What are the indications and options for surgical treatment

There is no absolute minimum age at which to consider spinal surgery. In general, operative treatment is considered when progressive curves exceed 40° or when patients develop trunk decompensation. Earlier surgical treatment is advised for patients with Duchenne's muscular dystrophy (when curves reach 20°) due to predictable pulmonary deterioration associated with further curve progression. It is not necessary to delay surgery until skeletal maturity. Curves up to 90° are most commonly treated with posterior spinal instrumentation and fusion. Curves exceeding 90° or curves with severe stiffness are considered for more complex procedures. Anterior release and anterior fusion or posterior-based osteomies/vertebral resection in combination with posterior spinal instrumentation and fusion are options for surgical treatment of severe curves.

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