Literature Addressing Surgical Correction of Scoliosis

The majority of the scoliosis cases treated by the Scoliosis Correction Centers are patients for whom bracing has failed and/or who do not want surgery. A significant percentage of the scoliosis cases that have been reduced and stabilized have been above the 35-40 degree level.

Literature Addressing Surgical Correction of Scoliosis

A retrospective review of the surgical correction of scoliosis was completed and published in Scoliosisin June of 2012. (See, CD Instrumentation for the Correction of Adolescent Idiopathic Scoliosis; Long Term Results with an Unexpected High Revision Rate, Mueller and Gluch, Scoliosis, 2012, 7:13. Exhibit __). This peer-reviewed article notes that, while Cotrel-Dubousset (CD) instrumentation (double rod instrumentation) has been regarded as the standard device for surgical correction of AIS, scientific long-term results on the procedure are lacking. The authors conducted a retrospective follow-up study of patients treated for AIS with this procedure. They found, based on radiological follow-up at 57.4 months post-surgery, an average loss of correction of 9.6 degrees (main curve) and 4.6 degrees (secondary curve). At an average of 45.7 months, 19 out of 40 patients (47.5%) required late operative revisions. The primary reason was late infection with the development of fistulae or putrid secretion. Average time until revision was 35.5 months after surgery. Also, complete implant removal was necessary in 8 out of 40 patients (20%) for late operative site pain. Altogether, only 22 out of 40 CD instrumentations (55%) were still in situ. This study documented, for the first time, a very high revision rate in patients with AIS treated with CD instrumentation. Nearly half of the instrumentation had to be removed due to late infection and/or pain.

This data is not generally discussed with patients and their families at the time surgical intervention is medically determined to be the one and only solution to their idiopathic scoliosis diagnosis. The statistical information noted should be addressed before any decision to proceed with spinal surgery is consented to. It is common in my practice to have patients tell me that when initially discussing the surgery for themselves or their child, they asked the orthopedic surgeon if normal activities of daily living would be expected after the surgical procedure is healed. They were told in the vast majority of cases that in fact yes their child or they themselves would be able to return to their normal life and participate in all manner of previous activities.

The reality is oftentimes quite different. Assuming that you are one of the ‘lucky’ ones in the 55% category that did not require late operative revisions, some of the long term considerations that can interfere with your ability to enjoy life are ‘flat back Syndrome’ in which the surgical rods have extended into the lumbar spine (lower back usually if a double ‘S’ scoliosis) whereupon you will not be able to swim easily since the normal lumbar ‘lordosis’ is absent. The normal curve in the lower back lumbar region is curved forward in a reverse ‘C’ shape. This contributes to your ability to swim in conjunction with your legs. When this normal curve has been fused, the intersegmental motions are disrupted. In an article entitled ‘Review of over 250 PubMed articles, Rate of Complications in Scoliosis Surgery-a systemic review of the Pub Med literature’ Winter et al. [59] argues that ‘it has long been a clinical observation by surgeons who manage scoliosis that patients seem to function well and be relatively unaware of the spinal stiffness, even after many motion segments have been fused’. No data in support of this observation is provided.

Just as today medical science is recognizing that the appendix and tonsils are not useless appendages as thought for most of the Twentieth Century, but serve as immune response organs which are vital parts of the human body, similarly removing parts of the normal spinal biomechanics in fusion of these segments, can and does cause adverse health considerations over the long haul.

It is time to look outside of the ‘standard Medical Tool Box’ when it comes to scoliosis and surgery. Once it’s done there is no ‘going back’. The idea that the human body will not ‘react’ to the implantation of any metal rods inserted in all or part of the length of a spinal column with the implantation of nuts, screws, bolts, metal surgical wires and not ‘reject’ this in toto or in part is incongruous with nature and the human organism.