Flexibility differences between younger and older patients who have scoliosis, and it's affect on curve correction during scoliosis surgery

We perform scoliosis and kyphosis surgery on a wide age range of people. For example, over the past 2 weeks we have treated people from 9 years old, to 75 years old.
In this video, I actually show a comparison of the spine flexibility between a 74 yo retired nurse who had surgery on Wednesday, and a 29 yo jewelry retailer yesterday.
Which one do you think ended up with the better correction?
Age alone is not the only factor.
In general, the children and adolescents are the most flexible and easily correctable, but there are exceptions, including congenital scoliosis, which is very "stiff" since there is an extra piece of bone, which acts like a wedge. This wedge can be removed in many cases, allowing for curve to be corrected.
However, there are other genetic and other factors that affect flexibility. I have treated relatively stiff teenage curves, that required some extra work to get an excellent correction. However, I have also found some 50 or even 60 yo people who had flexible curves.
Bending films, and supine films (X-Rays) can give you some indication of flexibility, as well as some observations on clinical examination.

In general, however, you do get a better scoliosis correction, and an easier recovery, with less risk if your scoliosis or kyphosis is corrected when you are younger, rather than older.

Factors that make scoliosis/kyphosis surgery "easier" in the younger group:
1. Flexibility
2. Curve size
3. Often shorter fusion needed, since long-term degeneration due to asymmetric loading does not collapse lower discs.
4. Better bone quality (less osteoporosis), which decreases chance of hardware loosening or pseudarthrosis (non-union)
5. Less medical risk (younger heart/lungs)
6. Faster recovery time
7. Less need for decompressive laminectomy surgery for stenosis, which tends to occur in older group.
8. More years to enjoy improved self-image, appearance and posture, and possible better quality of life with less pain, if pain is already an issue.
9. Fewer surgical and post-surgical complications, including wound infection, DVT, pseudarthrosis, adjacent level failure, major medical complications (stroke, MI)
10. Less stressful for surgeon!

As the spine surgeon, I always enjoy the younger scoliosis and kyphosis surgeries a bit more than the older cases, for some of the reasons above. However, the quality of life improvement that I have seen in the older group, (even up to age 96!) can be so dramatic that it is worth it to see them getting their life back, and standing up straighter, and be able to get out of some of the severe pain, and to be able to function better, and walk better.




Other big differences between the older an