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27 March 2011

Scoliosis Surgery - Medically Necessary or High Invasive Cosmetic Procedure?

The common approach and reasoning behind prescribing scoliosis surgery is questionable at best. The current system relies on a single measurement called a Cobb angle in order to justify a highly invasive, life altering scoliosis surgery that cost upwards of $250,000-$350,000. In a time where even the most basic of health care services are on the verge of being rationed.

The reasoning and justification for scoliosis surgery is often based on the "assumption" that if scoliosis surgery isn't performed the patient could have (not necessarily will have) problems with their pulmonary system (ability to breathe). This is a flawed logic, because it is known that life-threatening pulmonary scoliosis is extremely rare (in the absence of co-morbitities) if the severe curvature developed after the age of 5 years old (severe scoliosis could cause a heart/lung condition called Cor Pulmonale if the lung volume is compromised prior to full development which is complete by the age 5 in virtually all children). In fact, every single study on scoliosis surgery clearly shows the procedure does NOT improve lung function and can even significantly decrease lung function for up to 2 years post scoliosis surgery.

Chronic pain is another common justification for scoliosis surgery does not eliminate pain. Pain is not an indication for scoliosis surgery and many studies find that many patients are actually in more pain 3-5 years post op than pre-op. Don't believe me? Check out what I dub "the most unhappy place on earth" which is the scoliosis surgery revision section of the National Scoliosis Foundation Scoliosis Forum.

Many adult scoliosis patients exhibit signs and symptoms of decreasing quality of life measures, but all of the research shows scoliosis surgery does not improve quality of life. In fact, when asked if scoliosis surgery benefits the patient researcher Berven stated in the September 2007 SPINE Journal "there are no current, definitive studies that answer the question posed above." Which is odd, because a 17 year post scoliosis surgery follow-up study found 40% of the post scoliosis surgery patients were legally defined as "severely handicapped". This is in sharp contrast with the 50 year follow up study of un-treated scoliosis patients who seemed to have an significantly increased quality of life than many of the post scoliosis surgery patients.

All to often scoliosis surgery is considered as a last ditch effort to halt curve progression, but a closer examination of the data shows scoliosis surgery does not necessarily halt curve progression in adulthood. The average curve progression rate in adults with un-treated idiopathic scoliosis is 1-3 degrees a year. Post scoliosis surgery studies indicate a rate of curve progression in post scoliosis surgery adults at Initial average loss of correction post scoliosis surgery is 3.2 degrees the first year, 6.5 degrees after two years, and 1.0 degrees every year after that of the course of the patient's life.

I believe Dr. Paul Harrington, known for inventing the scoliosis surgery that implants metal rods in scoliotic spines, stated in 1963, "metal does not cure the disease of scoliosis, which is a condition involving much more than the spinal column".

I highly encourage every scoliosis patient whom is considering any scoliosis spine treatment to dig deep into the research available (both pro and con), ask your doctor as many questions as you can think of, and have your x-rays read by at least 2 radiologist (non-surgeons), because they are unbias and the cobb angle measurement (used to determine the "need" for scoliosis surgery for some reason) has a inter-examiner measurement error of /-5-10 degrees.

Everyone has the right to make a truly informed decision.

1 comment:

Dr Stitzel said...

Hi Dr. Lau,

Thank you for embracing and promoting many of the articles I have written on scoliosis surgery. Keep up the great work.

Clayton J. Stitzel DC

Genetic Pre-disposition + Environmental Influences = Idiopathic Scoliosis

Metaphorically, it could be described in terms of toothpaste being squeezed out of a tube.(Pictured below) The genetic pre-disposition would be the equivalent of how tightly the cap is screwed on; The environmental influence is how hard the hand is squeezing the tube; and the amount of toothpaste being ejected out of the tube is the resulting combination of both the cap tightness and the pressure from the squeezing hand.

Armed with this basic understanding of scoliosis of spine, it is readily apparent that one must alter either the patients genetic pre-disposition and/or eliminate the environmental influences prior the curvature becoming progressive and bio-mechanically driven.

Find out more about environmental risk factors at