When faced with a diagnosis of complex scoliosis, patients and families often begin an intensive search for the best surgical approach. For those with a double major curve, the challenge is amplified, as two significant curves in the spine require precise, specialized correction.
At The Advanced Spine Center in New Jersey, we focus on advanced, motion-sparing, and minimally invasive techniques to treat complex deformities. We believe that correcting the curve shouldn’t necessarily mean sacrificing all spinal movement, and spinal fusion is not your only option.
Understanding Your Double Major Curve Diagnosis
Double major curve scoliosis, also called “S-shaped scoliosis”, represents one of the most complex spinal deformities there is. This condition involves two significant structural curves, typically a primary thoracic curve in the upper back and a secondary lumbar or thoracolumbar curve in the lower back. When viewed from behind, these two curves create the characteristic “S-shape” that distinguishes this pattern from simpler, single-curve scoliosis.
What makes double major curves particularly challenging is that both curves are structural, meaning they don’t fully correct when you bend to the side. This is an important distinction. In some scoliosis cases, patients have one true structural curve and a second, more flexible curve that develops as the body’s way of keeping the head centered over the pelvis—essentially a balancing mechanism. These secondary curves are called compensatory curves, and they’re often less rigid than the primary curve. In double major curve scoliosis, however, both curves are rigid and structural. This means both curves require surgical correction, as neither will self-correct once the other is treated. This dual requirement makes treatment planning more complex and demands greater surgical expertise than treating a single structural curve with a flexible compensatory curve.
Traditional surgical approaches for double major curve scoliosis have historically been quite extensive, often requiring long spinal fusions that sacrifice significant mobility. However, advances in spine surgery have created specialized, less-invasive correction techniques that can address both curves while preserving spinal function. Understanding why your specific curve pattern requires this specialized approach is the first step toward exploring innovative surgical options that weren’t available to previous generations of scoliosis patients.
Candidates for Double Major Curve Scoliosis Correction Surgery
Not every patient with double major curve scoliosis is a candidate for fusionless or minimally invasive techniques. Your eligibility depends on several key factors that your spine surgeon evaluates during your initial consultation.
Age and remaining growth potential are critical factors. Younger patients who are still growing are often ideal candidates for Vertebral Body Tethering, which uses that growth to gradually straighten the spine. Your doctor assesses your skeletal maturity using X-rays and a scoring system called the Risser score. Patients with significant growth remaining can benefit from fusionless approaches, while those who have finished growing may still be excellent candidates for minimally invasive fusion techniques.
Curve flexibility also plays an important role. During your evaluation, we take special bending X-rays to see how much your curves move. More flexible curves typically respond better to less invasive correction techniques. We also consider the size and location of your curves, using classification systems that help us create a surgical plan tailored to your specific anatomy.
Our spine specialists conduct comprehensive evaluations that include a detailed physical examination, complete imaging studies, and a thorough review of your medical history to determine whether you’re a candidate for advanced surgical options that can preserve your spinal mobility while achieving excellent correction.
Vertebral Body Tethering for Double Major Curves
Vertebral Body Tethering (VBT) for double major curve scoliosis represents a revolutionary approach to treating complex spinal deformities. This innovative technique uses your body’s remaining growth potential to gradually correct both curves without fusing the spine—a significant departure from traditional surgical approaches.
During the VBT procedure, your surgeon places a strong, flexible cord along the outer side of each curve and anchors it to the vertebrae with small screws. As you continue to grow after surgery, the tethered side of the spine experiences controlled compression, while the inner side of each curve grows more freely. This difference in growth gradually straightens both curves over the months and years following surgery. It is a fusionless surgical option that corrects the curve without requiring the permanent rigidity of spinal fusion.
What makes Vertebral Body Tethering particularly effective for double major curve scoliosis is its ability to address both deformities simultaneously. By placing tethers along both curve patterns, surgeons can achieve balanced correction while maintaining your spine’s natural alignment. The surgical team carefully calculates the tension and screw placement for each level to ensure both curves correct proportionally over time. This approach requires exceptional surgical expertise, especially when managing two major curves at once. The surgeon must anticipate how each curve will respond and plan the procedure to achieve harmonious correction of both curves simultaneously.
The Benefits of Preserving Spinal Flexibility With Vertebral Body Tethering
One of the most compelling advantages of Vertebral Body Tethering is what it preserves: your spinal flexibility and natural range of motion. Because the procedure doesn’t fuse vertebrae together, you maintain motion in the treated areas.
Beyond motion preservation, the minimally invasive technique offers additional advantages. Surgeons perform VBT through small incisions using a camera and specialized instruments, avoiding the large cuts and muscle disruption of traditional open surgery. This approach typically means less pain after surgery, smaller scars, reduced blood loss, and shorter hospital stays
Minimally Invasive Fusion Surgery for Double Major Curve Scoliosis
For patients who are not Vertebral Body Tethering candidates, whether due to skeletal maturity, rigid curve characteristics, or other factors, there are minimally invasive fusion techniques that dramatically reduce surgical trauma compared to traditional open procedures. These advanced methods achieve the same excellent curve correction as traditional surgery while minimizing disruption to the muscles, tissues, and structures surrounding your spine:
- Anterior Minimally Invasive Approaches: Accessing the spine from the front through small incisions, which is highly effective for correcting the sagittal alignment (side profile) of the curves, particularly in the lower spine.
- Lateral Minimally Invasive Approaches: Accessing the lumbar spine from the side, which is often advantageous for correcting certain complex lumbar curve patterns found in double major scoliosis.
- Percutaneous Techniques (for Posterior Instrumentation): Placing screws and rods through tiny incisions using advanced navigation technology. This allows surgeons to stabilize and correct the spine with less trauma, even when fusion of the thoracic or lumbar segments is required.
The Benefits of Minimally Invasive Fusion Surgery for Double Major Curve Scoliosis
Minimally invasive fusion surgery approaches are designed to achieve excellent correction of both curves while minimizing surgical trauma, blood loss, and scarring, fundamentally changing the recovery experience.
The primary benefit is reduced muscle and tissue trauma. Unlike traditional open fusion, which requires detaching muscles from the spine, minimally invasive fusion surgery approaches utilize very small incisions and small tubes or ports to access the area. This reduced trauma directly translates to a faster recovery, as patients experience less pain and can become mobile sooner after surgery.
Furthermore, minimally invasive fusion surgery can create better surgical safety and aesthetic outcomes. The smaller incisions lead to reduced blood loss and a lower overall risk of surgical site infection, which are major considerations in complex spinal procedures. Additionally, for patients concerned with the visual impact of surgery, minimally invasive techniques replace a single, long midline scar with several small, strategically placed incisions, resulting in excellent cosmetic results and improved body image after the complex correction is achieved.
Know Your Surgical Options for Double Major Curve Scoliosis Care in New Jersey
At The Advanced Spine Center, complex spine surgery isn’t just something we do—it’s all we do. Our entire practice is dedicated to treating advanced spine conditions and complications that require the highest level of surgical expertise. This focus allows our team to refine techniques, develop specialized protocols, and accumulate the extensive experience necessary to achieve optimal outcomes in the most challenging cases.
If you or your child has been diagnosed with double major curve scoliosis, you have surgical options. The Advanced Spine Center offers comprehensive evaluations to determine whether you’re a candidate for Vertebral Body Tethering, minimally invasive correction, or other advanced surgical techniques that may preserve more function than conventional approaches.
Contact The Advanced Spine Center today to schedule your consultation and let our expertise in complex spinal deformities guide you toward the best possible outcome for your double major curve scoliosis.