When Does Scoliosis Need Surgery? A Parent’s Guide

If your child has just been diagnosed with scoliosis, the first question most parents ask is: Does this mean surgery?

The answer, for most children, is no. The majority of patients with adolescent idiopathic scoliosis (AIS) are treated with observation alone, or with bracing during the growing years. Surgery is recommended only in specific situations where the curve is severe enough that the long-term risks of leaving it untreated outweigh the risks of the operation itself.

That said, knowing when surgery is the right answer — and finding the right surgeon to make that call — matters enormously. This guide walks you through how spine surgeons think about the decision.

First: The Basics of Scoliosis Severity

Scoliosis severity is measured using the Cobb angle — the standard method for quantifying how much the spine curves on an X-ray. A Cobb angle is measured in degrees, and general treatment guidelines are organized around it:

  • Under 25°: Typically observed with periodic X-rays. No active treatment needed in most cases.
  • 25° to 45°: Bracing is usually recommended for skeletally immature patients (those still growing) to prevent the curve from worsening.
  • 45° to 50° or more: Surgery is typically recommended, particularly if the patient is still growing or the curve is progressing.

These are general thresholds, not rigid rules. Every patient is different, and the decision about surgery involves more than just the number.

The Key Factors That Go Into the Decision

When a surgeon evaluates a patient for potential scoliosis surgery, the Cobb angle is one data point among several. Here is what else matters:

1. Skeletal Maturity

A curve in a child who is still growing carries more risk of progression than the same curve in a fully grown teenager. Skeletal maturity is assessed using bone age and growth indicators visible on X-ray, including the Risser sign (which measures the maturity of the pelvic growth plate). A child with a 40° curve and significant growth remaining may be a stronger surgical candidate than a teenager with the same curve who is nearly done growing.

2. Rate of Progression

How fast is the curve changing? A curve that has grown by 10 degrees over the past six months tells a different story than one that has been stable for two years. Progression of 5 degrees or more per visit is generally considered significant, particularly during the adolescent growth spurt.

3. Curve Pattern and Location

Not all curves are the same. A curve in the thoracic spine (mid-back) behaves differently from one in the lumbar spine (lower back) or a double major curve that involves both regions. Thoracic curves tend to progress more than lumbar curves and are more likely to affect appearance and, in very severe cases, lung function. The pattern of the curve affects which levels need to be fused and how the surgery is planned.

4. Symptoms

Most adolescents with scoliosis do not have significant pain. When pain is present — especially if it is severe, constant, or associated with neurological symptoms like weakness or numbness — it warrants closer evaluation and may support an earlier surgical recommendation. Pain alone does not trigger surgery, but it is factored into the overall picture.

5. The Long-Term Natural History

Research on the natural history of untreated scoliosis informs a key part of the surgical decision. Curves above 50 degrees at skeletal maturity tend to progress slowly but steadily in adulthood — at a rate of approximately 1 degree per year. Over decades, a 55° curve at age 18 may become a 75° or 80° curve by middle age, with increasing pain, deformity, and in severe cases, cardiopulmonary compromise. This long-term trajectory is part of why surgery is recommended at meaningful thresholds rather than waiting until symptoms appear.

What Scoliosis Surgery Actually Does

The goal of surgery for AIS is to correct the curve as much as safely possible, then fuse the involved vertebrae so the correction is permanent. This is typically done through a posterior approach (through the back) using pedicle screws, connecting rods, and bone graft.

Modern techniques have significantly improved both the safety and the outcomes of this surgery. Surgeons at high-volume centers now routinely use:

  • Intraoperative neuromonitoring (IONM): Continuous monitoring of spinal cord and nerve function throughout the procedure, allowing the surgical team to detect and respond to any changes in real time.
  • Robotic-assisted navigation: Computer-guided systems that allow pedicle screws to be placed with a high degree of precision, reducing the risk of misplacement.
  • Real-time 3D imaging: Intraoperative CT-based imaging that confirms screw position before the patient leaves the operating room.

The result, in the hands of an experienced surgeon, is a well-corrected spine, a straight and balanced posture, and a fusion that is built to last a lifetime.

What Happens If Surgery Is Delayed or Avoided?

For curves that do not meet surgical thresholds, avoiding surgery is absolutely the right call. For curves that do meet those thresholds, delay carries real risks. The larger a curve becomes before surgery, the more levels typically need to be fused to achieve correction and balance. More fusion levels mean a longer operation, a longer recovery, and less spinal mobility preserved. Correction of a 70° curve is technically more demanding and carries more risk than correction of a 50° curve in the same patient.

This is one reason why a timely evaluation by an experienced scoliosis surgeon matters, even for patients who may ultimately not need surgery. Knowing where you stand — and having a plan — is always better than watching and waiting without guidance.

Questions to Ask at Your Consultation

Whether you are seeking a first opinion or a second one, here are the questions worth asking any surgeon you see:

  • What is my child’s exact Cobb angle, and what is the curve pattern?
  • How skeletally mature is my child, and how does that affect the risk of progression?
  • What is the likelihood this curve will progress without surgery?
  • If surgery is recommended, how many levels would be fused?
  • What are the risks,?
  • Do you use robotic guidance and intraoperative neuromonitoring?

A good surgeon will welcome these questions and answer them directly. If you feel rushed, dismissed, or unable to get clear answers, seeking a second opinion is entirely appropriate — and most experienced scoliosis surgeons will tell you the same.

When to Seek a Second Opinion

Second opinions are not just acceptable in scoliosis care — they are often encouraged. AIS surgery is elective in the sense that it is planned rather than emergent, which means you have time to make an informed decision. If your child has been told surgery is necessary and you are unsure, a consultation at a high-volume deformity center can provide clarity and peace of mind. Conversely, if you have been told surgery is not yet needed but the curve has been rapidly progressing, a second set of eyes may be equally valuable.

About Dr. Zeeshan Sardar
Dr. Sardar is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University and one of New York’s most experienced adolescent scoliosis surgeons. He completed his advanced spinal deformity fellowship at Columbia University and NewYork-Presbyterian and sees patients from across the United States and internationally. To schedule a consultation, call 212-932-5187 or visit the contact page.

This article is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your child’s specific condition.

Adult Scoliosis

Symptoms, Causes & When Surgery Is the Right Choice

Many people associate scoliosis with teenagers — the awkward school screening, the doctor with the scoliometer, the worried parent. But scoliosis doesn’t always stay in adolescence. For millions of adults, it either persists from childhood or develops for the first time after age 40. And unlike the mild curves that are often watched and managed in teens, adult scoliosis can cause real, daily suffering: back pain that never fully goes away, difficulty standing upright, and a gradual loss of the activities you love.

If you’ve been told you have adult scoliosis — or if your back pain just hasn’t added up — this guide will help you understand what you’re dealing with and when it might be time to seriously consider surgery.

What Is Adult Scoliosis?

Scoliosis is an abnormal sideways curvature of the spine, typically measuring 10 degrees or more on an X-ray. In adults, it comes in two main forms:

Adolescent idiopathic scoliosis (AIS) that has progressed into adulthood. If you were diagnosed with scoliosis as a child or teenager and weren’t treated — or were treated but still have a residual curve — that curve can continue to worsen over time, especially after age 40.

De novo (degenerative) scoliosis. This type develops in adulthood, usually after age 50, as the discs and joints of the spine wear down unevenly. It tends to affect the lower back and is one of the most common causes of new-onset back and leg pain in older adults.

Both types can significantly impact quality of life — and both deserve proper evaluation, not just reassurance that “it’s just getting older.”

Symptoms to Watch For

Adult scoliosis doesn’t always look the way people expect. You might not have a visible hump or dramatic lean. Instead, the signs are often subtler and easy to dismiss:

  • Persistent lower back pain, especially after standing or walking
  • Leg pain, numbness, or tingling (caused by nerve compression as the spine curves and shifts)
  • Difficulty standing upright — you may find yourself leaning on a shopping cart or countertop for relief
  • Uneven hips or shoulders that have gradually shifted
  • Fatigue from the effort of compensating for poor spinal alignment
  • A feeling that you’re getting shorter — a curve can cause measurable height loss over years

If any of these sound familiar, don’t wait. Adult scoliosis tends to worsen gradually, and earlier intervention — even if non-surgical — almost always leads to better outcomes.

What Causes Adult Scoliosis?

For degenerative scoliosis, the root cause is the cumulative wear and tear of aging. As the intervertebral discs lose height and the facet joints degenerate asymmetrically, the spine begins to tilt and rotate. Factors that accelerate this process include:

  • Osteoporosis — weakened bones are more vulnerable to collapse and deformity
  • Prior spinal surgeries — adjacent segment disease can cause curves to develop or worsen above or below a fusion
  • Genetics — a family history of spine problems raises your risk
  • Obesity — excess weight adds stress to an already compromised spine

Understanding the underlying cause matters enormously when planning treatment. A one-size-fits-all approach simply doesn’t work for adult spinal deformity.

When Is Surgery the Right Choice?

Most patients with adult scoliosis don’t need surgery immediately — and many do very well with physical therapy, core strengthening, anti-inflammatory medications, or targeted injections. But there are clear signals that surgery deserves serious consideration:

  1. Your symptoms are severe and not improving. If conservative treatment has been tried for three to six months without meaningful relief, surgery may offer the reset your spine needs.
  2. Your curve is progressing. If serial X-rays show your curve is getting worse — particularly past 50 degrees — waiting tends to mean a more complex operation later.
  3. You have significant nerve compression. Leg weakness, loss of bladder or bowel function, or severe radicular pain that doesn’t respond to injections often requires surgical decompression.
  4. Your posture has collapsed. Patients who can no longer stand upright — who stoop forward or lean to one side — often experience dramatic improvements in function and quality of life after realignment surgery.
  5. Your quality of life has declined significantly. This is underappreciated but crucial. Research consistently shows that adult scoliosis patients who undergo well-planned surgery report outcomes comparable to hip and knee replacement in terms of life improvement.

Surgery for adult spinal deformity has advanced enormously. With the integration of robotics, AI-driven surgical planning, and custom implants, outcomes are more predictable and recovery more manageable than ever before.

Taking the Next Step

If you’re living with back pain, difficulty walking, or a progressive curve, you deserve a thorough evaluation — not a dismissive “come back if it gets worse.”

Dr. Zeeshan Sardar is a scoliosis and spinal deformity specialist at NewYork-Presbyterian / Columbia University Medical Center in New York City. He specializes in the full spectrum of adult spinal deformity — from observation and conservative management to complex reconstructive surgery — and takes time to understand each patient’s goals before recommending any treatment.

To schedule a consultation, visit sardarspine.com or call our office directly. You don’t have to just live with it.

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 adult and adolescent scoliosis, spinal deformity, and complex revision spine surgery. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.

Pushing the Boundaries of Spine Surgery with Advanced Technology

Here’s a glimpse of my recent talk at the Saudi Spine Conference in Riyadh, where I had the privilege to discuss how I leverage cutting-edge technology to deliver precision-driven spine surgeries.

From robotics and AI-driven surgical planning to virtual modeling and custom implants, I’ve embraced a combination of tools that allow me to create tailored surgical plans for my patients—particularly those with scoliosis and spinal deformities.

What sets my approach apart is the seamless integration of these advanced technologies to ensure unparalleled accuracy and better outcomes for each patient.

Grateful for the opportunity to share my methods and to learn from the incredible expertise present at the conference. Together, we’re shaping the future of spine surgery!

#SpineSurgery #InnovationInMedicine #RoboticsInSurgery #SaudiSpineConference #PatientCenteredCare

About the Author

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C is Co-Chief of Spinal Deformity Surgery, Director of Quality & Patient Safety, and Medical Director of the Spine Unit at Och Spine Hospital, NewYork-Presbyterian / Columbia University. Board-certified in orthopaedic surgery, he completed three spine fellowships — combined orthopedic and neurosurgical spine (Cedars-Sinai), artificial disc replacement (Texas Back Institute), and complex spinal deformity (Columbia) — and specializes in scoliosis, kyphosis, complex revision and Harrington rod revision surgery, and motion-preserving and robotic-assisted spine surgery. He is a member of the Scoliosis Research Society. Read full bio →

Honored to Share and Learn at the Saudi Spine Society

I had the privilege of being invited by the Saudi Spine Society to deliver a keynote talk on the evolution of sagittal alignment of the spine. It was an incredible opportunity to dive deep into a topic that continues to shape the future of spine care.

In addition, I had the pleasure of presenting on optimizing patients prior to scoliosis and spinal deformity surgery, sharing strategies to improve outcomes and enhance patient care.

The highlight of the event, however, was reconnecting with old friends and meeting new colleagues who are as passionate about advancing spine surgery as I am. I was truly impressed by the complexity of cases being tackled in Saudi Arabia and the exceptional quality of care being provided.

Grateful for the opportunity to exchange ideas and be inspired by the innovative work being done globally.

#SpineSurgery #MedicalInnovation #GlobalCollaboration #SaudiSpineSociety

About the Author

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C is Co-Chief of Spinal Deformity Surgery, Director of Quality & Patient Safety, and Medical Director of the Spine Unit at Och Spine Hospital, NewYork-Presbyterian / Columbia University. Board-certified in orthopaedic surgery, he completed three spine fellowships — combined orthopedic and neurosurgical spine (Cedars-Sinai), artificial disc replacement (Texas Back Institute), and complex spinal deformity (Columbia) — and specializes in scoliosis, kyphosis, complex revision and Harrington rod revision surgery, and motion-preserving and robotic-assisted spine surgery. He is a member of the Scoliosis Research Society. Read full bio →

Case Study: Spondylolisthesis with Failed Prior Treatment — Surgical Correction and Recovery

The following is a three-part case study illustrating the evaluation, surgical planning, and outcome for a patient with lumbar spondylolisthesis and stenosis who had not improved with prior treatment. All imaging is shared with patient consent for educational purposes.

Part 1: Presentation

A 55-year-old woman presented with progressive back pain and bilateral leg pain that significantly limited her ability to walk. Imaging confirmed lumbar stenosis and spondylolisthesis at L4-5, disc degeneration at L3-4, and severe arthritis at L5-S1. She had already undergone a course of physical therapy and multiple epidural steroid injections with only short-term relief.

On examination, she had significant difficulty with prolonged standing and walking. Her X-rays on presentation are shown below, demonstrating the degree of listhesis and degenerative change at multiple levels.

AP standing X-ray showing lumbar spondylolisthesis at L4-5
AP standing X-ray demonstrating lumbar spondylolisthesis and multilevel degenerative changes.
Lateral extension X-ray showing lumbar spondylolisthesis
Lateral extension X-ray.
Lateral flexion X-ray showing dynamic instability at L4-5
Lateral flexion X-ray demonstrating dynamic instability.
Lumbar spine MRI sagittal view showing stenosis and disc degeneration
MRI sagittal view showing multilevel stenosis and disc degeneration.
MRI axial view at L4-5 showing severe stenosis
Axial MRI at L4-5 demonstrating severe central stenosis.
MRI axial view at L3-4 showing disc degeneration and stenosis
Axial MRI at L3-4.
MRI axial view at L5-S1 showing severe arthritis
Axial MRI at L5-S1 showing severe facet arthropathy.
MRI axial overview of lumbar spine
Axial MRI overview of the lumbar spine.

Part 2: Failed Prior Treatment and Worsening

Before presenting to Dr. Sardar, the patient had undergone a Vertiflex interspinous spacer procedure at another institution. Rather than improving her symptoms, the procedure was followed by progressive worsening. By the time of her follow-up evaluation, she was unable to stand upright and required a walker for mobility.

Repeat imaging confirmed that her underlying spondylolisthesis and sagittal malalignment had progressed. The interspinous spacer had not addressed the structural instability at the involved levels, and the added device had not stabilized the segment. Her clinical picture now represented a case of progressive lumbar deformity with neurogenic claudication and functional decline — a pattern that is not amenable to further conservative or minimally invasive intervention.

X-ray showing Vertiflex interspinous spacer in situ with worsened spondylolisthesis
X-ray showing the Vertiflex interspinous spacer in situ with worsened spondylolisthesis and alignment compared to prior imaging.
Post-Vertiflex AP X-ray showing lumbar alignment
AP X-ray at time of re-presentation.
Post-Vertiflex lateral X-ray showing sagittal malalignment
Lateral X-ray demonstrating sagittal malalignment at time of re-presentation.

Part 3: Surgical Treatment and Outcome

After a comprehensive evaluation — including full-length standing X-rays, CT, MRI, and medical optimization — the patient underwent posterior spinal reconstruction from L3 to S1/ilium with transforaminal lumbar interbody fusion (TLIF) at L4-S1. The Vertiflex device was removed as part of the procedure.

The surgical goals were to decompress the neural elements, restore lumbar lordosis, achieve solid segmental fixation, and correct the overall sagittal alignment. Robotic-assisted navigation was used for pedicle screw placement, and intraoperative neuromonitoring was maintained throughout the case.

At follow-up, the patient was able to stand upright without a walker — a functional milestone she had not achieved in years. Her leg pain resolved and her back pain improved significantly. Post-operative X-rays confirmed solid instrumentation, restored lordosis, and well-balanced sagittal alignment.

Post-operative AP X-ray showing L3-S1 posterior spinal fusion with pedicle screw instrumentation
Post-operative AP X-ray: L3-S1/ilium posterior spinal fusion with pedicle screw instrumentation and TLIF at L4-S1.
Post-operative lateral X-ray showing restored lumbar lordosis after L3-S1 fusion
Post-operative lateral X-ray demonstrating restoration of lumbar lordosis and sagittal balance.
Follow-up AP X-ray showing solid fusion and maintained alignment
Follow-up AP X-ray confirming solid instrumentation and maintained alignment.
Follow-up lateral X-ray showing maintained sagittal balance after lumbar reconstruction
Follow-up lateral X-ray showing maintained sagittal balance.

Case presented for educational purposes with patient consent. This post does not constitute individualized medical advice. Treatment decisions should be made in consultation with a qualified spine specialist based on individual clinical findings.

About Dr. Zeeshan Sardar
Dr. Sardar is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University and specializes in complex spinal reconstruction, revision surgery, and adult spinal deformity. To schedule a consultation, call 212-932-5187 or visit the contact page.

New Research: Preoperative Optimization for Adult Spinal Deformity Surgery

Preoperative optimization for adult spinal deformity surgery - publication cover

Preoperative optimization of adult patients undergoing surgery for scoliosis, kyphosis, or spinal deformity is one of the most important — and often underappreciated — factors in achieving good surgical outcomes. Patients who present for major spinal deformity surgery with suboptimal bone density, nutritional deficiencies, poorly controlled diabetes, or other modifiable risk factors have measurably higher rates of complications, hardware failure, and prolonged recovery than those who have been appropriately optimized before surgery.

Our recent systematic review, published in Spine (March 2024), provides a practical, evidence-based framework for physicians managing patients in the preoperative period ahead of adult spinal deformity surgery.

Key Modifiable Risk Factors

The review identifies and synthesizes the evidence on the following modifiable risk domains:

  • Osteoporosis — bone quality directly affects pedicle screw purchase and fusion rates; medical treatment before elective deformity surgery is strongly supported by the evidence
  • Malnutrition — albumin and prealbumin levels predict wound healing and infection risk; nutritional supplementation should be initiated early in the preoperative period
  • Diabetes and glycemic control — HbA1c levels above 7.5–8% are associated with significantly higher surgical site infection rates and impaired fusion
  • Frailty — validated frailty indices predict major complication risk and should inform patient selection and timing for major deformity surgery
  • Tobacco use — smoking is associated with pseudarthrosis; smoking cessation before surgery meaningfully improves fusion rates

The central finding of the review is that systematic, proactive optimization across these domains — ideally coordinated through a multidisciplinary preoperative clinic — can meaningfully reduce complications and improve long-term outcomes in adult spinal deformity surgery.

Summary table of preoperative optimization factors for adult spinal deformity
Evidence summary for preoperative optimization in spinal deformity

Full citation: Katiyar P, Reyes J, Coury J, Lombardi J, Sardar Z. Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review. Spine. 49(5):304-312, 2024.

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 co-authored this systematic review and leads a multidisciplinary preoperative optimization program for complex spinal deformity patients. 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.

Presenting at the AO Spine Global Spine Congress in Bangkok

It was a privilege to present research and exchange ideas with colleagues from around the world at the AO Spine Global Spine Congress in Bangkok last week. The congress brings together spine surgeons, researchers, and educators from across the globe to share the latest advances in spine surgery, deformity management, and clinical outcomes research.

In addition to presenting, I had the opportunity to continue collaborative work with the AO Spine Deformity Knowledge Forum — a multidisciplinary group focused on advancing the science and practice of spinal deformity surgery worldwide. These meetings are invaluable for staying at the forefront of the field and ensuring that the work being done at NewYork-Presbyterian reflects the best current evidence and technique.

Dr. Sardar presenting at AO Spine Global Spine Congress Bangkok
Presenting at the AO Spine Global Spine Congress, Bangkok.
AO Spine Global Spine Congress Bangkok conference hall
AO Spine Global Spine Congress, Bangkok.
AO Spine Deformity Knowledge Forum meeting Bangkok
AO Spine Deformity Knowledge Forum session.
Spine surgery faculty at AO Spine Global Congress Bangkok
Faculty and colleagues at the AO Spine Global Spine Congress.
Dr. Sardar with colleagues at AO Spine congress Bangkok
With colleagues at the AO Spine Global Spine Congress.
AO Spine congress session on spinal deformity
AO Spine Global Spine Congress, Bangkok.

Ongoing engagement with the international spine surgery community — through research, education, and collaborative organizations like AO Spine — is central to how we continue to improve care for patients with complex spinal conditions. I look forward to continuing this work in the year ahead.

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 an active faculty member of the AO Spine Deformity Knowledge Forum. To schedule a consultation, call 212-932-5187 or visit the contact page.

For more information about Dr. Sardar’s practice, visit sardarspine.com or call 212-932-5187.

Case Follow-Up: Severe Sagittal Malalignment Corrected with Pedicle Subtraction Osteotomy

This is the follow-up on a previously presented case of severe lumbar sagittal malalignment — a patient who had been living with progressive forward imbalance that significantly impaired her quality of life and ability to stand upright.

After comprehensive preoperative evaluation and medical optimization, the patient underwent posterior spinal instrumentation from T12 to S1/pelvis, with a transforaminal lumbar interbody fusion (TLIF) at L5-S1 and a pedicle subtraction osteotomy (PSO) at L5. The PSO allowed correction of the severe sagittal imbalance by removing a posterior and middle column wedge of bone at L5, enabling the spine to be repositioned into a balanced, upright alignment.

The results at long-term follow-up have been excellent. The patient is now able to stand upright comfortably — something she had not been able to do for decades. She has expressed significant gratitude for the outcome and remains neurologically intact with a solid fusion construct on imaging.

This case illustrates several important principles in adult spinal deformity surgery: the importance of addressing sagittal balance rather than coronal deformity alone, the role of three-column osteotomy in correcting fixed deformity, and the durability of well-executed reconstruction over the long term.

Post-operative X-ray showing T12-pelvis posterior spinal fusion with PSO at L5 and restored sagittal balance
Post-operative X-ray: T12-S1/pelvis posterior instrumented fusion with TLIF L5-S1 and PSO at L5, demonstrating restored sagittal balance.

Case presented for educational purposes with patient consent. This post does not constitute individualized medical advice. If you are experiencing difficulty standing upright or progressive spinal deformity, consult a qualified spine specialist.

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 pedicle subtraction osteotomy, adult spinal deformity, and complex revision surgery. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.

To schedule a consultation with Dr. Sardar, call 212-932-5187 or visit the contact page.

Cervical Epidural Abscess

An update on a cervical epidural abscess case: Successful partial C4 corpectomy led to significant neurological recovery. The abscess was more phlegmon than liquid. A fibular allograft was used for anterior column reconstruction and stability.

Key takeaways:

  • Abscesses can be more solid than expected on imaging — surgical planning should account for this
  • Partial corpectomy offers excellent anterior cord decompression with anterior column reconstruction
  • Material choice (titanium/allograft/autograft) matters less than the quality of decompression and fixation achieved
Post-operative imaging following C4 corpectomy for cervical epidural abscess

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, performing the full range of cervical spine surgery including anterior cervical reconstruction and complex revision cases. To schedule a consultation, call 212-932-5187 or visit the contact page.

Case shared for educational purposes. This post does not constitute individualized medical advice.

How good is AI in Spine?

Is AI good at deciphering spinal intricacies? Take a look at this AI-generated spine image. While it mimics the spine from a distance, the details are off in ways that matter clinically — proportions, anatomical relationships, and structural specifics that a trained eye catches immediately.

This reflects a broader truth about AI in medicine: it is often seemingly promising at the surface level, yet frequently lacking in the specific accuracy required for clinical application. AI’s efficacy depends entirely on the quality, completeness, and clinical specificity of the data it has been trained on — and current models still have meaningful limitations when applied to complex spinal anatomy and pathology.

Where AI shows real promise in spine surgery is in the data-driven domains: surgical planning tools that use CT-based anatomical modeling, alignment planning algorithms that incorporate large normative datasets, and predictive models for complication risk. Where it continues to fall short is in tasks requiring clinical judgment, nuanced interpretation of imaging, and the kind of pattern recognition built from years of operative experience.

AI-generated image of a spine showing anatomical inaccuracies
An AI-generated spine image — recognizable at first glance, but anatomically imprecise in the details.

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 incorporates validated AI-assisted planning tools into complex deformity surgery while remaining a proponent of critical, evidence-based evaluation of new technologies. 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.