What I Tell Every Patient Before Major Spine Surgery

The most important conversation I have with a patient is not the one where I explain the anatomy of their deformity or describe the surgical technique. It is the one where I try to make sure they understand, as clearly and honestly as I can make it, what they are actually agreeing to — and what they should realistically expect from it.

Most patients arrive at a surgical consultation already having done significant research. They have read condition pages, watched videos, found forums, and compared surgeons. What they have often not found is someone willing to tell them the less comfortable things alongside the encouraging ones. This post is my attempt to write down what I actually say in those conversations.

The Decision to Operate Belongs to You

I can tell you what I see on your imaging. I can tell you what the natural history of your specific condition looks like — what happens to a deformity like yours if it is left alone, what happens if it is treated surgically. I can tell you what surgery would involve, how long recovery takes, and what the realistic range of outcomes looks like in patients like you. That is my job and I will do it as completely and honestly as I can.

What I cannot do is make the decision for you. Surgery of this magnitude — long-segment fusion, deformity correction, revision reconstruction — is not something that should be done because a surgeon recommended it and a patient felt unable to say no. It should be done because a patient understood the tradeoffs and concluded that the expected benefit was worth the real risk and the real recovery. My role is to give you the information you need to reach that conclusion. The conclusion itself is yours.

This means I expect you to ask questions. If something I have said is unclear, ask me to explain it again. If you want to understand why I am recommending a specific approach over an alternative, ask me to walk through my reasoning. If you want to know what another surgeon might say, I will tell you honestly whether I think a second opinion would be valuable in your case, and I will never discourage you from seeking one.

Recovery Takes Longer Than You Expect It To

Every patient who has had major spine surgery and was told recovery takes three to six months will tell you that no one told them it would feel like this at month two.

The first two to four weeks after major spine surgery are difficult. You will have more pain than you expected, less function than you expected, and less ability to care for yourself than you expected. This is normal — it does not mean something has gone wrong. The spine is a load-bearing structure that has just undergone a significant operation, and the early healing phase is demanding regardless of how well the surgery went. Planning for this phase — having help at home, not scheduling obligations, managing expectations with your family and employer — is not optional. It is part of the procedure.

The second half of recovery — months three through twelve, sometimes beyond — is where functional improvement actually happens. The bone is consolidating. The muscles are rebuilding. The neurological function that was compressed or stretched is recovering at the pace that nerve tissue recovers, which is slow and nonlinear. The recovery curve is not a straight line. There will be good weeks and difficult weeks. A difficult week at month four does not mean the surgery failed; it means the body is still healing.

I tell patients this not to discourage them but because I have watched patients panic unnecessarily at month two because no one prepared them for what month two feels like. A patient who understands what normal recovery looks like is a better-equipped patient.

What You Do Before Surgery Matters as Much as What I Do During It

The outcome of major spine surgery depends on the surgeon and the operation — but it also depends heavily on the patient who walks into the operating room. There are modifiable factors that significantly affect surgical outcomes, and I take them seriously enough to delay surgery when they have not been addressed.

Bone density is the most important one for my patient population. Scoliosis correction, flatback correction, and revision surgery all rely on screws that must hold in bone under significant cyclic load. A screw that pulls out of osteoporotic bone produces a complication that requires another operation. For patients with significant untreated osteoporosis, I refer them to a metabolic bone specialist first, begin bone-building therapy, and schedule surgery after bone density has improved to a level where I believe the fixation will hold. This takes time — sometimes three to six months. I understand that patients are anxious to proceed. The delay is the right thing to do.

Nutrition matters more than most patients realize. Low albumin — a marker of protein malnutrition — is associated with significantly higher rates of wound complications and infection after major spine surgery. I check nutritional markers routinely before major cases and address deficiency before proceeding.

Smoking is associated with substantially higher pseudarthrosis rates after spinal fusion — the fusion may not heal, which usually means another operation. I discuss this directly.

Cardiovascular fitness predicts recovery. Patients who are deconditioned before major surgery recover more slowly and have higher complication rates. In patients for whom it is safe and feasible, prehabilitation — physical therapy and conditioning before surgery — improves outcomes on the other side.

I raise these things not to create obstacles but because addressing them genuinely changes outcomes. The time spent optimizing before surgery is not wasted time. It is part of the surgical episode.

Your Surgery Is Planned Specifically for You

I want patients to understand how their surgery is planned, because I think it matters — not as a marketing point, but as something that directly affects what the surgery accomplishes.

Complex spinal deformity surgery is not a standardized operation applied uniformly. The amount of correction a patient needs is not a round number — it is a specific target derived from the patient’s own anatomy: their pelvic incidence, their age, their skeletal proportions. I plan correction targets using normative alignment data from the MEANS study — a large multi-ethnic database of healthy adult spine alignment that I led — which gives me population-specific benchmarks rather than the same arbitrary thresholds applied to everyone. A 45-year-old woman needs a different alignment target than a 65-year-old man, even if their curves look identical on the front view of an X-ray.

When appropriate, the rods used to hold the correction are not pulled from a shelf — they are custom-contoured to the planned correction geometry. The interbody cages that go between the vertebrae, in cases that require them, can be manufactured from the patient’s own CT scan to match the specific geometry of that patient’s disc space. For patients with very abnormal bone anatomy — severe deformity, prior surgery that has altered the bone surfaces, congenital variants — I use Firefly® patient-specific navigation guides, 3D-printed to fit the exact contour of that patient’s spine, to guide screw placement where standard navigation is unreliable. Before closing, I verify screw position with an intraoperative CT scan.

I describe this not because these technologies make me a better surgeon than someone who does not use them, but because they represent a coherent philosophy: surgery that is built around the specific patient in front of me, not adapted from a template. Patients deserve to understand how their procedure is planned. More detail is on the Ultra-Personalized Spine Surgery page.

I Will Tell You What I Cannot Fix

Surgery corrects structural problems. It decompresses nerves that are compressed. It stabilizes segments that are unstable. It restores alignment that has been lost. What it cannot do is undo years of chronic pain sensitization, reverse muscle atrophy that has been progressive for a decade, or reliably eliminate all pain in a patient whose nervous system has been in a pain state for a long time.

I tell patients what I am trying to accomplish surgically — the specific structural problems I am addressing — and I try to be honest about which of their symptoms are most likely to improve and which ones may not. A patient with severe flatback deformity and a 15-cm positive sagittal imbalance who cannot stand for five minutes — that patient’s functional limitation is most likely mechanical, driven by the deformity, and surgery has a strong likelihood of producing meaningful improvement. A patient with a 10-cm imbalance and two years of central sensitization who rates their pain at a 9 out of 10 at rest — the surgical outcome in that patient may be more modest, not because the operation is less well performed but because the nervous system component of their pain will not be addressed by restoring alignment.

I would rather have that conversation before surgery than have a patient ask me afterward why they are still in pain. The answer is always clearer and easier to give when both parties understood it going in.

A Second Opinion Is Always Reasonable

What I do ask is that patients bring their actual imaging — not just radiology reports — to any surgical consultation, including the one with me. Reports are summaries. I review the images themselves. A full-length standing scoliosis X-ray series, if it exists, is the single most important study for deformity evaluation and should come to every consultation.

One More Thing

A patient who has read their reports, done their research, and arrived with a list of questions is a patient who is taking their health seriously. That is exactly the kind of engagement that leads to good outcomes. I find those conversations easier and more satisfying, not more difficult.

The goal of the consultation is for you to leave with a clear picture of your spine, an honest assessment of what surgery can and cannot accomplish for your specific situation, and enough information to make a decision you are confident in. That is what I am trying to provide. If that has not happened by the end of an appointment, the appointment is not over.

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

To schedule a consultation, call 212-932-5187 or visit the contact page. Telemedicine consultations available in NY, NJ, CT, FL, PA, MO, CA, and TX. For patients considering revision or complex deformity surgery, the second opinion page describes what a remote evaluation involves.

This post reflects the author’s general approach to patient consultations and does not constitute individualized medical advice for any specific patient or condition.

How Do I Know If My Flatback Is Severe Enough to Need Surgery?

If you have been told you have flatback deformity, you have probably been given some version of the same answer when you asked whether you need surgery: it depends. That is true, but it is not useful. What it depends on is specific, measurable, and worth understanding — because knowing it will help you have a more informed conversation with your spine surgeon and give you a clearer sense of where you actually stand.

This post explains the functional and radiographic criteria that determine surgical candidacy in flatback deformity, what the surgery actually corrects, and what non-surgical management can and cannot accomplish.

What Flatback Deformity Is (Briefly)

The lumbar spine is supposed to have an inward curve — lordosis — that positions the body’s center of gravity over the pelvis. When that lordosis is lost, the spine straightens or reverses into a flat or even kyphotic (forward-bent) position in the lumbar region. The result is that the upper body shifts forward relative to the pelvis, and maintaining an upright posture requires muscular and pelvic compensation: bending the knees, tilting the pelvis backward, thrusting the hips forward, extending the thoracic spine. These compensatory mechanisms allow upright posture but are exhausting to maintain, and they fail progressively as the deformity worsens or as the muscles that sustain them fatigue.

Flatback deformity is most commonly seen after spinal fusion surgery that inadequately restored lumbar lordosis — historically the defining late complication of Harrington rod instrumentation, but also occurring after modern long-segment lumbar fusion when lordosis restoration is incomplete. It can also develop in adults with degenerative disc disease as the discs lose height and the lordotic curve is gradually worn away. A detailed overview of the condition, its causes, and surgical treatment is on the Flatback Deformity Surgery page.

The First Question: How Much Are You Compensating?

Before any imaging, the most telling assessment is functional: how much effort does it take for you to stand upright?

A patient with mild flatback may stand fully upright with no visible effort, have minimal symptoms at rest, and experience back fatigue only with prolonged activity. Their body still has enough compensatory reserve — in the pelvis, hips, and thoracic spine — to mask the radiographic deformity in daily life. Surgery is rarely warranted in this group unless imaging shows the deformity is progressing.

A patient with moderate to severe flatback typically cannot stand fully upright without noticeable effort. Visible signs that the compensation is working hard include:

  • Bent-knee posture — the knees flex slightly to shift the center of gravity backward
  • Hip thrust — the hips push forward relative to the trunk
  • Forward trunk lean — the upper body leans ahead of the pelvis when walking or standing
  • Gaze elevation — difficulty maintaining a level gaze without consciously lifting the chin
  • Rapid fatigue — pain or exhaustion within minutes of standing or walking

When these compensatory mechanisms are visibly active at rest and failing with routine activity, the patient is using their full reserve just to appear upright. That is a meaningful indicator of severity. A surgeon watching a patient walk into the exam room and stand through a history can learn a great deal from that observation alone.

The Imaging Criteria: What the X-Ray Shows

The primary imaging study for flatback evaluation is the full-length standing scoliosis X-ray — a 36-inch cassette that captures the entire spine and pelvis in a single standing image. Spot X-rays of the lumbar spine, lying down, or taken with the patient seated are not adequate for assessing global sagittal balance. The full-length standing study is the only image that reveals the total extent of the deformity and the degree of pelvic compensation.

The key radiographic parameters that guide the surgical decision are:

Sagittal Vertical Axis (SVA)

The SVA measures how far forward the center of the C7 vertebra (at the base of the neck) sits relative to the posterior corner of the sacrum (the base of the spine). In a well-balanced spine, this distance is typically less than 5 centimeters. An SVA above 5 cm indicates clinically significant sagittal imbalance. Above 10 cm is severe.

The landmark study by Glassman and colleagues demonstrated a clear, dose-dependent relationship between increasing SVA and declining health-related quality of life scores — SVA was the single strongest radiographic predictor of pain, disability, and functional limitation in adult spinal deformity. A patient with an SVA of 12 cm has measurably worse function than a patient with an SVA of 6 cm, independent of how the curve looks on a frontal image.

Reference: Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024–2029. PMID 16166889

Lumbar Lordosis and Pelvic Incidence Mismatch

Every pelvis has a fixed anatomical measurement called pelvic incidence (PI) — a geometric property of the pelvis that determines how much lumbar lordosis a person ideally needs to achieve a balanced upright posture. When lumbar lordosis falls significantly short of the PI-matched target, the spine is in mismatch: the pelvis is demanding more lordosis than the lumbar spine is providing, forcing compensatory mechanisms to bridge the gap.

A PI–lumbar lordosis (PI-LL) mismatch of more than 10 degrees is generally considered clinically significant. Larger mismatches correlate with greater symptom burden and stronger indication for surgical correction. This is why two patients with the same lumbar curve angle can have different surgical recommendations — a patient with a large PI needs more lordosis than a patient with a small PI to achieve the same functional balance.

Pelvic Tilt

Pelvic tilt is the measure of how much the pelvis has rotated backward to compensate for loss of lumbar lordosis. A pelvic tilt above 20 to 25 degrees indicates the pelvis has already been maximally recruited as a compensator. When the pelvis is already tipped as far back as it can go, the patient has exhausted that compensatory reserve. Any further increase in the deformity will directly worsen their functional posture with no remaining pelvic reserve to absorb it. A high pelvic tilt, in a patient with an elevated SVA and a large PI-LL mismatch, is a strong radiographic marker of a patient who is clinically decompensated.

Putting It Together: A Practical Framework

No single number determines whether flatback surgery is appropriate. The decision integrates functional status and imaging findings into a clinical picture. As a practical guide:

  • Mild functional impact, SVA under 5–6 cm, good compensatory reserve: non-surgical management is appropriate. Physical therapy focused on thoracic extension and hip flexor stretching, activity modification, and pain management when needed. Surveillance imaging every 1–2 years to monitor for progression.
  • Moderate functional impact, SVA 5–10 cm, compensatory mechanisms visibly active: the surgical question is open. A thorough consultation with a deformity specialist is indicated to assess the degree of reserve remaining, the rate of progression, bone quality, and the patient’s overall health relative to the risk of the procedure required. Many patients in this group choose non-surgical management and do reasonably well; others in this group are appropriate surgical candidates, particularly if they are progressing or if their functional limitation is significant.
  • Severe functional impact, SVA above 10 cm, decompensated posture, pelvic tilt > 20–25 degrees: surgery is typically indicated for patients who are otherwise medically fit. The compensation has been exhausted. Continued conservative management will not recover postural balance; it will only manage symptoms while the underlying deformity persists or worsens.
  • Neurological symptoms (leg pain, numbness, weakness): the presence of neurological involvement from adjacent segment stenosis or deformity-related nerve compression moves the evaluation toward surgery regardless of where the patient sits on the functional spectrum above, because conservative management cannot decompress a compressed nerve.

What Non-Surgical Management Can and Cannot Do

Physical therapy, pain management, and activity modification can meaningfully reduce symptom burden in patients with mild to moderate flatback. Core strengthening, thoracic extension exercises, and hip flexor stretching support the muscular compensatory system that keeps upright posture functional. For patients who are not surgical candidates due to medical comorbidities, or who prefer to defer surgery, these approaches are reasonable and can maintain function for extended periods.

What conservative management cannot do is restore lumbar lordosis. The mechanical deficit that produces flatback deformity — insufficient lordosis relative to the patient’s pelvic incidence — exists in the bony and ligamentous architecture of the spine. No amount of physical therapy changes the shape of fused bone or restores disc height that has been lost. For patients whose compensatory mechanisms are failing, the trajectory of conservative management is symptom control while functional decline continues, not reversal of the underlying problem.

What Surgery Involves and What It Corrects

Flatback surgery aims to restore lumbar lordosis by making controlled corrections in the fused or degenerated spine. The cornerstone procedure is an osteotomy — a bone cut that releases the spine from its rigid position and allows it to be repositioned into lordosis before new instrumentation is placed to hold the corrected alignment.

The type and magnitude of the osteotomy depends on how much lordosis needs to be restored:

  • Posterior column osteotomy (PCO / Smith-Petersen osteotomy): removes the posterior elements at one or more levels, gaining approximately 8–10 degrees of lordosis per level. Used for mild to moderate corrections with a mobile anterior column (mobile discs below the fusion).
  • Pedicle subtraction osteotomy (PSO): removes a wedge of bone across the entire vertebra — posterior elements, pedicles, and anterior body — collapsing the spine into lordosis at a single level. Gains approximately 25–35 degrees per level. The workhorse procedure for flatback correction in patients with a fused or very rigid anterior column who need a large correction at a single segment.
  • Vertebral column resection (VCR): the most powerful and most complex osteotomy, involving complete removal of one or more vertebral bodies and their adjacent discs. Reserved for severe, rigid deformities requiring very large corrections that cannot be achieved with PSO.

Determining precisely how much lordosis to restore — and at which level — requires careful preoperative planning. At this practice, that planning incorporates MEANS-derived alignment targets: normative sagittal balance parameters from Dr. Sardar’s own published research, stratified by the patient’s age, sex, and pelvic incidence, to set a correction goal appropriate for that specific patient rather than an arbitrary population average. Combined with robotic preoperative planning, custom-contoured rods manufactured to the planned correction, and intraoperative CT verification before wound closure, this ultra-personalized approach ensures the osteotomy is planned to restore the specific alignment each patient’s anatomy requires — not a round number applied uniformly. For patients with significantly altered posterior bone architecture from prior surgery, Firefly® patient-specific navigation guides — 3D-printed to fit the exact contour of the patient’s remaining bone — may be used to place instrumentation accurately in a distorted operative field.

For further reading on flatback deformity, including the surgical techniques used in correction and what recovery involves, see the Flatback Deformity Surgery page. For patients whose flatback follows prior Harrington rod instrumentation, see Harrington Rod Revision Surgery. For patients who have had a prior correction that is failing or insufficient, see When Scoliosis Surgery Doesn’t Go As Planned.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University and Director of Quality & Patient Safety at Och Spine Hospital. He performs osteotomy-based flatback correction as a core part of his complex deformity practice, including many patients referred after prior corrections that were insufficient or have failed. Telemedicine consultations are available in NY, NJ, CT, FL, PA, MO, CA, and TX. To schedule, call 212-932-5187 or visit the contact page.

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

Scoliosis Surgery at 30, 40, 50: Is It Too Late?

A significant number of adults with scoliosis fall into this category: diagnosed as a teenager, told the curve was mild enough to watch, given a brace they wore inconsistently or not at all, and then released from follow-up when they stopped growing. For years — sometimes decades — life was largely normal. Then, somewhere in their 30s or 40s or 50s, something shifted. The back pain arrived and didn’t leave. The curve started looking different in photos. A new doctor, reviewing a chest X-ray for something else, flagged it. Or the forward lean that started mild became something their kids noticed.

These patients often ask the same question when they come in for an evaluation: Is it too late for surgery?

The honest answer is no — but the goals, the risks, and the decision-making process for adult scoliosis surgery are genuinely different from what they would have been at 16. This post explains what those differences are and how surgery is actually evaluated in adults who never had it as teenagers.

What Happens to Scoliosis After Skeletal Maturity

The classic teaching about adolescent scoliosis was that curves stabilize once a patient finishes growing. This is largely true for mild curves — but not uniformly true for larger ones. Long-term natural history studies have consistently shown that curves above approximately 40 to 50 degrees at skeletal maturity tend to progress slowly throughout adult life, typically at a rate of roughly 1 degree per year for thoracic curves and somewhat more for thoracolumbar and lumbar curves.

A patient who was discharged at age 18 with a 45-degree thoracic curve might present at 48 with a 70-degree curve. The same curve that was manageable at the end of adolescence, and that required no immediate intervention at the time, may now be significantly larger, more rigid, and layered with degenerative changes that were not present at the time of original diagnosis.

Reference: Weinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003;289(5):559–567. PMID 12578488

How Adult Scoliosis Surgery Differs from Adolescent Surgery

If you had surgery at 16 for a 50-degree curve, the goal would have been correction and prevention of progression: straightening the curve as much as possible, achieving a well-balanced spine, and stopping the curve from growing further. Recovery would be several months. The bone is young, flexible, and heals reliably. The result, for most patients, is a well-corrected, solid fusion with few complications and decades of good function.

Adult scoliosis surgery is a fundamentally different proposition in almost every dimension:

The Goals Are Different

In adults, the primary surgical goals are pain relief, functional improvement, neurological decompression (when the curve is compressing nerves), and prevention of further decline — not cosmetic correction. Achieving a perfect radiographic result is rarely the primary aim and is often not possible given the rigidity of a long-standing deformity. What surgery can realistically achieve in an adult is a well-balanced, stable spine that allows the patient to stand, walk, and function with significantly less pain and limitation than before.

The Curves Are More Rigid

An adolescent curve is relatively flexible. The discs and joints can be maneuvered during surgery, and significant correction is achievable through posterior instrumentation alone. An adult curve, particularly one that has been present for 30 or 40 years, is often significantly stiffer. The discs have degenerated and lost height. The facet joints are arthritic. The ligaments have contracted. More correction requires more intervention — sometimes including osteotomies (controlled bone cuts) to release the spine from its rigid deformed position before instrumentation can achieve meaningful alignment improvement.

The Spine Has Degenerative Changes

Decades of abnormal loading across a curved spine produce degenerative changes that compound the deformity. Discs collapse asymmetrically, adding to the curve. Facet joints deteriorate on the concave (compressed) side. Nerve roots can become compressed by a combination of deformity and arthritic change. Any surgery must address not only the curve but these degenerative components — decompressing nerves, restoring disc height, managing the arthritic joint architecture — making the procedure more complex than a primary adolescent correction would have been.

The Body’s Reserve Is Different

A 17-year-old heals from major surgery with a physiological reserve that a 55-year-old simply does not have. Bone density, nutritional status, cardiovascular fitness, and the absence or presence of conditions like diabetes, osteoporosis, and hypertension all affect surgical risk and recovery. This does not mean surgery is inappropriate in older adults — it means the preoperative evaluation is more thorough and the surgical planning more individualized.

What Age-Specific Evaluation Actually Looks Like

In Your 30s

Patients presenting in their 30s with scoliosis that was never treated are often physiologically close to the adolescent situation — but the curves have usually had 15 or more years to progress, the discs are beginning to show degenerative changes, and the body’s healing capacity, while still excellent, is not identical to a teenager’s. Surgery in the 30s, when indicated, is generally well-tolerated. The decision is driven by curve magnitude, symptoms, and evidence of progression. If a curve has grown significantly since skeletal maturity and is causing symptoms, the case for surgery is often stronger than it was at 18 — the window of ease has passed, but surgery is still very much possible and effective.

In Your 40s

The 40s is the decade when scoliosis and degenerative changes most commonly begin to compound. A curve that was 45 degrees at age 18 may now be 60 degrees with multilevel degenerative disc disease and early stenosis. Back pain that was mild becomes more limiting. Leg symptoms from nerve compression may appear for the first time. The surgical planning becomes more complex: the curve must be corrected, but the decompression of compressed nerves is now an equally important component. Surgery in this decade is common and the outcomes are good in appropriately selected patients, but the preparation is more thorough and the recovery more involved than it would have been earlier.

In Your 50s and Beyond

The common assumption that surgery becomes unavailable past a certain age is not accurate. Age alone is not a contraindication. What matters is functional status, bone quality, cardiovascular reserve, and the degree of functional impairment caused by the deformity. Many patients in their 50s and 60s undergo adult scoliosis surgery with good outcomes. The difference is that the preoperative evaluation is more comprehensive, the optimization more deliberate, and the surgical planning more individualized to account for osteoporosis, medical comorbidities, and the physiological changes of the sixth decade and beyond.

The relevant question is not how old are you? but what is the impact of the deformity on your quality of life, what is the realistic potential for improvement with surgery, and what is your overall health relative to the risk of the procedure required? These are answered through evaluation, not assumed from a date of birth.

When Non-Surgical Management Is the Right Answer

Not every adult with scoliosis who never had surgery needs surgery now. Many adults with curves in the moderate range (40 to 60 degrees) who have manageable symptoms and no neurological compromise are appropriately managed with physical therapy focused on spinal extension and core strengthening, periodic imaging surveillance, and pain management when needed. The fact that a curve exists and is larger than it was at 18 does not automatically mean surgery is indicated.

The decision to pursue surgery is driven by symptoms and functional impact, not by the curve magnitude alone. A patient with a 65-degree curve who has mild, well-controlled back pain and full functional capacity is a very different situation from a patient with a 50-degree curve who can no longer stand for 10 minutes without significant pain and leg symptoms. The second patient may be a stronger surgical candidate despite the smaller curve.

What Consultation Actually Involves

An adult scoliosis evaluation involves a full-length standing X-ray series (the 36-inch cassette that shows the entire spine and pelvis in a single standing image), MRI to evaluate the discs and nerves, CT in selected cases for bony anatomy planning, and bone density testing in patients over 50. The consultation itself covers the imaging findings, what they mean for your specific situation, a realistic discussion of what surgery could achieve and what it would involve, and an equally candid discussion of what non-surgical management offers.

The goal is not to recommend surgery. The goal is to give you an accurate picture of your spine, a clear explanation of your options, and an honest answer to the question you came in with. For patients who have been living with untreated scoliosis for decades and have never had a formal evaluation by a deformity specialist, that evaluation alone — regardless of what it concludes — is worthwhile.

For more detail on what adult scoliosis surgery involves and how the decision is made, see the Adult Scoliosis Surgery page. For patients over 50 specifically, see Scoliosis in Adults Over 50.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University. He evaluates adults at all stages of life who are considering scoliosis surgery for the first time, including patients who were diagnosed decades ago and never treated. Telemedicine consultations are available in NY, NJ, CT, FL, PA, MO, CA, and TX. To schedule, call 212-932-5187 or visit the contact page.

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

My Scoliosis Surgery Was 20 Years Ago and I’m Not Doing Well — What Should I Do?

You had scoliosis surgery years ago — maybe as a teenager, maybe as a younger adult. At the time, it went well. You recovered, you moved on, and for a long stretch of years life was largely normal. But somewhere along the way things shifted. The back pain that was manageable has become harder to ignore. You notice that you lean forward more than you used to. You fatigue standing in ways you didn’t before. Or maybe you’ve noticed your curve looks different on a recent X-ray, or a rod broke and you’re not sure what that means. You’ve gone back to your original surgeon and been told things look acceptable. Or your original surgeon has retired. Or you’ve been told that nothing more can be done.

This post is for you. What you’re experiencing is not unusual, it is not simply aging, and it is not something that should be accepted without a proper evaluation by someone who specializes in exactly this kind of problem.

Why Scoliosis Surgery Doesn’t Always Stay Fixed

Spinal fusion corrects and stabilizes a defined segment of the spine. What it cannot do is stop the rest of the spine from aging, prevent the discs above and below the fusion from degenerating, or guarantee that the fusion mass will remain solid indefinitely. It also cannot fully predict, at the time of surgery, how the spine will behave decades later as the body’s compensatory reserves diminish.

The spine is a dynamic structure under continuous load. A fusion construct placed at age 16 will be under different mechanical stresses at age 40 than it was at age 20. The disc immediately above the top of the fusion is now absorbing forces that were previously shared across multiple levels. The muscles that compensate for any residual imbalance work reliably at 25 but may begin to fail at 45. The alignment that was adequate at the time of surgery may be insufficient two decades later, particularly if baseline lordosis was not fully restored during the index procedure.

None of this means the surgery was wrong or that a mistake was made. It means that complex spinal fusion — like any major reconstruction — has a finite durability, and that the body it was performed in continues to change after the procedure.

The Most Common Reasons Patients Deteriorate After Prior Scoliosis Surgery

Pseudarthrosis — The Fusion Never Fully Healed

This is the most common and most underdiagnosed cause of persistent or worsening pain after scoliosis surgery. Pseudarthrosis means the bone graft placed during the fusion never consolidated into solid bone at one or more levels within the construct. Instead, a fibrous non-union persists — a zone of micromotion that causes pain and, over time, hardware stress fractures.

The critical point: pseudarthrosis does not show up on plain X-rays. The spine looks fused, the hardware looks intact, and the curve looks corrected. Only a CT scan with fine cuts through the fusion mass reveals whether true bony union has occurred. Patients who have been told for years that their X-rays look fine, but who have never had a dedicated fusion CT, have not been adequately evaluated for pseudarthrosis.

Flatback Deformity — Loss of Lumbar Lordosis

The lumbar spine needs a normal inward curve — lordosis — to place the body’s center of gravity over the pelvis. When a long-segment fusion leaves the lumbar spine flat or straightened, the patient must compensate by bending their knees, tilting their pelvis backward, and extending their hips just to stay upright. This compensation is exhausting. It works for a while, then it stops working well enough.

Flatback deformity was the defining complication of Harrington rod surgery from the 1960s through the 1980s — those rods corrected the scoliosis curve but simultaneously eliminated lumbar lordosis. But it is not only a Harrington rod problem. Any long-segment lumbar fusion that inadequately restores lordosis can produce flatback syndrome over time, including modern surgeries performed with pedicle screws. The progressive forward lean, the bent-knee posture, and the inability to stand for more than a few minutes are its hallmarks. Many patients with this pattern have been told they are simply getting older.

Adjacent Segment Disease

A long spinal fusion places increased mechanical stress on the discs and joints immediately above and below the fused segment. Over years and decades, this accelerated wear produces degeneration at those adjacent levels — disc collapse, facet arthritis, stenosis, nerve compression — that was not present at the time of the original surgery. Adjacent segment disease manifests as new back pain, new leg pain, neurological symptoms, or some combination, typically developing 5 to 15 years after the index procedure.

Proximal Junctional Kyphosis

Proximal junctional kyphosis (PJK) refers to new kyphotic angulation at the vertebral levels immediately above the top of the fusion construct. When the fusion ends and the mobile spine resumes, the segment at the junction between the two — the mobile segment right above the top screw — experiences concentrated stress that can lead to progressive kyphosis over time. Mild PJK is common after long-segment fusion and is often asymptomatic. When it is significant — producing pain, deformity visible to the patient, or neurological compromise — it requires evaluation and sometimes surgical correction.

Reference: Sardar ZM, Kim Y, Lafage V, et al. State of the art: proximal junctional kyphosis — diagnosis, management and prevention. Spine Deform. 2021;9(3):635–644. PMID 33452631

Adding-On — Curve Progression Below the Fusion

The fusion corrected and stabilized the surgical levels. But the lumbar segments below the fusion remained mobile, and if the fusion endpoint was not chosen to include the full structural component of the curve, those unfused segments can develop progressive curvature over time. This is called adding-on, and it can occur years after what was technically a successful surgery. The original curve is stable within the fusion, but the spine below it curves progressively — reproducing the cosmetic and functional problems the surgery was intended to address.

Hardware Failure

Rods and screws are designed for long-term durability, but they are not permanent. A broken rod is almost always the mechanical consequence of an underlying pseudarthrosis at that level — the rod is absorbing cyclic loading that solid fusion bone should be absorbing instead, and eventually it fails from metal fatigue. A broken rod is therefore not just a hardware problem; it is a signal to look carefully for pseudarthrosis at that level. Other hardware events — loose screws, hook migration, implant prominence — can also develop years after surgery and may require evaluation.

Why “Your X-Rays Look Fine” Is Not the Complete Answer

Plain X-rays are the most commonly used surveillance tool after scoliosis surgery — but they are poorly suited to detecting most of the failure patterns described above. They show hardware position and gross alignment, but they do not show:

  • Whether the fusion mass is solid (CT required to diagnose pseudarthrosis)
  • Whether disc levels above or below are degenerating (MRI required)
  • Whether nerves are being compressed by adjacent segment disease (MRI required)
  • Whether global sagittal balance is maintained (full-length standing 36-inch X-ray required, not a spot X-ray of the fusion)

A patient who is symptomatic years after scoliosis surgery and whose most recent evaluation consisted of a spot AP and lateral X-ray — which showed intact hardware and no gross deformity — has not been evaluated for the problems most likely to be causing their symptoms. The workup that is actually indicated typically includes a full-length standing X-ray series, a CT scan of the fusion, and an MRI of the entire spinal axis.

What a Proper Evaluation Involves

When a patient presents to Dr. Sardar with new or worsening symptoms after prior scoliosis surgery, the evaluation is comprehensive and imaging-led. It typically includes:

  • Prior operative reports — knowing what was done at the index surgery (levels fused, hardware used, complications noted, alignment achieved) provides essential context for interpreting current imaging
  • Serial X-rays over time — comparison of current imaging with immediate postoperative films reveals how much has changed since surgery
  • Full-length standing X-ray series — the 36-inch cassette that shows the entire spine and pelvis in a single standing image, allowing measurement of global sagittal balance (SVA), lumbar lordosis, pelvic tilt, and coronal alignment. This single study often reveals the problem that standard X-rays have been missing for years
  • CT scan of the fusion — fine-cut sequences through the fusion mass to evaluate for pseudarthrosis, hardware integrity, and bony anatomy available for revision instrumentation
  • MRI — to evaluate disc levels above and below the fusion, neural compression, spinal cord signal, and the condition of the unfused segments
  • Bone density assessment — particularly relevant for patients in their 50s and 60s, as osteoporosis significantly affects revision surgical planning and outcomes

The output of this evaluation is a clear, evidence-based picture of what is actually happening. Not reassurance without data. Not a recommendation to “give it more time.” A specific diagnosis, a specific explanation of why you are experiencing what you are experiencing, and an honest discussion of what surgical and non-surgical options are available for your specific situation.

When Surgery Is and Isn’t the Answer

Not every patient with late deterioration after scoliosis surgery needs another operation. Some findings — a small amount of adjacent segment degeneration causing manageable pain, a mild PJK without neurological involvement — are best managed conservatively with physical therapy, pain management, or close monitoring. Revision surgery is major surgery, and it is not recommended unless the clinical picture strongly supports it.

What revision surgery is appropriate for includes: pseudarthrosis with persistent pain and hardware failure, significant flatback deformity causing progressive functional decline, symptomatic adjacent segment disease with neurological compression, and significant adding-on or junctional failure that is progressing. For patients with these specific findings, revision surgery at a high-volume deformity center offers the realistic prospect of meaningful, durable improvement.

The important thing is not to accept deterioration as inevitable without understanding its specific cause. “Nothing more can be done” is among the most common things patients with late scoliosis surgery complications have been told before arriving at NewYork-Presbyterian / Columbia University for evaluation. In many of those cases, something more can be done — but it requires a surgeon and a center with specific expertise in exactly this kind of problem.

Practical Steps If You’re In This Situation

  • Gather your prior records. If at all possible, locate your original operative report, your immediate postoperative X-rays, and any imaging you have had since. If records are old and hard to find, contact the hospital where the original surgery was performed — they may still have imaging archived.
  • Get a full-length standing X-ray. If you have not had a 36-inch scoliosis series recently, request one before or at your evaluation. This single study provides information that is simply not available from standard X-rays.
  • Consider requesting a CT of your fusion. If you have had persistent pain after scoliosis surgery and have never had a fine-cut CT of the fusion mass, ask about this specifically at your next evaluation. It is the gold standard for diagnosing or excluding pseudarthrosis.
  • Seek an independent second opinion at a dedicated deformity center. The surgeons best positioned to evaluate late complications of scoliosis surgery are those who see many of these patients routinely — at high-volume academic centers where complex revision is a core part of the practice, not an occasional event.

For an overview of the specific failure patterns covered in this post — pseudarthrosis, hardware failure, imbalance, and adding-on — and what revision surgery involves, see the When Scoliosis Surgery Doesn’t Go As Planned page. For patients with flatback and loss of lumbar lordosis, see Flatback Deformity Surgery. For patients with prior Harrington rod instrumentation specifically, see Harrington Rod Revision Surgery.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University. A significant portion of his practice consists of revision and re-revision cases referred from surgeons and institutions across the country, including many patients who have been told nothing more can be done. To schedule a consultation or telemedicine visit, call 212-932-5187 or visit the contact page. Telemedicine available in NY, NJ, CT, FL, PA, MO, CA, and TX.

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

At What Cobb Angle Does Scoliosis Need Surgery?

If you have spent any time searching for information about scoliosis and surgery, you have almost certainly encountered the same number: 40 to 50 degrees. That is the Cobb angle, measured on a standing X-ray, that most sources cite as the threshold at which scoliosis surgery is typically recommended. It is a real and meaningful number. It is also incomplete — and relying on it alone to understand whether surgery is or is not appropriate for you or your child leads to confusion, unnecessary anxiety, and sometimes to patients being told they do or don’t need surgery when the complete picture is more nuanced than a single measurement.

Here is a clinically grounded answer to the question patients actually need answered: not just what the number is, but what goes into the decision.

What the Cobb Angle Actually Measures

The Cobb angle is the standard measurement used to quantify how much the spine curves on a standing X-ray. The surgeon identifies the most tilted vertebra at the top of the curve and the most tilted vertebra at the bottom, draws lines along those endplates, and measures the angle where those lines intersect. A curve under 10 degrees is not classified as scoliosis at all. A curve between 10 and 25 degrees is mild. Between 25 and 45 degrees is moderate. Above 45 to 50 degrees is generally considered severe.

The measurement is reproducible — but not perfectly so. Studies have documented inter-observer variability in Cobb angle measurement of up to 5 to 7 degrees even among experienced spine surgeons, which means a curve measured as 47 degrees by one radiologist may be reported as 42 or 52 degrees by another. This variability does not change the clinical significance of large differences, but it is worth understanding when a curve sits right at a commonly cited threshold.

Reference: Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH. Measurement of the Cobb angle on radiographs of patients who have scoliosis. J Bone Joint Surg Am. 1990;72(3):320–327. PMID 2312967

Why 40 to 50 Degrees Is the Reference Point

The 40 to 50 degree threshold emerged from natural history studies — research that followed patients with untreated scoliosis over time to understand what happens to different curves at different magnitudes. The key finding: curves below 30 degrees at skeletal maturity almost never progress significantly in adulthood. Curves between 30 and 50 degrees may progress modestly — on the order of 1 degree per year — in adult life. Curves above 50 degrees at skeletal maturity are significantly more likely to progress throughout adulthood, with the rate of progression accelerating as the curve increases.

This natural history is the foundation of the 40 to 50 degree surgical threshold for adolescent idiopathic scoliosis (AIS): curves that are already in or approaching the range where significant adult progression is expected should be corrected before they get worse. Surgery at 45 to 50 degrees is consistently more straightforward than surgery at 70 or 80 degrees, and the outcomes are generally better.

Why the Cobb Angle Alone Is Not Sufficient

The threshold does not answer the question for any individual patient, because it does not account for the factors that determine whether a specific curve at a specific Cobb angle in a specific patient represents a surgical problem. Here are the key variables that modify the decision:

Skeletal Maturity

This is the single most important modifier of the surgical threshold in adolescents. A 40-degree curve in a 12-year-old girl with significant growth remaining and a Risser grade 0 (maximum immaturity) is a very different clinical problem from a 40-degree curve in a 16-year-old girl who is Risser 4 (near skeletal maturity). The first patient has months or years of growth remaining during which the curve could progress dramatically; the second patient has almost no growth left and the curve may not change much at all.

This is why some surgeons recommend surgery for curves in the mid-30s in very immature patients who show documented rapid progression — waiting for the curve to reach 45 degrees in a rapidly growing 11-year-old means waiting until the curve may be at 60 or 70 degrees. Conversely, a patient who is already skeletally mature with a 45-degree curve that has been stable for years may not need surgery at all.

Rate of Documented Progression

A curve that has progressed 8 degrees over the past 6 months is a fundamentally different clinical situation from a curve at the same absolute magnitude that has been stable for two years. Documented rapid progression — typically defined as 5 or more degrees of increase on serial X-rays over 4 to 6 months — pushes the decision toward earlier intervention even when the absolute Cobb angle has not yet crossed the commonly cited threshold.

Curve Type and Pattern

A 45-degree thoracic curve centered at T8 behaves differently from a 45-degree thoracolumbar or lumbar curve. Thoracic curves are more likely to produce cosmetic deformity (rib prominence) and are less likely to produce significant back pain in adolescence; lumbar curves are more likely to cause pain and imbalance in adulthood and may need to be addressed at somewhat lower thresholds if they are producing symptoms. Curve patterns also determine which levels must be fused — a consideration that matters for the functional impact of the surgery.

Symptoms

Adolescent idiopathic scoliosis is typically painless. If a teenager with scoliosis has significant back pain, this should prompt additional investigation — pain can indicate an underlying cause (like osteoid osteoma, a small benign tumor that can cause painful scoliosis) that changes the treatment plan entirely. In adult patients, symptoms — pain, leg symptoms from nerve compression, difficulty standing — play a more prominent role in the surgical decision, because adults develop scoliosis in the context of degenerative changes that can compress nerves even at modest curve magnitudes.

Thoracic Hypokyphosis

The Cobb angle measures the coronal (side-to-side) curve. But scoliosis is a three-dimensional deformity — the spine also rotates and, in the thoracic region, often loses its normal forward bend (kyphosis), producing a flat or hypokyphotic thoracic spine. A thoracic curve with significant hypokyphosis is less amenable to anterior correction techniques and may require a different surgical approach than a curve with preserved kyphosis. This is a technical detail that does not change the threshold for surgery but does affect the plan.

The Role of Bracing

Between the observation zone (curves under 25 degrees in growing patients) and the surgical zone sits a middle range — approximately 25 to 40 to 45 degrees in skeletally immature patients — where bracing is the primary intervention. Bracing does not correct scoliosis. It is a growth-modulation tool designed to prevent progression until the patient reaches skeletal maturity, after which the curve typically stabilizes.

The landmark BrAIST trial, published in the New England Journal of Medicine in 2013, confirmed that bracing is effective at preventing progression in adolescent patients with curves between 20 and 40 degrees — but only when worn for a sufficient number of hours per day. Patients who wore the brace for 13 or more hours per day had a success rate (curve not reaching 50 degrees) of 72 percent, compared to 48 percent in the observation group. Brace compliance is therefore one of the most important variables in whether bracing actually works for a given patient.

Reference: Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of Bracing in Adolescents with Idiopathic Scoliosis. N Engl J Med. 2013;369(16):1512–1521. PMID 24047455

Thresholds for Adult Scoliosis Are Different

The 40 to 50 degree threshold that guides AIS decisions does not translate directly to adult scoliosis. In adults, the decision about surgery is driven much more by symptoms — back pain, leg pain from nerve compression, difficulty walking, progressive deformity — than by the Cobb angle alone. An adult with a 60-degree stable curve causing minimal symptoms may not be a surgical candidate; an adult with a 35-degree curve causing significant neurogenic claudication and imbalance may be.

Adult scoliosis surgery is also meaningfully more complex than AIS surgery, because the degenerated discs, facet arthritis, osteoporosis, and comorbidities that accompany aging all factor into the risk assessment. The risk-benefit calculation for adult scoliosis surgery is never reducible to a Cobb angle threshold — it is an individual conversation about what the curve is doing, what symptoms it is causing, and whether the patient’s overall health makes surgery a reasonable option.

What the Surgical Consultation Actually Involves

A consultation for scoliosis surgery is not a binary determination that a number has been crossed. It is a comprehensive conversation that covers:

  • Review of prior X-rays to assess progression over time
  • Skeletal maturity assessment — Risser grade, bone age
  • Clinical examination for flexibility, rotation, balance, and neurological status
  • Detailed discussion of the specific curve type and what the natural history of that curve pattern looks like
  • Assessment of what surgery would involve, what it would achieve, and what the realistic recovery looks like
  • Discussion of the non-surgical alternatives and whether any of them are appropriate given the specific situation

If you leave a scoliosis consultation without understanding why surgery was recommended or not recommended for your specific curve, that is worth addressing — either by asking your surgeon to walk through the reasoning in more detail, or by seeking a second opinion that provides the clarity you need to make a confident decision.

A Practical Framework

As a rough guide to how the decision typically works:

  • Under 25 degrees in a growing adolescent: observation with serial X-rays every 4 to 6 months
  • 25 to 40–45 degrees in a growing adolescent: bracing — with the goal of preventing progression to the surgical threshold until skeletal maturity
  • 40–45 degrees or more in a growing adolescent: surgery is typically recommended, because bracing is unlikely to prevent the curve from progressing into the range where adult progression is significant
  • 45–50 degrees or more at or near skeletal maturity: surgery is recommended because natural history data shows meaningful risk of continued progression into adulthood
  • Under 40 degrees at skeletal maturity in an asymptomatic patient: observation is typically appropriate — the curve is unlikely to progress significantly in adulthood
  • Any curve with documented rapid progression: the absolute magnitude matters less than the trajectory
  • Adult scoliosis: symptoms and functional impact drive the decision more than Cobb angle

This is a framework, not an algorithm. Individual patients deviate from it for good reasons. The goal of this post is not to replace a clinical consultation — it is to give you enough understanding to have a more informed one.

For more on the decision-making process for adolescent scoliosis, see the Adolescent Idiopathic Scoliosis page. For adult scoliosis, see Adult Scoliosis Surgery. If you have already received a recommendation and want an independent evaluation, see Second Opinion for Scoliosis & Spinal Deformity.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University and Chair of the IMAST Committee of the Scoliosis Research Society. He evaluates patients across the full spectrum of adolescent and adult scoliosis, including those seeking a second opinion on surgical recommendations. To schedule a consultation, call 212-932-5187 or visit the contact page. Telemedicine available in NY, NJ, CT, FL, PA, MO, CA, and TX.

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

I Had a Harrington Rod and My Back Pain Is Getting Worse — What Now?

If you had a Harrington rod placed for scoliosis in the 1960s, 70s, or 80s, and your back pain has been getting progressively worse over the past few years, you are not alone — and the answer you have probably received, that this is just aging or that nothing more can be done, may not be accurate.

Harrington rod surgery was the standard of care for scoliosis correction for three decades. It worked well for many patients in the short term, but it created a set of late mechanical consequences that are now presenting in exactly the population that received these implants as teenagers — patients who are now in their 40s, 50s, 60s, and 70s. The pain you are experiencing is real, it has specific causes, and in appropriate candidates it has specific treatments. The first step is understanding what is actually happening in your spine.

Why Harrington Rods Create Long-Term Problems

The Harrington rod was a long metal rod hooked to the spine at the top and bottom of the scoliosis curve and used to distract — pull apart — the curve into a straighter position. This worked in the coronal plane: the side-to-side curve was reduced. But the distraction force also straightened the lumbar spine in the sagittal plane, eliminating the normal inward curve (lordosis) of the lower back. Patients left surgery with a straighter spine from the front but a flatter spine from the side.

For years or even decades, this went unnoticed — the body compensated by tilting the pelvis backward, bending the knees slightly, and using the hip and gluteal musculature to maintain an upright position. This compensation is exhausting, but it is invisible to others and easy to dismiss as “just how you walk” or “back weakness from getting older.” Then, at some point — usually in the 40s or 50s but sometimes earlier or later — the compensation begins to fail. The pain worsens. The walking distance shortens. Standing for any length of time becomes progressively impossible.

The Specific Causes of Worsening Pain After Harrington Rod Surgery

Worsening back pain after Harrington rod surgery is almost never simply “aging.” It has identifiable, specific mechanical causes that show up on imaging when the right imaging is ordered and reviewed by someone who knows what to look for.

Flatback Deformity

The most common and most important cause of worsening symptoms after Harrington rod surgery. The elimination of lumbar lordosis by the distraction rod produces a flat or even kyphotic lumbar spine that, over decades, causes progressive forward postural decompensation as compensatory mechanisms fail. Patients describe the classic flatback picture: an increasing forward lean that gets worse through the day as muscles tire, a need to bend the knees to stand upright, back and leg exhaustion with any sustained standing or walking, and the progressive loss of activities that require an upright posture.

Flatback deformity is measurable on a full-length standing X-ray. The sagittal vertical axis — the distance between the center of C7 and the back of the sacrum — is the primary measurement of global sagittal imbalance, and it directly quantifies how far forward your center of gravity has shifted from where it should be. Many patients have never had a proper standing X-ray reviewed for sagittal balance. A lumbar spine MRI taken lying down will not show this problem, which is one reason it goes undiagnosed for so long.

Adjacent Segment Disease

The Harrington rod fused a long segment of the thoracic and lumbar spine, leaving the levels above and below the fusion to absorb all of the motion and mechanical load that would otherwise be distributed across many levels. Over decades, this accelerated wear degrades the unfused disc levels — particularly at L4–L5 and L5–S1 below the fusion, and at the upper thoracic levels above it. Adjacent segment degeneration produces disc collapse, facet arthritis, and nerve root compression at the levels above and below the fused segment. The resulting pain may feel like it is “everywhere” rather than localized to the prior fusion site, because it is originating from multiple degenerated unfused levels rather than from the hardware itself.

Hardware Failure

Harrington rods were designed to be temporary — to hold position while fusion consolidated. After that, the rods were expected to be a passive component within a solid fusion mass. In practice, many patients carry their Harrington rods for 30 to 50 years. Over this time, the hooks at the ends of the rod can loosen, migrate, or pull out of the bone. A hook that was well-seated in 1975 may no longer be seated securely in 2026, and the micromotion at a loose hook creates pain and, in some cases, neural compression if the hardware migrates toward the spinal canal. A broken or migrated hook is a specific and entirely diagnosable finding on plain X-ray or CT.

Pseudarthrosis

Some patients who had Harrington rod surgery did not achieve solid fusion across all instrumented levels — a non-union (pseudarthrosis) that may have been asymptomatic for decades became symptomatic as the unfused zone accumulated stress and the instrumentation fatigued. Pseudarthrosis within an old Harrington rod construct is underdiagnosed on plain X-ray and requires CT with fine cuts through the fusion mass to identify reliably.

Spinal Stenosis at Adjacent Levels

The segments above and below the Harrington rod fusion — particularly L4–L5 and L5–S1 in patients fused to L3 or L4 — often develop significant stenosis as adjacent segment degeneration progresses. Patients may experience leg pain, cramping, or heaviness with walking (neurogenic claudication) in addition to back pain. The combination of flatback-related back and leg fatigue with adjacent-segment neurogenic claudication can be clinically difficult to disentangle without careful imaging review.

Why a Standard MRI Often Misses What Is Actually Wrong

The vast majority of patients who present with worsening symptoms after Harrington rod surgery have had an MRI. Most have been told the MRI shows “degenerative changes consistent with age” or that the hardware is in place and the fusion appears intact. This evaluation, while not wrong, is almost always incomplete.

An MRI taken lying down cannot show sagittal imbalance — the forward postural decompensation of flatback deformity is a standing, loaded problem that disappears on a supine scan. A lumbar MRI that shows “degenerative disc disease at L4-L5 and L5-S1” in a post-Harrington rod patient is describing adjacent segment disease, but it cannot tell you whether that degeneration is the primary problem or a secondary consequence of flatback imbalance driving all the load onto those levels.

The study that cannot be skipped in this population is a full-length standing lateral X-ray — showing the entire spine from head to pelvis to feeet in the standing position. This is the study that measures sagittal balance, lumbar lordosis, pelvic incidence, and pelvic tilt — the parameters that determine whether flatback deformity is present and how severe it is. It is the most important study in the evaluation of a symptomatic post-Harrington rod patient, and it is the one most often not obtained.

What a Specialist Evaluation Involves

  • Full-length standing X-rays in both AP and lateral planes — measuring residual scoliosis, lumbar lordosis, and sagittal vertical axis
  • CT scan of the fusion construct — assessing hardware integrity, pseudarthrosis within the fusion mass, and anatomy available for revision instrumentation
  • MRI to evaluate unfused levels above and below for neural compression and adjacent segment degeneration
  • Bone density assessment — osteoporosis is common in this patient age group and directly affects revision instrumentation planning
  • Your original operative report and serial imaging — context for what was done and how things have changed

What “Nothing Can Be Done” Often Actually Means

The most common thing patients with worsening Harrington rod symptoms have been told before seeing a deformity specialist is that nothing more can be done. This deserves to be examined carefully, because it means different things depending on who said it and why.

Sometimes it means the patient’s medical condition makes major revision surgery genuinely inappropriate — a legitimate clinical judgment. More often, it reflects the limited experience of the evaluating surgeon with Harrington rod revision surgery specifically. Revision flatback correction is performed at a very small number of centers nationally, and a general spine surgeon who has not trained in and does not regularly perform these procedures cannot be expected to offer them. The statement is accurate within the scope of that surgeon’s practice. It is not necessarily accurate as a statement about what medicine can offer.

Dr. Sardar receives referrals from across the United States specifically for patients told nothing more can be done after Harrington rod surgery. The evaluation at a center that performs Harrington rod revision regularly often reveals correctable problems that were either not identified or not offered by prior evaluators.

The Next Step

If your back pain after Harrington rod surgery is getting progressively worse — and particularly if you have not had a full-length standing X-ray reviewed for sagittal balance, or if you have been told nothing more can be done — a formal evaluation at a high-volume deformity center is the right next step. Bring your original operative report (if obtainable), X-rays, any recent MRI or CT, and a clear description of when symptoms started and how they have changed over time.

Telemedicine consultations are available for patients who want to discuss their imaging before committing to travel to New York. For more on what Harrington rod revision evaluation and surgery involves, see the full Harrington Rod Revision Surgery page. For information specifically on flatback deformity correction, see Flatback Deformity Surgery. If you are also considering whether a second opinion is appropriate, see Second Opinion for Spinal Deformity Surgery.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University. He is Chair of the IMAST Committee of the Scoliosis Research Society and Co-Chair of the NASS Deformity Section. A significant proportion of his practice consists of complex revision cases after prior spine surgery, including late Harrington rod complications and flatback correction with PSO. He has no prior involvement in the original surgery of patients who come to him for evaluation. To schedule a consultation or request a second opinion, call 212-932-5187 or visit the contact page. Telemedicine available in NY, NJ, CT, FL, PA, MO, CA, and TX.

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

Adding-On After AIS Surgery — When the Scoliosis Curve Continues to Progress Below the Fusion

Adding-on is a term used by spine surgeons to describe a specific pattern of scoliosis progression after surgery: new curve development below the lowest fused vertebra. A patient who had a thoracic scoliosis corrected with fusion to L1, for example, may develop a progressive lumbar curve below L1 in the months to years after their surgery. The fused segment holds; the correction is intact; but below the lowest instrumented level, the spine is progressing in a way that was not expected.

Adding-on is not rare. It is recognized in published series as one of the more common indications for reoperation after AIS surgery, yet it receives very little attention in patient-facing resources. Patients who experience it often have difficulty understanding what is happening — they were told their surgery was successful, and technically the fusion is holding — and are sometimes told to watch and wait without clear information about at what point intervention is appropriate.

What Causes Adding-On?

The most common cause of adding-on is selection of a lower instrumented vertebra (LIV) that did not adequately encompass the structural extent of the scoliosis curve. In AIS surgery, one of the most important and most technically demanding decisions is where to stop the fusion — the lower instrumented vertebra. Stopping too high leaves unfused levels that are still part of the structural deformity; the residual structural curve at and below the LIV continues to exert rotational and translational forces on the unfused lumbar spine, and the unfused segment progressively develops a new curve.

Additional contributing factors include:

  • Residual rotation at the LIV — if the lowest fused vertebra is not adequately derotated and horizontalized, its tilt exerts a progressive deforming force on the mobile segment below
  • Unfused disc wedging at the LIV — a disc that is still wedged at the last fused level perpetuates the mechanical imbalance into the unfused segment below
  • Continued skeletal growth — in patients who had surgery with significant growth remaining, the unfused segments below the LIV continue to grow asymmetrically under the influence of the residual curve pattern

How It Presents

Adding-on typically presents as a progressive shift or lean that was not present immediately after surgery but develops over months to years. Patients notice that their waistline asymmetry is returning, that their trunk is drifting to one side, or that their shoulder balance — which was corrected at surgery — is deteriorating as the lower spine progressively curves. Back pain may accompany the curve progression, particularly as the unfused lumbar levels rotate and degenerate under asymmetric loading.

Radiographically, adding-on is defined as a progressive increase in the Cobb angle of the lumbar curve below the LIV, combined with increasing lateral deviation of L5 or the sacrum relative to the center sacral vertical line. Serial standing X-rays — not a single set — are required to document the trajectory. A single postoperative image showing a lumbar curve below the fusion is insufficient to diagnose adding-on; the pattern must be demonstrated to be progressive over time.

When Is Observation Appropriate vs. When Is Revision Needed?

Not every patient with some adding-on below their AIS fusion requires revision. The clinical decision depends on several factors:

  • Rate of progression. A curve that is progressing consistently across multiple imaging timepoints argues for intervention earlier rather than later. A stable or very slowly progressing curve may be observed.
  • Degree of coronal imbalance. Adding-on that is producing significant trunk decompensation — a trunk shift greater than 3 centimeters — is more compelling for revision than adding-on that remains radiographic without clinical decompensation.
  • Skeletal maturity. Patients who are still growing at the time adding-on is detected have a different risk profile from skeletally mature patients; growth modulation in the unfused segment can drive rapid progression in immature patients.
  • Symptoms. Pain, progressive deformity, or functional limitation that is clearly related to the adding-on pattern supports intervention.

Revision Surgery for Adding-On

Revision surgery for adding-on after AIS typically involves extension of the fusion distally to include the structural curve that was incompletely captured by the original fusion. The revision adds one or more levels below the original LIV, incorporating the levels that are driving the progressive decompensation and stabilizing the construct to prevent further adding-on below the new LIV. This is generally less complex than revision surgery for pseudarthrosis or osteotomy-based correction, but it does require working around the prior instrumentation at the lower end of the existing construct and careful planning of the new fusion endpoint.

Published evidence shows that early revision — before significant deformity has accumulated — produces better outcomes and is technically simpler than delayed revision of a more advanced deformity. This is one of the clearest arguments for not taking a pure watch-and-wait approach when adding-on is documented to be progressive.

For the comprehensive overview of scoliosis surgical failure patterns and revision options, see the main When Scoliosis Surgery Doesn’t Go As Planned page. If you are also experiencing trunk imbalance that you believe is related to your adding-on, see Still Off-Balance After Scoliosis Surgery.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in AIS revision surgery including extension of fusion for adding-on and correction of postoperative coronal imbalance. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice.

Still Off-Balance After Scoliosis Surgery — Understanding Coronal and Sagittal Imbalance After Fusion

One of the most distressing experiences after scoliosis surgery is looking in the mirror and seeing the same imbalance you expected the surgery to correct. Your shoulders are still uneven. Your trunk still leans to one side. Or you stand upright for the first time after surgery and find that your posture, while different from before, is not the balanced, centered result you expected. Your surgeon reviews your X-rays, tells you the correction looks good, and you leave the appointment unsure of what to do with the gap between what you see and what you were told.

Residual imbalance after scoliosis surgery exists on a spectrum. Some degree of asymmetry is expected and acceptable — the goal of scoliosis correction is never radiographic perfection but functional balance and stability. But significant imbalance that affects function, and quality of life should be further evaluated.

Coronal Imbalance — The Trunk That Won’t Center

Coronal imbalance refers to the trunk sitting off-center over the pelvis when viewed from the front. It is measured on standing X-ray as the horizontal distance between a plumb line dropped from the center of C7 and the center of the sacrum (the C7 plumb line). In a balanced spine, this distance is close to zero. Coronal imbalance greater than 3 centimeters is generally considered clinically significant.

Postoperative coronal imbalance typically results from one or more of the following:

  • Incorrect lower instrumented vertebra (LIV) selection — if the fusion stops at a level where a significant structural curve continues below, the unfused spine can shift, producing progressive trunk decompensation. This is the most common cause of postoperative coronal imbalance in AIS surgery.
  • Overcorrection of the main curve without matching correction of compensatory curves — scoliosis curves are not independent; correcting the main curve disproportionately while leaving compensatory curves mobile can pull the trunk toward the concave side of the corrected curve, producing a lateral trunk shift
  • Undercorrection with persistent structural deformity — a fusion that achieves inadequate correction of the primary structural curve leaves residual deformity that keeps the trunk off-center

Patients with significant coronal imbalance often describe difficulty walking in a straight line — they find themselves drifting to one side, compensating with hip and knee positioning, and experiencing asymmetric hip and knee pain from abnormal loading. The cosmetic impact — shoulders that remain visibly uneven, a waistline that is asymmetric — affects confidence and social function.

Sagittal Imbalance — The Forward

Sagittal imbalance — the loss of the normal front-to-back spinal curvature that produces a progressive forward lean — is a distinct problem from coronal imbalance and typically more functionally disabling. It occurs when scoliosis surgery doesn’t restore or maintain adequate lumbar lordosis, allowing the center of gravity to shift forward of the pelvis. The body compensates through pelvic retroversion (tucking the pelvis under), knee flexion, and hip extension — compensatory mechanisms that work in the short term but fail progressively as muscles fatigue.

Sagittal imbalance after scoliosis surgery represents a specific form of flatback deformity. It is the defining complication of Harrington rod surgery — the technique that straightened the spine in the coronal plane while eliminating lumbar lordosis — but it can also develop after modern instrumented fusion when lordosis is not adequately restored. The detailed discussion of causes, evaluation, and correction is on the Flatback Deformity Surgery page and the Harrington Rod Revision page.

Distinguishing Structural Imbalance From Compensatory Imbalance

Not every case of apparent imbalance after scoliosis surgery represents a surgical failure. Some apparent imbalance is compensatory — the spine above or below the fusion is doing what it was designed to do, accommodating the corrected construct. Differentiating structural imbalance from compensatory imbalance requires careful evaluation of full-length standing X-rays in multiple planes, with attention to the C7 plumb line, the position of the fused construct relative to the pelvis, and the behavior of the unfused segments.

This distinction matters because compensation can typically be managed conservatively — physical therapy, core strengthening, and time — while structural imbalance may require revision surgery if it is significant, progressive, or symptomatic.

When Is Revision Surgery Appropriate for Imbalance?

Revision for coronal or sagittal imbalance is considered when:

  • The imbalance is structural rather than compensatory, and significant on measurement
  • The imbalance is progressive on serial imaging
  • The functional or quality-of-life impact is significant and well-documented
  • Conservative measures have not provided adequate relief
  • The patient’s overall medical condition is appropriate for revision surgery

Revision for coronal imbalance typically involves correction and fusion extension to include a more appropriate LIV and to balance the main and compensatory curves more appropriately. Revision for sagittal imbalance may require osteotomy — the same PCO, PSO, or VCR techniques used for flatback correction — to restore lumbar lordosis and re-center the body’s gravity line over the pelvis and feet.

For the full picture of scoliosis revision scenarios, see the main When Scoliosis Surgery Doesn’t Go As Planned page.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in correction of coronal and sagittal imbalance after prior scoliosis surgery. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice.

Pseudarthrosis After Scoliosis Surgery — Why Bone Sometimes Doesn’t Fuse and What Can Be Done

Pseudarthrosis is the most common reason patients require revision surgery after scoliosis fusion, yet it is also one of the most frequently unrecognized complications of spinal surgery. Patients with pseudarthrosis are often told for months or years that their X-rays look fine — because on plain X-rays, they often do. The fusion mass can appear present and intact on standard imaging while harboring a fibrous non-union that is the true source of persistent pain and, ultimately, hardware failure.

What Is Pseudarthrosis?

Spinal fusion surgery achieves its goal when the bone graft placed between vertebrae consolidates into continuous, solid bone — the same process that heals a fracture. When this consolidation fails to occur, the result is a pseudarthrosis: a false joint at the non-union site, where fibrous tissue rather than solid bone bridges the gap. The vertebrae in this zone are not truly fused; they retain a small degree of micromotion at the non-union site, and this persistent micromotion is the source of the pain and mechanical stress that eventually causes hardware to fail.

Why Does Pseudarthrosis Happen?

Bone fusion requires adequate bone graft material, mechanical stability, good blood supply, and a biological environment that supports new bone formation. Pseudarthrosis occurs when one or more of these conditions is not met:

  • Insufficient bone graft or poor graft incorporation — the biological material needed for new bone formation was inadequate or failed to integrate at a specific level within the fusion mass
  • Excessive motion at the non-union site — even with hardware in place, micromotion at specific segments can prevent consolidation if the construct is not sufficiently rigid
  • Osteoporosis or poor bone quality — reduced bone density impairs both screw purchase and the bone’s capacity to form new fusion mass
  • Smoking — one of the most well-established risk factors for pseudarthrosis; nicotine impairs the vascular supply required for bone healing
  • Nutritional deficiencies — inadequate protein, vitamin D, or calcium impair the biological environment for bone formation
  • Long fusion constructs — the longer the fusion, the more levels that must all consolidate simultaneously; longer constructs are at higher risk of isolated pseudarthrosis at one or more levels within the fusion mass

How Pseudarthrosis Presents

The classic presentation is persistent back pain at or near the fusion site that never fully resolved after surgery — or that improved initially and then returned or worsened. This pain is often positional: worse with loading (standing, walking), better with rest and unloading. Some patients notice a subtle mechanical quality to the pain — a sense of movement or instability at a specific spinal level. Leg pain may accompany back pain if the micromotion at the pseudarthrosis site irritates adjacent nerve roots.

The eventual hardware failure that reveals the pseudarthrosis is often dramatic by comparison: a broken rod detected on routine follow-up imaging, or a sudden change in pain character when the rod fractures. A clean transverse rod fracture at a single level — rather than at a connector or screw junction — is the classic imaging pattern that points to an underlying pseudarthrosis at that segment. The rod failed because it was absorbing all the mechanical load that solid bone should have been absorbing.

Why X-Rays Miss It

Plain X-rays assess the overall alignment of the fusion construct and the gross appearance of the bone. They are not designed to detect the difference between solid cortical fusion and fibrous non-union within the fusion mass. A pseudarthrosis that has not yet caused rod fracture or obvious lucency around hardware can look completely normal on AP and lateral X-rays. This is why many patients with pseudarthrosis are told repeatedly that their images look acceptable.

CT scanning with fine-cut sequences through the fusion mass is the gold standard for diagnosing pseudarthrosis. The key finding is the absence of continuous trabecular bridging bone across the fusion levels — a gap in the fusion mass that represents the non-union site. CT can also detect subtle hardware loosening, early rod stress fractures before complete fracture, and screw halo signs (lucency around the screw-bone interface indicating micromotion).

What Revision Surgery Involves

Revision surgery for pseudarthrosis addresses both the mechanical failure and its biological cause. The procedure typically involves:

  • Removal of any failed hardware (broken rod, loosened screws) at and around the pseudarthrosis site
  • Thorough debridement and preparation of the pseudarthrosis site — removing fibrous tissue and creating fresh, vascularized bone surfaces capable of supporting new graft consolidation
  • Placement of abundant, high-quality bone graft at the non-union site; bone morphogenetic protein (BMP) may be used to enhance fusion biology in difficult revision cases
  • Re-instrumentation with new hardware providing adequate stability across the non-union; in some cases the construct is extended proximally or distally to improve mechanical stability
  • Correction of any associated deformity or imbalance that may have contributed to or resulted from the pseudarthrosis

Published series report bony union rates of approximately 98 percent with revision surgery for pseudarthrosis after scoliosis fusion — making this one of the most reliably fixable revision scenarios when properly identified and addressed. The key is making the diagnosis before the mechanical consequences become more complex to address.

For a comprehensive overview of all scoliosis revision scenarios, see the main When Scoliosis Surgery Doesn’t Go As Planned page. For more on the revision surgery process generally, see Complex Revision Spine Surgery.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in revision scoliosis surgery including pseudarthrosis repair and re-instrumentation. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice.

Cervical Kyphosis: A Different Kind of Neck Problem

Most patients familiar with cervical spine problems think of disc herniation, nerve compression, or stenosis. Cervical kyphosis is less widely known but represents a distinct and clinically important problem: the neck loses its normal inward curve and develops a forward bend instead, placing the spinal cord under progressive stretch across the kyphotic apex and creating a pattern of neurological deterioration that differs from simple disc disease.

What Is Cervical Kyphosis?

The normal cervical spine has a lordotic curve — it curves inward (toward the back of the throat) when viewed from the side. This lordosis distributes compressive loads evenly across the disc spaces and keeps the spinal cord in a relaxed, non-stretched state. When cervical lordosis is lost and the cervical spine develops a kyphotic curve instead — bending forward — several problems arise:

  • The spinal cord must drape over the kyphotic apex, stretching and compressing it from the front
  • The disc spaces at the apex of the kyphosis undergo excessive anterior loading, accelerating degeneration
  • The posterior muscles of the neck must work continuously to maintain head position, producing chronic muscle fatigue and pain
  • The natural tendency of the kyphosis is to progress over time as the disc spaces at the apex continue to degenerate under abnormal loading

Causes

Post-Surgical (Post-Laminectomy)

The most common cause of iatrogenic cervical kyphosis. Cervical laminectomy removes the posterior bony arches — and in doing so, disrupts the posterior tension band that maintains lordosis. Without this posterior restraint, the cervical spine can progressively fall into kyphosis, particularly at levels where the disc spaces are already degenerated or where pre-existing lordosis was reduced. Post-laminectomy kyphosis is one of the principal reasons that cervical laminoplasty has largely replaced multilevel laminectomy at centers where both are available.

Degenerative

Cervical spondylosis with multilevel disc height loss can produce a loss of lordosis or frank kyphosis as the disc spaces collapse and the anterior column shortens. This is typically a gradual process and may be an incidental finding on imaging in patients with mild disease, or may contribute to progressive myelopathy in patients with more severe degeneration and cord compression.

Congenital and Developmental

Some patients develop cervical kyphosis from congenital vertebral anomalies, failure of anterior vertebral body development, or conditions such as neurofibromatosis. These are less common causes but can produce severe cervical deformity requiring complex anterior and posterior reconstruction.

Inflammatory (Ankylosing Spondylitis)

Ankylosing spondylitis — a seronegative inflammatory arthropathy — can produce a chin-on-chest deformity as the cervical spine progressively ankylovers in kyphosis. This is one of the most severe forms of cervical kyphosis and requires specific surgical approaches designed for the inflammatory, fused spine.

Why Cervical Kyphosis Is Neurologically Urgent

Spinal cord compression from cervical kyphosis can be more insidious than compression from disc herniation. With disc herniation, compression is localized; with kyphosis, the cord is compressed over a longer segment and stretched over the kyphotic apex. This combination produces a myelopathy pattern that may not respond as well to simple decompression — because decompression without correction of the kyphosis leaves the cord still draped over the kyphotic apex, still under tension.

Any patient with cervical kyphosis and progressive neurological symptoms — hand clumsiness, gait instability, balance problems, Lhermitte’s sign — requires urgent evaluation including MRI to assess cord signal. Cord signal change on MRI indicates established injury to the cord and argues for expedited surgical planning rather than prolonged observation. For more on cervical myelopathy and why early recognition matters, see the dedicated page.

Surgical Correction

Cervical kyphosis correction can involve a combination of anterior and posterior approaches to address both the structural kyphosis (anterior column reconstruction to restore lordosis) and the posterior stability (instrumented fusion to hold the corrected position). For flexible kyphosis, posterior-only correction with lateral mass or pedicle screw fixation may be sufficient.

Intraoperative neuromonitoring throughout the entire correction procedure is absolutely non-negotiable — the spinal cord is at risk during both the decompression and the correction maneuver, and real-time monitoring provides the only reliable warning if the cord is being compromised during surgery. For more on kyphosis surgical techniques, see the Kyphosis Surgery page.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, evaluating and treating cervical kyphosis including post-surgical, degenerative, and complex reconstruction cases. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice.