When is Scoliosis Surgery Necessary?
To date, the bulk of the information you will find related to Adolescent Idiopathic Scoliosis (AIS) on the Internet supports the use of scoliosis bracing and scoliosis surgery. Initially, treatment from a medical doctor consists of "observation only", until the Cobb angle progresses to 25 degrees, at which point the patient is placed in a scoliosis brace. When back bracing is unsuccessful in stabilizing the progression of the disease, which is frequently the case, scoliosis surgery is the only other option that the traditional scoliosis treatment approach has to offer.
Due to the complicated nature of idiopathic scoliosis and the difficulty in understanding and treating this condition, the development of a surgical method of treating idiopathic scoliosis by Dr. Harrington was understandable. However, science, & long term research agree that this procedure does not cure idiopathic scoliosis, but rather replaces one deformity (a flexible, curved spine) with another (a straighter, fused spine).
Are Today's Scoliosis Surgery Procedures Better and Safer?
"No long-term, prospective controlled studies exist to support the hypothesis that surgical intervention for adolescent idiopathic scoliosis is superior to natural history. There is no medical necessity for surgery based upon current research adn the majority of medical opinions. (1)"
Are scoliosis surgeries worth the money/cost and long-term complication risks? This question was discussed by the Department of Orthopedic Surgery at the University of Pittsburgh Children's Hospital in a paper presented at the 2009 annual meeting of the Pediatric Orthopedic Society of North America in Boston. The paper was recently accepted by the Journal of Pediatric Orthopedics.
In this paper, the researchers questioned whether the newer, more expensive systems of spine fusion used to treat scoliosis today justify their higher price tags with better outcomes for the patient. Their conclusion is definitive:
"Unfortunately, patient outcomes when the latest, most expensive implants are used are not significantly different from outcomes when older, less expensive implants are used. Patient outcomes have not improved in proportion to the increase in costs. Outcomes from the newest, all pedicle screw constructs are not significantly better than outcomes from the older, less expensive hybrid constructs."
This conclusion confirms what other research articles have suggested previously; newer methods of scoliosis (spinal fusion) surgery do not necessarily offer substantially improved outcomes than the older systems which have reported failure rates as high as 40% in some long-term studies. (2) Regardless of the surgical procedure used the end result is the same: the normal bio-mechanical function of the spine is destroyed and rather than achieving a true resolution of the condition, deformity is traded for massive dysfunction and often, chronic pain.
Spinal fusion for scoliosis, regardless of the system used, is not supported by research or medical necessity.
- (Westrick ER & Ward WT: Adolescent idiopathic scoliosis: 5-year to 20-year evidence-based surgical results. J Pediatr Orthop 2011 Jan-Feb;31(1 Suppl):S61-8.
- Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8
A majority of people we see, who have been treated with scoliosis surgery, report after the operation that their pain levels either stayed the same or worsened, leading to long term use of stronger and stronger pain medication. "On average, 16 years after surgery, 40% of post spinal surgery scoliosis patients are permanently handicapped for the rest of their lives" (Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Gotze C, Slomka A, Gotze HG, Potsl W, Liljenqvist U, Stienbeck J. Z Orthop Ihre Grensgeb 2002 Sep-Oct, 140(5): 492-8).
We believe that surgery for scoliosis, while potentially necessary at times for very large spinal curvatures, is only symptomatic/cosmetic procedure for a much more complex condition. Hardware failure does occur, and poses a very serious health risk for the patient and results in the obvious need for further scoliosis surgery. Furthermore, after looking at the hardware removed from patients, it has been revealed that two out of three demonstrate significant corrosion, (Corrosion of spinal implants retrieved from patients with idiopathic scoliosis. Akazawa T, Minami S, Takahashi K, Hanawa T, Moriya H. Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan. J Orthop Sci. 2005; 10(2):200-5. "Corrosion was seen on many of the rod junctions (66.2%) after long term implantation"), which can cause heavy metal toxicity, depression of the immune response, and chronic inflammation.
After understanding these facts and considering the other complications involved with this procedure, you can see why we believe that scoliosis surgery should be a last resort for
the treatment of idiopathic scoliosis, to be considered only after every other non-invasive treatment option has been thoroughly exhausted.
"The current trend for management of these curves is early surgical spinal fusion for scoliosis, the rationale being the ineffectiveness of back bracing in preventing the progression of such a large curve and the difficulty in obtaining satisfactory correction by postponing scoliosis surgery to a later date. On the basis of our results, we propose a conservative line of management for these curves, in contrast with current views, rather than to rush into a major spinal surgery. If the curve progresses, scoliosis surgery can always be considered later, keeping in mind the excellent correction obtained with the pedicle screw systems even for large curves of 70 to 100 degrees."
~ A large adolescent idiopathic scoliosis curve in a skeletally immature patient: is early surgery the correct approach? Overview of available evidence.
Telang SS, Suh SW, Song HR, Vaidya SV. Department of orthopedics, Korea University, Guro Hospital, Guro-Dong, Guro-Gu, Seoul, Korea.
J Spinal Disord Tech. 2006 Oct;19(7):534-40.
"Correction of scoliosis (scoliosis fusion surgery) is largely an elective cosmetic procedure in the young population, who account for the largest portion of the scoliosis surgery population. Associated with the correction, however, is a very real possibility of major neurological injury, including paralysis."
~Tod B. Sloan MD, PhD
Anesthesiology Clinics of North America
Volume 15, Issue 3, 1 September 1997, Pages 573-592