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27 March 2011

Is Trading "Deformity for Dysfunction" a Good Deal?

Many people choose surgery because they just want their worries about scoliosis to be over. However, scoliosis surgery is not the final solution; merely an irreversible one. Scoliosis can continue to get worse even after spinal fusion, and over 20% of patients require more than one operation.15,16 Furthermore, 40% of patients are legally disabled 16 years after the procedure.17

Long-term evidence suggests that living with a fused spine may be worse than living with a curved one. 38% of patients stated that, if they had the chance to go back in time, they would not have undergone the surgery.18 76% of patients suffer from back pain after 10 years.16 After 15 years, patients report increased difficulty sitting, standing, carrying, bending at the waist, participating in sports, lying on their backs or sides, lifting, performing household chores, and driving a car.20 In every patient who undergoes spinal fusion surgery, there is a permanent loss of spinal flexibility & function.21

The documented risks of scoliosis surgery are bone fragments or instrumentation penetrating into the spinal canal; breakage of the implants; and, compression of the spinal nerves.22 This can lead to neurological deficits such as partial or total paraplegia, quadriplegia, or peripheral nerve damage - which may occur immediately after the operation, or as much as 10 years later.23

Surgery does not reduce rib deformity; instead, thoracoplasty (shaving down the ribs) or rib removal is often recommended for this purpose. This can result in a serious & permanent impairment of normal lung function, and can in fact cause the scoliotic curvature to progress.24 Even if the rib hump does improve after spinal fusion, in the majority of patients, the improvement is temporary, and eventually the situation is worse than it was before.25

The truth is, spinal surgery is an invasive and dangerous procedure, and one that should only be undertaken after all other options have been exhausted. Unfortunately, it is increasingly being recommended as the first resort for children with progressive scoliosis and adults with painful scoliosis. Once done, it cannot be undone; to operate or not is an important decision, and all factors should be considered carefully before committing to spinal fusion surgery.26


15) Danielsson, AJ, Nachemson, AL. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine 2001; 26:516.
16) Connolly PJ, Von Schroeder HP, Johnson GE, Kostuik JP. Adolescent idiopathic scoliosis (AIS): long-term effect of instrumentation extending to the lumbar spine. Journal of Bone and Joint Surgery 1995;77-A:1210-1216.
17) Gotze C et al: Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentantion and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002;140(5):492-498.
18) Lenke et al: Radiographic results of arthrodesis with Cotrel-Dubousset instrumentation for the treatment of adolescent idiopathic scoliosis: a five to ten year follow-up. J Bone Joint Surg Am 1998;80(6):807-814.
19) Dickson JH, Erwin WD, Rossi D. Harrington instrumentation and arthrodesis for idiopathic scoliosis; a 21-year follow-up. J Bone Joint Surg 1990;72-A:678-690.
20) Dickson JH, Erwin WD, Rossi D. Harrington instrumentation and arthrodesis for idiopathic scoliosis; a 21-year follow-up. J Bone Joint Surg 1990;72-A:678-690.
21) Moreland MS. Outcomes of scoliosis fusion - is stiff and straight better? Stud Health Tech Inform 2002;91:492-497.
22) Hawes M: Impact of spine surgery on signs & symptoms of spinal deformity. Ped Rehab 2006;9(4):318-339.
23) Rittmeister M et al: Cauda equina compression due to a laminar hook: a late complication of posterior instrumentation in scoliosis surgery. Eur Spine J 1999;8:208-210.
24) Hall JE: Spinal surgery before and after Paul Harrington. Spine 1998;23:1356-1361.
25) Weiss HR, Goodall D: Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. Scoliosis 2008;3:9.
26) Weiss et al: Adolescent idiopathic scoliosis - To operate or not? A debate article. Patient Safety in Surgery 2008;2:25.

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