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Scoliosis Surgery

Scoliosis Surgery : The Untold Truth

Scoliosis is estimated to affect 4.5% of the general population. In a nation of approximately 300 million people, this means that over 13 million cases of scoliosis exist, and almost 500 more are diagnosed each day – about 173,000 every year. According to some studies, the average scoliosis patient will suffer a 14-year reduction in their average life expectancy1. This means that if by some miracle we could eliminate scoliosis completely, this would add 168 million years of health and productivity to our society. Clearly this is not a minor issue, but an epidemic, and one that should be taken very seriously.

There are no scoliosis experts. If there were, there would be no scoliosis patients

Please consider all the information you get carefully, evaluate the alternatives, and then make a conscious and deliberate decision on its validity. For too long, professional jealousy and ego have dominated all facets of the healthcare profession. It is time to refocus on the real reason our profession exists – without any patients, there would be no doctors. Let us place the health and well-being of those who have been entrusted to our care before any personal considerations, and work together to find the most effective cure for every condition.

Please do not hesitate to copy and distribute the information on this page to all who might benefit from it, but under no condition should you sell it for a profit.

Every year in the United States, roughly 20,000 Harrington rod implantation surgeries are performed on patients with scoliosis, at an average cost of $120,000 per operation2. One-third of all spinal surgeries are performed on scoliosis patients. Every year, about 8,000 people who underwent this surgery in their youth for the correction of their scoliosis are legally defined as permanently disabled for the rest of their lives.

Even worse, follow-up x-rays performed upon these individuals reveal that, an average of 22 years after the surgery was performed, their scoliosis has returned to pre-operative levels3. The Harrington rods inserted into these individuals’ spines will either bend, break loose from the wires, or worse, break completely in two, necessitating further surgical intervention and removal of the rod. Once the rod is removed, corrosion (rust) is found on two out of every three4.

After the operation is performed, the average patient suffers a 25% reduction in their spinal ranges of motion5. Non-fused adult scoliosis patients do not have this same impairment. This flatly contradicts the claim that having a steel rod fused to your spine will not affect your mobility, physical activities, or quality of life. These facts are never shared with the patient prior to the surgery. Parents do not choose the Harrington rod implantation procedure because it is the best choice for their  son or daughter, but rather because they are misled into believing that it is the only choice. However, many studies suggest that the side effects of the surgery are worse than the side effects of the scoliosis itself.

“Many with curvature of spine go on to lead normal lives. Many adolescents diagnosed with spine curvatures can skip braces, surgery or other treatment without developing debilitating physical impairments, a 50 year study suggests.” 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, Potzl W, Liljenqvist U, Steinbeck J. Z Orthop Ihre Grenzgeb

2002 Sep-Oct;140(5):492-8

“CONCLUSION: Forty percent of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons 16.7 years after the surgery.”

Medical Complications in scoliosis surgery

Curr Opin Pediatr 2001 Feb;13(1):36-41

“[Complications] include the syndrome of inappropriate antidiuretic hormone, pancreatitis, superior mesenteric artery syndrome, ileus, pneumothorax, hemothorax, chylothorax and fat embolism. Urinary tract infections, wound infection and hardware failure are not addressed.” [They were not addressed because happened so often!]

Results of Surgical Treatment of Adults with Idiopathic Scoliosis

J Bone Joint Surg AM 1987 Jun;69(5) :667-75 Sponseller, Nachemson et al,“Frequency of pain was not reduced… pulmonary function did not change… 40% had minor complications, 20% had major complications, and… there was 1 death [out of 45 patients]. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to the patient.”

Corrosion of spinal implants retrieved from patients with scoliosis

Akazawa T, Minami S, Takahashi K, Kotani T, 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.” Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation Int Orthop 2001;25(2):66-0  “The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.” [e.g., whether fused in the front or back of the spine, surgery will not improve cardiopulmonary function.]

Radiologic findings and curve progression 22 years after treatment for AIS Spine

2001 Mar 1;26(5):516-25

“Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life.” [So, if a 50 degree Cobb angle is corrected by surgery to 25 degrees, it will return to its pre-operative condition of 50 degrees after roughly twenty years.]

Prospective Evaluation of Trunk Range of Motion in AIS Undergoing Spinal Fusion

Spine 2002 Jun 15;27 (12) :1346-54 Engsberg et al, Wash U, St. Louis, MO

“Whereas range of motion was reduced in the fused regions of the spine, it was also reduced in un-fused regions [emphasis added]. The lack of compensatory increase at un-fused regions contradicts current theory.” Health-related quality of life in patients with AIS; a matched follow-up at least 20 years after treatment with brace (BT) or surgery (ST)

European Spine Journal 2001; Aug; 10(4): 278-88

“49% of surgically-treated patients admitted limitation of social activities due to their back.”

NEW YORK (Reuters Health) Jan 29, 2008 – Screening for scoliosis and subsequent brace treatment appears to be of no utility in avoiding surgery, Dutch researchers report in the January issue of Pediatrics.

“We think that abolishing screening for scoliosis seems justified,” lead investigator Eveline M. Bunge told Reuters Health. This is “because of the lack of evidence that screening and/or early treatment by bracing is beneficial.” “For now, instead of screening large numbers of asymptomatic children, the appropriate approach would be to look at a child’s back when there are indications that something is wrong,” she added. Overall, 32.8% of the surgical group had been screened between the age of 11 and 14 years, compared to 43.4% of the controls. Scoliosis was detected at screening at a significantly earlier age (10.8 years) in the 43 surgical patients known to have been screened, than was the case in those whose condition was detected under different circumstances (13.4 years). Although there was no significant difference in the duration of brace treatment prior to surgery (average, 2.5 years) between these groups, screened patients had an almost threefold greater chance of being treated with a brace before surgery.

New Research on Scoliosis Surgery

Out of the scientific Journal of Pediatric Rehabilitation comes perhaps the most truthful and comprehensive study ever published on the surgical treatment of scoliosis: “Pediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even when the curvature remains stable. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, the outcome was fair or poor…. [S]uccessful surgery still does not eliminate spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood.

For most patients there is little or no improvement in pulmonary function… The rib deformity is eliminated only by rib resection which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse in patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible spinal deformities is long overdue.” [emphasis added]

Impact of spine surgery on signs and symptoms of spinal deformity.

Pediatric Rehabilitation, 2006 Oct-Dec;9(4):318-36

Hawes, M.

Paul Harrington, known for inventing the surgery that implants metal rods in scoliotic spines, stated in 1963 that, “metal does not cure the disease of scoliosis, which is a condition involving much more than the spinal column.” These x-rays show Harrington rods that bent and broke while still inside the patient’s body. Many surgeons will refuse to operate on this condition, leaving the patient with few options to alleviate their pain & suffering.

New Research, New Possibilities for Scoliosis

On September 14th, 2004, an article was published in BMC Musculoskeletal Disorders entitled, “Scoliosis treatment using a combination of manipulative and rehabilitative therapy,” by Mark Morningstar, D.C., Dennis Woggon, D.C., and Gary Lawrence, D.C. In this study, twenty-two scoliosis cases with Cobb angles ranging from 15 to 52 degrees were treated with an experimental rehabilitation protocol involving specific spinal adjustments, exercise therapy, and vibratory stimulation. Three subjects were dismissed from the study for non-compliance. After 4-6 weeks of treatment, the nineteen scoliosis patients who remained had experienced an average reduction in their Cobb angle of 62%. Individually, reduction varied from 8 to 33 degrees. None of the patients’ Cobb angles increased. The conclusion of the study was that these results warrant further testing of this new protocol. Since this study, we have attempted to understand exactly why such positive results were achieved, and our research has led us to the following theories:

1. Scoliosis is caused by a dysponesis between the motor-sensory input/output from the upper trunk to the lower. This dysponesis is in turn caused by a unilateral impairment of the spino-cerebellar loop, which is located in the area between the atlas and the first cervical vertebra. Supporting this theory is the fact that 100% of scoliosis patients have a problem with proprioception (orientation of the body in time and space), and 100% of scoliosis patients have a loss of the cervical lordosis resulting in forward head posture. Scoliosis patients are often unable to touch their chins to their chests; this is due to a flexion mal-position of C0 and C1. Correcting this subluxation restores the neuro-musculoskeletal proprioceptive function to the patient. However, the postural aspect must still be corrected for the correction of the Cobb angle to progress.

Exercise rehabilitation therapy is mandatory to reverse the scoliosis

Without patient compliance, no amount of care can help. It is necessary to retrain the postural muscles of the body. Vibratory stimulation overrides the body’s proprioceptive signals and mechanoreceptors, thus facilitating retraining of the postural muscles.

3. Cobb angles over 30 degrees cannot be reduced in the same manner as Cobb angles under 30 degrees. The muscles contract more on the convexity of the curve, rather than the concavity, as is the case with angles under 30 degrees. Normal laws of biomechanics do not apply in patients with Cobb angles of more than 30 degrees! These theories have led to the composition of a treatment protocol for scoliosis patients that, so far, has had universal success in compliant patients.

While surgery may be necessary in some cases, such as when the patient exhibits non-compliance with mandatory exercise rehabilitation protocols, this information should be encouraging to parents of children with scoliosis who are debating whether or not to schedule the Harrington rod implantation surgery for their son or daughter.

We encourage you to delay the surgery until all other non-surgical options have been exhausted

Long-term ramifications of the Harrington surgery have been so unfavorable that the new recommendations are to remove the rods after four years4. Little to nothing is known about how the build-up of scar tissue and the disruption of the spinal pathology will affect the patient in the future once the rods have been removed.

Before & After of 55 yr old patient

Recommendations for Scoliosis Treatment

One component is universally lacking in nearly all forms of scoliosis treatment today: the effect of the cervical spine in determining spinal pathology, gait, stance, and overall posture. The head controls all components of the spine below it, much like how the engine controls the direction of a train. Without regard for which direction the locomotive is heading in, how is it possible to control the boxcars behind it? The very first aspect that must be addressed in scoliosis correction is the cervical spine; specifically, correcting the forward head posture by restoring the cervical lordosis and normal ranges of motion in the cervical spine, especially between the atlas and the first cervical vertebra. Precision x-rays are mandatory; a C0-C1 flexion malposition will manifest most readily with lateral cervical views in neutral, flexion, and extension.

Follow-up x-rays should be performed roughly every three months as objective proof of improvement; should the patient’s progress plateau or regress, additional rehabilitation or alterations to the protocol may be required.

Obviously thoracic and lumbar views are necessary to measure the Cobb angle, but stay away from full-spine views! The rate of distortion is too high to allow for consistency and accuracy when comparing measurements between pre- and post- x-rays. Balance and proprioception also play an important role in the rehabilitation of the scoliotic patient. A neurological short leg will always be found at first; this imbalance should be corrected with specific spinal adjustments. Once the patient is balanced, proprioceptive retraining exercises can be prescribed to maintain the correction.

One method of reducing forward head posture and retraining postural muscles is deceptively simple: by blocking the superior half of the lens on a pair of glasses, and instructing the patient to wear them for at least twenty minutes, the postural muscles of the neck are retrained to better hold the cervical lordosis in place.

Various spinal weights may be placed on the head and/or hips to activate the weakened postural muscles. Also, whole-body vibration therapy (WBV) has been scientifically proven to be extremely effective at proprioceptive re-education. Do NOT make the mistake of trying to “push” a scoliosis out of the spine! This type of adjustment is foreign to the body, and will be resisted. Most scoliosis braces are ineffective or even harmful because they do exactly this. A scoliotic spine must be visualized and corrected three-dimensionally; the lateral curve will not reduce until the spine has been de-compressed and de-rotated. Adjusting the apex of the curve, whether into the concavity or the convexity, will inevitably make the situation worse. Traction – pulling – is far more effective because it is a subtler, gentler force, and one that is less readily resisted by the body.

Dr. Clayton Stitzel has developed a chair that incorporates cervical decompression with lateral thoracic and lumbar traction, and also addresses the rotational aspect of the scoliosis simultaneously. This passive exercise therapy can be performed by the patient at the clinic or at home.

Advanced Health & Physical Medicine | 504-C Red Banks Road, Greenville, NC | Call (252) 375-3170