Institute for Spine and Scoliosis

Institute for Spine and Scoliosis Anterior Scoliosis Correction Dedicated to the practice of spine surgery, renowned spine and scolios

The Institute for Spine & Scoliosis strives to offer the latest techniques and improvements in spinal surgery, developing new, less invasive and motion sparing treatment options for scoliosis, spondylolisthesis, herniated disk or stenosis, especially in the still-growing spine. Specializing in Spinal Surgery Treatments such as Anterior Scoliosis Correction (ASC). Your child’s scoliosis (for curvatures over 35 degrees) could benefit from

10/13/2025

QUESTION: We know with fusion, some of the muscles in the back get destroyed. With ASC, does any of the muscles in the abdomen get damaged? If so, which ones usually get affected?

👉 So there's a big distinction between that comment, meaning with fusion, you're really kind of destroying the muscles of the back on purpose.

But they're not needed because the metal rods are in place and you're not moving. So you basically end up with fibrotic muscle scarred. For the ASC surgery, this is an abdominal approach or a thoracic approach where you're splitting the muscles to get into the abdomen, just like you would be doing if you were doing another abdominal type of surgery.

So we're very particular about how we don't cut the muscle. We split the muscle to work between it. That would be like if I was working on my arm bone and I needed to get through the biceps muscle, I'm not cutting the muscle.

I'm going to split the muscle to get down to the bone. So that minimizes damage. It also minimizes injuries to the nerves that supply the muscle.

And so typically the muscle can rebound and get stronger again with time. But surgery is surgery and it can take a long time for these muscles to get stronger. And also with scoliosis, if you're off like this and the abdomen has been shifted, one abdominal wall is actually quite more lax than the other.

And so there's different excursions of that muscle. And when you reposition that, there may be slack in the muscle and that could take a long time to overcome and feel like it's a weak muscle, but it's actually repositional so that the actual excursions of muscles have actually changed and they need to be retoned and recored. And that's why we really promote a lot of the pilates toning, stretching, hamstring stretching, and psoas muscle strengthening.

All those things that we do with the ASC before and after the surgery.

Thank you.🙏 That was all the questions for today.

They were very good questions and we look forward to the next Q&A.


10/12/2025

Any concerns with getting an MRI post-op? No. Assuming post-op after anterior scoliosis correction with screws in place.

And that's true for most implants type surgeries where there's fixation of a metal into a bone. It doesn't move under the MRI, even though it might create some magnetism. So it's safe to have an MRI with the screws in place.



10/10/2025

What percentage of patients over 40 years of age with scoliosis, but not surgery, experience considerable back pain from their experience?

It's fairly high. And there's two types of scoliosis, right? There's the adolescent scoliosis that as you get up to 30, 40, 50 years of age, keeps progressing.

That's one type. And then there's adult degenerative scoliosis where you're 40 years old and you never had it, but your degenerative discs are settling, collapsing, and as they settle, they create a scoliosis. So that latter group is probably more painful, meaning you're 40 years old, 50 years old, you have herniated discs, it's settling, you're creating unevenness in your low back and it's not taking the loads well.

And then the adolescent ones, if you're maintaining your Pilates tone, swimming tone of your back muscles and your core, you can certainly minimize the amount of pain going throughout life, but it is a mechanical phenomenon. If I'm sitting here like this versus like this, if I sit like this for a few hours, I'm going to have pain. And that's the mechanical phenomenon of the scoliosis.

It can be diminished by doing your Pilates, toning, stretching your hamstrings and psoas muscles, and maintaining your core tone. The numbers say that as much as 60% of people over 40 may have pain with their scoliosis.




10/08/2025

“𝗪𝗵𝗮𝘁 𝗮𝗿𝗲 𝘁𝗵𝗲 𝗰𝗿𝗶𝘁𝗲𝗿𝗶𝗮 𝗯𝘆 𝗞𝗲𝗹𝗹𝘆 𝗶𝗻 𝘁𝗲𝗿𝗺𝘀 𝗼𝗳 𝗰𝘂𝗿𝘃𝗮𝘁𝘂𝗿𝗲 𝗱𝗲𝗴𝗿𝗲𝗲 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗱𝗲𝘁𝗲𝗿𝗺𝗶𝗻𝗲 𝗲𝗹𝗶𝗴𝗶𝗯𝗶𝗹𝗶𝘁𝘆 𝗳𝗼𝗿 𝘀𝘂𝗿𝗴𝗲𝗿𝘆 𝗮𝗻𝗱 𝘄𝗵𝗮𝘁 𝗶𝘀 𝘁𝗵𝗲 𝗿𝗮𝘁𝗶𝗼𝗻𝗮𝗹𝗲 𝗯𝗲𝗵𝗶𝗻𝗱 𝗶𝘁?”
It's a very good question.
It goes back decades, back in the early days of scoliosis correction from the 70s, 80s on. The measurement degree for a thoracic curve was 50 degrees where it was recommended to undergo surgery. The reason that number was chosen for metal rods back in those days was because it was well documented with longevity studies that if you're 18 years old and you have a 50 degree curve, it's going to slowly progress over your lifetime, almost a degree a year.
So it will slowly increase quite considerably. So initially that became the magic number. 15 over, you get surgery.
Over the decades as the technique improved considerably for metal rods in terms of correction, power of correction, that criteria started drifting down to 40 degrees because we could get better results, earlier results, and better outcomes by bringing it down to 40. And that's basically the number that's used today even for anterior scoliosis correction is about 40 degrees. That doesn't mean people with 35, 37 degree curves don't have some pain or this or that from their scoliosis.
But in the metal rod world for sure, you're not really recommending surgery under 40. In the ASC world, it's more of a question that can be further delineated going forward because earlier you get to the curvatures in ASC, the easier the corrections are, you're not losing your flexibility, you're actually maintaining it. So there might be a rationale for bringing that threshold down further.

09/27/2025

Rachel asked, “𝗪𝗵𝗲𝗻 𝗱𝗼𝗶𝗻𝗴 𝘁𝗵𝗲 𝗱𝗶𝘀𝗰 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝘀 𝗵𝗮𝘃𝗲 𝘆𝗼𝘂 𝗲𝘅𝗽𝗲𝗿𝗶𝗺𝗲𝗻𝘁𝗲𝗱 𝗼𝗿 𝗰𝗼𝗻𝘀𝗶𝗱𝗲𝗿𝗲𝗱 𝗶𝗻𝗷𝗲𝗰𝘁𝗶𝗻𝗴 𝗳𝗶𝗯𝗿𝗶𝗻 𝗶𝗻𝘁𝗼 𝘁𝗵𝗲 𝗱𝗶𝘀𝗰 𝗯𝗮𝘀𝗲 𝗮𝗳𝘁𝗲𝗿 𝗰𝗼𝗿𝗿𝗲𝗰𝘁𝗶𝗼𝗻 𝗶𝘀 𝘀𝗲𝘁? ”

So that question is probably coming from more of the adult chronic pain world for degenerative discs, where there are some pain management physicians injecting fibrin into the disc. At this point, there's really no great controlled studies that demonstrate its effectiveness and certainly probably does not have a role in what we do, where the release is a soft tissue release of the entire disc plus the soft contracting ligaments on the surface of the spine, which creates the scoliosis.
So probably would not consider using fibrin in this situation and would need further studies for sure before considering it.


09/10/2025

Once surgery is done, approximately how long does it take for the pain to completely go away? OK. Maricela asks, well, that just depends on such an individualized basis. So we have teenagers, for instance, that will go back to school at four weeks. We have teenagers that will go back to school at six to eight weeks. And their pain is mostly gone by six to eight-week, two-month, three-month period. But then you have patients that take several months. Then you have older adults who take six months to a year to a year and a half. So it really has to be individualized. There is no absolute number. People have different pain tolerances. They have different reactions to medicines. On average, though, what you can say is the pain typically goes away sooner than a metal rod fusion surgery, probably by a lot.

09/09/2025

Victoria asked, does post-surgery recovery get exponentially more difficult or lengthy the older you wait for surgery as an adult? Absolutely. So there's no question we can see differences between teenagers, 21 to 25, even up to 30, and then over 30. So the time course of healing, like any other injury, whether it's your shoulder, your knee, a teenager bounces back relatively quickly. In fact, I think 70% of the teenagers go back to sports within the first two months to three months. So that's longer, obviously, for an adult who is more deconditioned, has older tissue, stiffer tissue, things like that. So the process is longer, but they do well as well. But there's definitely hallmarks of time change for someone who's over 40, definitely a lot longer versus someone who is under that age. And the dividing road, though, is still big. So if you were to say, well, what would happen with that same 40-year-old with a metal rod surgery? It's even bigger, longer recovery versus the ASC surgery.

09/08/2025

Catherine asks…
I am a patient post-surgery of three years. Can you discuss additional correction and scar tissue? Yes, great question. So we learned in the very early years. So if your curves are between 40 and 70 degrees today, that's generally, in the vast majority of cases, a one and done surgery. We do the correction and you stay wet like that. In the early days, and we still deal with a lot of curves that are over 70 degrees, quite large, 80 degrees, 90 degrees. The analogy there is simply like braces on your teeth. If you have really teeth that are way over, you're migrating those teeth over. And same with such big curves and stiff curves in scoliosis. We sometimes will do that in two stages. And we did a lot more of that in the early first half of the years, 2013 to 17. We weren't even able to get the major correction the first time we had to do it in parts. Now we get really significant corrections the first time. But if you have a 90 degree curve and you get a 50% correction, which would be really great, that's still a 45 degree curve. So you wait a year and then you can go back and make an additional correction. And at that time, the reason we wait a year is because the scar tissue in the surgery of the healing inside the chest is resorbed. And there's not a lot of issues with the scar tissue. If you were to go back at four or six weeks after surgery, there's a ton of scar healing that's going on, just like any wound. Very difficult surgery. So you just wait and you stage the surgery a year later. I would say that these are the unique situations, individualized. The vast majority of 40 to 70 degree curve scoliosis, adolescent scoliosis, younger age scoliosis, mid-20s, 30s, that's all a one and done surgery with today's technique of ASC. OK. Thank you.

09/07/2025

“𝗜𝘀 𝗔𝗦𝗖 𝗮𝘃𝗮𝗶𝗹𝗮𝗯𝗹𝗲 𝗳𝗼𝗿 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗵𝗼 𝗵𝗮𝘃𝗲 𝗱𝗶𝘀𝗰 𝗵𝗲𝗿𝗻𝗶𝗮𝘁𝗶𝗼𝗻𝘀 𝘄𝗶𝘁𝗵𝗶𝗻 𝘁𝗵𝗲𝗶𝗿 𝘀𝗰𝗼𝗹𝗶𝗼𝘁𝗶𝗰 𝗰𝘂𝗿𝘃𝗲?”

Kelly asks, is ASC available for patients who have disc herniations within their scoliotic curve? So the answer on the surface is definitely yes. This actually drives home a very important point that the discs in scoliosis patients are not normal.

And I go over that a lot and a lot. But if you just think about pillows between bricks, if the bricks are canted and torqued, that pillow is shifted off to the side. And the disc is like the pillow between the bricks.

So very often when you get MRIs of scoliosis patients, the radiology reports mention lots of disc bulging, herniations, degeneration. That's all normal for a scoliosis patient. Because if you're taking an MRI through a canted disc, it's going to look degenerative.
But beyond that, the main point to drive home is that when you actually operate on those discs, they are abnormal. They're not normal. That's part of the contracture that leads to the scoliosis.

The disc is very fibrotic, very abnormal. And by doing the releases from the ASC, we're actually putting the vertebra into better position for healing. And so it's a very hard point to keep driving home.

But it's really important because the information out in the other parts of the world in the treatment of metal rod fusions, etc., is that the discs are being damaged by our releases, which is the opposite of the truth. So it's very important. But if you have a bulge or herniation, that's usually typical for scoliosis.

It can be a little bit more, if you have symptoms from a herniated disc, it's pressing on a nerve root, it's clearly extruded. There are other different types of situation, but for the vast majority, not an issue.










09/03/2025

Are progesterone birth control pills safe after the surgery? Yes. So hormones can cause lots of different things in your body, as everyone knows, and hormones can cause pain that can cause some laxity of tissues and things. But there's no real association between birth control pills and a structural spine problem.

There can be some changes in local laxity of tissues, but not really a structural change. And certainly there is no data at all looking at birth control pills with ASC surgery long-term. But you can extrapolate from other surgeries, and you can use birth control pills to manage the menstrual cycle around time of surgery.

But it does not impact the structure of a spine, per se, with scoliosis. Okay, next question. And that's it.

Thank you for joining us today and submitting those questions. We'll try to do this more often as we try to continue to promote ASC and the technique and get more people well-informed. Thank you.







09/03/2025

Will more doctors perform the surgery in the future? For sure. Absolutely. If I do my job, we continue to get the publications out and we need to start training.

So it's tied to the other question, but it's not a small job. If I go back to when I was going for a spine fellowship and training back in 1999, those fellowships were trained with, you know, I was an adult spine fellow as well as a pediatric, but learning how to do surgery from the front, the back, side. And but like I said, from 2005 onward, the scoliosis surgeons really don't do that.

They just have done the metal rod. So it requires revamping up a whole fellowship training programs to learn how to operate from the front of the spine. So it will happen.

It's going to take a lot of time and effort, and it will happen from the younger generation that's going to be coming out and being willing to change their practice patterns over the next 10 years. But we have a big job to do on that. Next question.






08/23/2025

𝗖𝗼𝘂𝗹𝗱 𝘁𝗵𝗲𝗿𝗲 𝗯𝗲 𝗻𝗼𝗻-𝗺𝘂𝘀𝗰𝘂𝗹𝗮𝗿 𝗽𝗮𝗶𝗻 𝘆𝗲𝗮𝗿𝘀 𝗮𝗳𝘁𝗲𝗿 𝘀𝘂𝗿𝗴𝗲𝗿𝘆 𝗮𝗻𝗱 𝘄𝗵𝗮𝘁❜𝘀 𝘁𝗵𝗲 𝗿𝗶𝘀𝗸?

Could there be non-muscular pain years after surgery and what's the risk? Okay, that's a great question too. So I guess the general underlying question is if I want my child, teenager, or adult to have the surgery, is it going to create pain later on? All our data suggests the opposite. So when we go back and we look at the data and we collate it and we're putting it more and more detail, we get pain scores before surgery and after.

And the majority of patients report three or four years later after surgery that their pain is actually lower than it was before surgery with the correction that we do. Now even for corrections, for instance, we have 97% success rates of getting our corrections down. Well, 97% is super, super high, great surgery.

That's not 100%, which means even for pain, there's going to be perhaps somebody who has pain later. But overall, that risk is very low. And if you compare it to the alternative, metal rod, the metal rod fusion rate for chronic pain five to 10 years out from surgery is as high as it's quoted between 17 and 60%.

Five years, 20%, 30, you know, it's a high number and it's a combination of factors. You're transitioning structures to all the movement to above or below, the junctional failure rates, all those things, no motion in your back muscles. So you also have to keep that in perspective.

What's the relative risks compared to what else is there? But there can also be a lot of other reasons I just want to touch on too. One is we don't cure scoliosis. We correct the curve where we operate.

You can still have a residual curve above or below, and you're dealing with the aging of that spine as it goes on. So that's one reason. A second reason is, and which is why we keep evolving our technique to more and more, and now for the last five years, every level being released, is that in our 2015 to 18, 19 time period, I would make a correction, you know, and so it would be from here to here if it's a double curve.

And then as VBT would do, you know, if you don't release the levels, the cord breaks and it migrates back some. Because of the technique of ASC where we released other levels, we were able to hold the curves into a non-operative curve. But that slight loss in those categories could lead to some pain.

And so of the ones I do know about online that talk about their pain from ASC surgery, I can almost always go back and define it exactly to a cord break at unreleased levels. And our data suggests that too, that with all the breakages that we do see, they're almost invariably at unreleased levels. And so there's lots of factors here that go into play.

I would say the number one reason is actually just structural change over time, not necessarily related to surgery itself. And the risk of pain from surgery itself is actually very low.






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