Spinal deformities affect patients at every stage of life, from children born with congenital scoliosis to adults facing degenerative changes that alter posture and function. Each age group presents unique challenges, requiring surgical strategies tailored to growth, activity and long-term health. Dr. Larry Davidson, a leader in minimally invasive spinal surgery, has emphasized that age-specific planning is essential to achieving meaningful outcomes. This work reflects the principle that spinal deformity surgery must adapt to the needs of patients, rather than relying on a one-size-fits-all approach.
By comparing surgical approaches for children, teens and adults, it becomes clear that spine care develops alongside the patient. What unites these groups is the need for safe correction, but the techniques and goals differ, shaped by factors, such as bone maturity, lifestyle and comorbidities.
Childhood Deformities: Preserving Growth
Children with scoliosis or kyphosis present unique surgical challenges because their spines are still developing. Traditional fusion procedures, while effective at stabilizing curves, restrict growth and may interfere with lung and chest development. For this reason, growth-friendly approaches have become the preferred option in pediatric cases.
Expandable rods, which can be lengthened as the child grows, are central to modern pediatric scoliosis surgery. Magnetic systems now allow for adjustments in outpatient settings, reducing the need for repeated surgeries. These methods correct deformity, while preserving growth potential. Careful planning is required to balance correction with the child’s natural development. Surgeons must also account for the psychological and social impact of scoliosis, making sure that children can participate in school and activities, with minimal disruption.
Adolescence: Balancing Growth and Stability
Adolescence brings its own set of challenges. Rapid growth during puberty can accelerate curve progression, making timely intervention critical. Unlike younger children, teenagers may be closer to skeletal maturity, allowing for more definitive corrections. In adolescent idiopathic scoliosis, fusion is often considered once curves reach thresholds likely to progress. Modern techniques use rods and screws to realign the spine, while minimizing the impact on mobility.
Three-dimensional imaging and navigation improve accuracy, reducing the risks of implant misplacement. Adolescents require a careful balance between preserving remaining growth and achieving long-term stability. Patient-centered discussions are also important in this age group, as teenagers are often active participants in decisions about their care.
Adults: Addressing Degeneration and Complexity
Adult spinal deformities are often the result of degenerative changes, such as arthritis, disc collapse or osteoporosis. Unlike pediatric and adolescent cases, adult surgeries frequently involve longer fusions, more extensive corrections and strategies to reinforce weakened bone.
Dr. Larry Davidson emphasizes, “The future of spinal fracture surgery lies not only in what we do in the operating room, but in how we guide the patient from diagnosis through recovery and prevention. It’s a full spectrum of care.” This perspective aligns seamlessly with the unique needs of adult patients, underscoring that true success depends on holistic strategies that extend beyond surgical correction, to long-term health and independence.
Osteoporosis complicates fixation. Choosing screws, rods and grafts is critical. Cement augmentation and expandable screws are often used to improve stability in fragile bone. Revision surgeries are also more common in adults, as prior operations or degenerative progression may create complex anatomical challenges. For adults, surgical goals extend beyond alignment, to include pain reduction, nerve decompression and improved mobility. Quality of life, rather than cosmetic appearance, is often the primary concern for older patients.
Rehabilitation and Recovery at Different Ages
Recovery after deformity surgery varies by age. Children often adapt quickly, supported by their natural resilience and shorter healing times. Rehabilitation focuses on mobility and participation in normal activities. Teenagers may face emotional challenges, as they adjust to their new posture and restrictions during recovery. Physical therapy supports not only physical healing but also confidence, as they return to sports and school.
Adults generally face longer recovery periods, influenced by comorbidities and bone health. Rehabilitation in this group emphasizes pain management, strengthening and strategies for maintaining independence. Rehabilitation is not secondary but central to successful outcomes, with programs designed to match the needs of each patient group.
Athletes Across the Lifespan
Athletes of all ages face special considerations. Pediatric and adolescent athletes may require surgical strategies that support ongoing growth and performance, while adult athletes often focus on returning to activity safely, despite degenerative changes. For younger athletes, minimally invasive approaches and growth-friendly systems reduce downtime and protect performance potential. For adults, careful fusion planning and rehabilitation strategies preserve mobility, while supporting a return to recreational or competitive activity.
Training Surgeons for Age-Specific Care
Preparing surgeons to handle deformity surgery across the lifespan requires diverse training. Simulation labs replicate pediatric and adult cases, allowing trainees to practice a range of techniques. Mentorship further reinforces the importance of tailoring approaches to age and patient goals. By providing trainees with experience across the full range of deformity cases, surgical education prepares new surgeons to address the unique challenges of each age group with skill and confidence.
Patients as Partners in Care
Shared decision-making is essential in deformity care, but it looks different across age groups. Parents are heavily involved in pediatric cases, while adolescents often want direct input in decisions about their bodies. Adults must weigh surgical risks against expected improvements in quality of life. Involving patients and their families in these discussions helps align outcomes with individual goals, building trust and enhancing satisfaction at every stage of care.
Research continues to refine deformity surgery for every age group. Advances in biologics, patient-specific implants and robotics promise safer and more effective corrections for children, teens and adults. Growth-friendly technologies may expand further, while regenerative treatments hold potential for addressing degenerative deformities in older patients.
Spinal deformity surgery is a continuum of care that evolves throughout life. Children often require growth-preserving techniques, adolescents benefit from strategies that support ongoing development, and adults need durable corrections that address pain and degeneration. Emphasizing age-specific planning highlights the importance of tailoring surgery to each patient. This approach represents the future of deformity care, adapting to every stage of life to help patients achieve lasting improvements in health and quality of life.
