deformity
Progressive forward lean or lateral trunk shift — the body leaning forward or to one side as sagittal or coronal imbalance develops
Fatigue — the muscular effort required to compensate for imbalance is exhausting; patients describe fatigue disproportionate to their activity level
Visible postural change — a shoulder or hip that appears higher on one side, a visible curve, or a change in how clothing fits
Reduced walking tolerance — the combination of stenosis, deformity, and fatigue limits how far and how long patients can walk

DIAGNOSIS & EVALUATION

A comprehensive evaluation for adult scoliosis includes:

Full-length standing X-rays — 36-inch scoliosis films that allow measurement of the Cobb angle, sagittal vertical axis (SVA), pelvic incidence, lumbar lordosis, and pelvic tilt; these parameters collectively define spinal balance and guide surgical planning
MRI — to evaluate the discs, nerves, and spinal cord; identifies stenosis, disc herniation, and nerve compression within the deformity
CT scan — in patients with prior surgery or complex anatomy, CT provides detailed bony assessment for surgical planning
Bone density testing (DEXA scan) — critical in older patients; osteoporosis significantly affects implant selection, fusion strategy, and surgical risk
Health optimization assessment — nutrition, cardiovascular and pulmonary status, diabetes control, and frailty are all evaluated before recommending surgery

Dr. Sardar will walk you through all findings in detail and explain exactly what they mean for your symptoms and your options. He takes the time to ensure every patient fully understands their condition before any treatment decision is made.

NON-SURGICAL TREATMENT

Surgery is not the first step for most adults with scoliosis. Non-surgical management is always explored first and may include:

Physical therapy — core strengthening, postural training, and flexibility exercises can improve pain and function in many patients with mild to moderate deformity
Pain management — anti-inflammatory medications, activity modification, and targeted injections (epidural steroid injections, nerve blocks) can provide meaningful relief
Osteoporosis treatment — bone-strengthening medications improve bone quality and reduce fracture risk; in patients who may eventually need surgery, optimizing bone density before the procedure improves outcomes
Activity modification and assistive devices — for patients with significant functional limitation who are not surgical candidates

Non-surgical treatment does not correct the deformity or reverse neurological compression, but it can significantly improve quality of life for many patients. The goal is always to use the least invasive approach that achieves meaningful, durable improvement.

SURGICAL TREATMENT

Surgery for adult scoliosis is considered when symptoms are severe, progressive, or not adequately controlled with non-surgical treatment, and when the patient is medically fit to undergo the procedure. The goals of surgery in adults are different from those in adolescents — the emphasis is on decompression of neural structures, restoration of sagittal balance, achieving a stable and durable fusion, and improving the patient’s ability to stand and walk comfortably.

Decompression Alone

In carefully selected patients with primarily neurological symptoms and mild deformity, decompression of the compressed nerve roots without fusion may be appropriate. This is a limited procedure with a faster recovery, but it is not suitable for patients with significant deformity, instability, or sagittal imbalance, as it can worsen these problems over time.

Limited Fusion

For patients with focal instability or stenosis at one or two levels within the curve, a limited fusion addressing only those segments may be appropriate. This is a less extensive procedure than a full deformity correction and is suited to selected patients with localized disease and well-preserved overall spinal balance.

Long-Segment Deformity Correction and Fusion

For patients with significant coronal or sagittal deformity, progressive curves, or failed prior short-segment surgery, a comprehensive deformity correction with long-segment fusion is the definitive treatment. This involves correction of the curve and restoration of spinal balance, decompression of all compressed neural structures, interbody fusion at involved disc levels, and fixation from the upper thoracic spine to the pelvis when indicated.

When the spine is rigid and cannot be corrected with instrumentation alone, osteotomies — controlled bony cuts that allow the spine to be repositioned — are performed. Dr. Sardar performs the full range of osteotomy techniques including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR) for the most severe cases.

Robotic-assisted navigation and intraoperative neuromonitoring are used as standard in all adult deformity correction procedures.

PREOPERATIVE OPTIMIZATION

Adult deformity surgery is major surgery. Preparing carefully before the procedure is one of the most important steps in achieving a good outcome. Dr. Sardar and his team evaluate and address the following before recommending surgery:

Bone density — osteoporosis is treated medically before elective surgery whenever possible to improve screw purchase and fusion rates
Nutrition — albumin and prealbumin levels are checked; nutritional deficits are corrected before surgery to reduce wound complication risk
Cardiovascular and pulmonary status — appropriate specialist clearance for patients with cardiac or respiratory conditions
Diabetes control — hemoglobin A1c optimization reduces infection risk
Smoking cessation — strongly recommended before any spinal fusion procedure
Frailty and functional status — formal assessment to identify patients who may benefit from prehabilitation before surgery
Psychosocial factors — depression and anxiety are screened for and addressed, as they significantly affect recovery and satisfaction

WHAT TO EXPECT: RECOVERY

Recovery from adult scoliosis surgery depends on the extent of the procedure. Comprehensive deformity correction is major surgery with a meaningful recovery period, but the functional gains for well-selected patients are significant and durable.

Hospital stay: Typically 4–7 days for long-segment deformity correction. Most patients are walking with assistance the day after surgery.
Return to light activity: 6–12 weeks for most daily tasks.
Return to work: Sedentary roles typically 6–8 weeks; physical roles 3–6 months or longer depending on the extent of surgery.
Full fusion maturation: 12–18 months. Maximum functional gains are often realized gradually over this period.
Physical therapy: A structured rehabilitation program begins in the hospital and continues after discharge to optimize strength, endurance, and function during recovery.

FREQUENTLY ASKED QUESTIONS

Am I too old for scoliosis surgery?

Age alone is not a contraindication. Many patients in their 60s, 70s, and even 80s undergo adult deformity surgery successfully. What matters is overall health, functional status, bone quality, and the extent of surgery required — not chronological age. A thorough pre-operative evaluation will give you and Dr. Sardar the clearest picture of whether surgery is appropriate and safe for your specific situation.

Will surgery fix my back pain?

Surgery for adult scoliosis reliably improves leg pain from nerve compression in well-selected patients. Back pain improvement is less predictable — most patients experience meaningful improvement, but complete resolution of all back pain is not guaranteed. The goal is significant functional improvement: the ability to stand, walk, and engage in daily activities that the deformity has taken away. Dr. Sardar will give you a frank, honest assessment of what is realistically achievable for your specific situation.

How do I know if I need short-segment or long-segment surgery?

This is one of the most important decisions in adult scoliosis surgery and requires careful analysis of your full-length X-rays, MRI, CT, and clinical picture. Treating too few levels risks adjacent segment failure and reoperation. Treating too many levels adds surgical risk and recovery. Dr. Sardar’s approach is to match the extent of surgery precisely to each patient’s deformity, symptoms, and goals — neither undertreating nor overtreating.

I had scoliosis surgery as a teenager. Is this the same?

Not exactly. If your curve has progressed, you have developed adjacent segment disease, or you are experiencing new symptoms decades after your original surgery, the evaluation and surgical planning are different from a primary adolescent case. Revision surgery after prior instrumentation is more complex and requires a surgeon with specific expertise in that setting. Dr. Sardar has extensive experience in revision surgery.

WHY CHOOSE DR. SARDAR FOR ADULT SCOLIOSIS

Adult spinal deformity surgery requires a surgeon with deep expertise in deformity correction, osteotomy technique, revision surgery, and the medical complexity of older patients. It is not a procedure that should be performed by a surgeon who sees it infrequently.

As Co-Chief of Spinal Deformity Surgery at the Och Spine Hospital at NewYork-Presbyterian, Dr. Sardar leads one of the highest-volume adult spinal deformity programs in New York. A significant portion of his surgical practice is adult deformity — including a high volume of revision and re-revision cases referred from surgeons across the country who are not comfortable proceeding.

His three fellowship training programs span orthopedic and neurosurgical spine, disc replacement, and complex spinal deformity, giving him a uniquely broad technical foundation. He is an active member of the Scoliosis Research Society (SRS) and regularly contributes to the research that advances the field.

He uses robotic-assisted navigation, intraoperative neuromonitoring, and real-time 3D CT imaging as standard in all adult deformity cases. He personally follows every patient from the initial consultation through all post-operative visits.

Patients travel from across the United States and internationally to see Dr. Sardar for adult scoliosis. Telemedicine consultations are available for patients in NY, NJ, CT, FL, PA, MO, CA, and TX. International patients can contact NewYork-Presbyterian Global Services at +1-212-746-9100.

This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition and treatment options.