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X-Ray Showing broken Harrington Rod
Scoliosis
Surgery: the Untold Truth
Scoliosis
Correction questions?
Email:
scoliosiscorrection@gmail.com
or
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Dr. Hersh: 860-499-0433 or 860-727-8820
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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.
Surgery or Alternative Treatment: Dr. Hersh explains your
choices.
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
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.”
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
patient wore 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!
Good Questions & Honest Answers about Scoliosis
You may contact
Dr. Hersh by email:
ScoliosisCorrection@gmail.com
 
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.
Before
Treatment After Treatment
Before
After
Before
After
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 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.
Works Cited
- 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.
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