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 $150,000 per operation ². 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 levels ³. 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 three. After the operation is performed, the average patient suffers a 25% reduction in their spinal ranges of motion. Non-fused adult scoliosis patients do not have this same impairment. This flatly contradicts the claim that having a steel, stainless steel or titanium 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 scoliosis surgery 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.
Consider the titles & conclusions of the following Scoliosis studies:
Treating Scoliosis in Young Unneeded
Journal of the American Medical Association (JAMA), Stuart Weinstein, MD, University of Iowa, 2003.
“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
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.”
WATCH & WAIT – RECIPE FOR FUTURE TROUBLE!
The medical model as discussed is when the initial diagnosis is made for Scoliosis, and the patient is asked to return in several months for another set of x-rays. If there is progression of the disease, bracing or just waiting is usually prescribed, with the advice to return once again for re-evaluation generally within 4-6 months.
Upon the next set of x-rays if there is additional progression of the Cobb Angle, at least above 30 degrees, surgery is recommended or future surgery is given serious consideration if progression persists.
Here is what can happen when proper non-surgical treatment is not started early at the appropriate time: Although it is rare to have a complete set of spinal x-rays going back to a patient’s early years, we are fortunate to have such a case.
At age 13, as noted on x-ray on the right, the patient had Cobb Angles (scoliotic curves) of 23 degrees upper thoracic Cobb Angle and 26 degrees lower lumbar Cobb Angle. At this time the patient was advised to do nothing and come back in a few years. Note that this patient had no pain at all.
As seen on x-rays on left, at age 16 the patient’s Cobb Angles increased to 52 degrees upper thoracic Cobb Angle and 55 degrees lower lumbo-dorsal Cobb Angle. At this point a hard plastic brace was prescribed. This brace was to be worn 23 hours per day. The patientwore the brace for 24 months faithfully. When the brace was removed new x-rays were taken showing 55 upper Cobb Angle and 55 lower Cobb Angle. The brace did prevent significant progression (no reduction or correction); however as you will see once the brace is removed, in many cases the scoliosis rapidly progresses.
At age 34 the x-rays on the right reveal Cobb angles increased to 60 and 63 degrees respectively. What is important to note is that up until now this patient continued to have no ‘symptoms‘, i.e. no pain as well as no problems with lungs or heart.
The x-rays to the left, were taken at age 48, showing a lumbo-dorsal Cobb Angle of 82 degrees. At this point back pain and internal organ problems were present. Surgery was highly recommended.
The most recent x-rays (on the right) taken only a few months ago show a lumbo-dorsal Cobb Angle over 100 degrees.
For the past couple of years the patient noticed some breathing difficulties as well as stating “I feel like my body is being compressed and my ribs and pelvis are almost touching”!
Early detection and optimal non-surgical correction of Scoliosis is very important.Don’t wait!
WATCH & WAIT – RECIPE FOR FUTURE TROUBLE!
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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:
- 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.
- 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.
After & Before of 55 yr old patient
Typical Scoliosis Posture
(right head tilt, left upper cervical angle, left lower cervical angle, right high shoulder, right dorsal-upper dorsal angle, right dorsal-lower dorsal & lumbo-dorsal angle, left lumbo-sacral angle, right hip anterior & superior, left hip posterior & inferior. Also forward head posture, superior optical orbits, left dominant eye)
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 exercisescan 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.
- Idiopathic Scoliosis: long-term follow-up & prognosis in untreated patients J Bone Joint Surg Am 1981 Jun;63(5):702-12
- The estimated cost of school scoliosis screening Spine 2000 Sep 15;25(18):2387-91 Yawn & Yawn
- Radiologic findings and curve progression 22 years after treatment for AIS Spine 2001 Mar 1;26(5):516-25
- Corrosion of spinal implants retrieved from patients with scoliosis J Orthop Sci 2005;10(2):200-5
- The Effect of Scoliosis Fusion Surgery on Spinal Ranges of Motion: a Comparison of Fused & Nonfused Patients with Idiopathic Scoliosis Spine 2006;31(3):309-314
- The etiology of Adolescent Idiopathic Scoliosis Am J Orthop 2002 Jul;31(7):387-95
- Adolescent Idiopathic Scoliosis: the effect of brace treatment on the incidence of surgery Spine 2001 Jan 1;26(1):42-7
- Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8
- The Search for Idiopathic Scoliosis Genes Spine 2006;31(6):679-81
- The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study Spine 1994 Jul 15;19(14):1573-81
- Long-term follow-up of patients with untreated scoliosis: a study of mortality, causes of death, and symptoms Spine 1992 Sep 17;(9):1091-6
- Back pain and disability after Harrington rod fusion to the lumbar spine for scoliosis Spine 1992 Aug 17;(8 Suppl):S249-53
- Results of surgical treatment of adults with idiopathic scoliosis J Bone Joint Surg Am 1987 Jun;69(5):667-75
- Thoracic Scoliosis and restricted neck motion: a new syndrome? Eur Spine J 1998;7:155-57.
Don’t Just Watch & Wait!
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