How Effective is Scoliosis Surgery?

How effective is surgery for treating scoliosis anyway? Admittedly, it is a question with very subjective set of answers, so I thought it would be interesting to compare the benefits of surgical correction for scoliosis against the SOSORT rankings of most important scoliosis treatment outcomes.

Ranking Importance of factors in scoliosis according to SOSORT

1. Aesthetics ( I guess, if you don’t count the big scar going down the entire length of the patient’s back…cosmetic improvement IS the only indication for scoliosis surgery…”Correction of scoliosis is largely an elective cosmetic procedure in the young population, who account for the largest portion of the surgical population. Associated with the correction, however, is a very real possibility of major neurological injury, including paralysis.”)
SCOLIOSIS SURGERY: APPROPRIATE MONITORING. Tod B. Sloan MD, PhD. Anesthesiology Clinics of North America
Volume 15, Issue 3, 1 September 1997, Pages 573-592

2. Quality of life (Nope. Not with 40% of patients being legally defined as severely handicapped with in 17 years post surgery.)
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

3. Psychological well-being (Nope. “The psychological health status is significantly impaired.”)
Quality of Life and Back Pain: Outcome 16.7 Years After Harrington Instrumentation
Spine 2002 Jul 1;27 (13) :1456-63 Gotze et al, Dept. of O Surg, Hamm,Germany

4. Disability (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons”
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 instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

5. Back Pain (Nope. “Standardized gradations of pain and function showed improvement over-all, but significant impairment remained. There was a reduction in the levels of peak and constant pain, but no change in the frequency of peak pain after operation. The number of patients who were pain-free after surgery was not increased…..In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to patients before the procedure is undertaken.”)
Results of surgical treatment of adults with idiopathic scoliosis.
J Bone Joint Surg Am 1987 Jun;69(5):667-75
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.

6. Rib hump (Potentially, some cases may require an additional rib resection surgery though….not a small procedure.)

7. Breathing function (Nope. “The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.”)
Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation. Int Orthop 2001;25(2):66-0

8. Progression in adulthood (Nope. “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.”)

9. Needs of further treatments in adulthood (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons” )
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 instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

10 Knowledge and understanding of scoliosis in general and their specific pattern (Nope.)

11 Balance (Unknown, but probably not)

12 Scoliosis Cobb degrees (radiographic lateral flexion) (Yep)

13 Self control of posture (Nope.)

14 Movement of the vertebral column (sagittal plane) (Definitely NOPE)

15 Perdriolle degrees (radiographic rotation) (Yep, but to a lesser extent than cobb angle)

16 Kypho-lordosis Cobb degrees (radiographic lateral alignment) (Yep)

17 Sensory motor integration of the corrective ideal pattern (Nope)

18 Exercise efficiency (Nope.)

19 Equality of weight bearing (Perhaps a little?)

20 Improved body motor awareness and motor learning skills (Nope.)

21 Improved processing of vestibular input (Nope.)

Final total:

5 total positive outcome measures achieved.

14 total Negative outcome measures achieved.

2 unknown outcome measures

Overall: We need a better way!