Overview
Complex spinal deformity — adult scoliosis, sagittal imbalance, and curves that have progressed or shifted over time — is a different kind of problem from routine degenerative spine disease. It affects how the spine, head, and pelvis line up together as a whole, not just how a single level looks on an X-ray, and it is evaluated and treated that way.
Modern deformity care starts by measuring this global alignment and then plans correction toward alignment targets specific to that patient, rather than a one-size-fits-all goal. Complex deformity and scoliosis are part of Dr. Gerlach's clinical practice at Indiana Spine Group, and this level of surgical planning is a direct extension of the spine fellowship training he completed at the University of Utah.
Treatment Options
Deformity correction is planned in stages, well before surgery begins. Imaging is used to measure the specific pattern of misalignment, and the surgical plan is built around osteotomies — controlled cuts in the bone that allow the spine to be re-shaped — and instrumented fusion where indicated, using rods and screws to hold the corrected alignment in place while the bone heals into a solid, stable construct.
This is genuinely major surgery, and Dr. Gerlach discusses that directly with every deformity patient rather than downplaying it. Recovery is a structured, months-long process: early mobility and pain management in the hospital, a gradual return to daily activities over the following weeks, and continued healing and strengthening that typically continues for several months. Patients are given that timeline honestly, up front, as part of deciding whether surgery is the right path.
Frequently Asked Questions
Am I too old for deformity surgery?
Age by itself is usually not the deciding factor. Overall health, bone quality, and how well a patient can be optimized before surgery matter more than age on its own. Dr. Gerlach evaluates each patient's health and goals individually rather than applying a strict age cutoff.
How long is recovery?
Deformity correction recovery is measured in months, not weeks. Most patients see meaningful improvement over the first three to six months, with continued gains in strength and function that can carry on for up to a year as the fusion fully matures.
Can smaller surgery work instead?
Sometimes. Not every deformity requires full correction — for some patients, a more focused decompression can relieve the symptomatic segment without addressing the entire curve. Dr. Gerlach discusses whether a smaller, targeted approach is appropriate as part of surgical planning.