The treatment of Idiopathic Adolescent Scoliosis has always been controversial and ranging from those whom recommend radical multi-level spinal fusion surgery in very young patients to those whom don't feel any treatment is required at all. Part of the confusion and varied treatment recommendations has been the lack of available research data and of course the very nature of treating a condition with an unknown cause.
Hippocrates, the father of medicine, famously (and infamously in some cases) proclaimed, "First, do no harm" which essentially translates into recommending treatment from a least invasive to most invasive manner. Good and generally heeded advice, but it still leaves quite a bit of grey area in terms of discussion of does spinal fusion surgical intervention really benefit the scoliosis patient?
The results of long-term "quality of life" studies on Scoliosis patients would suggest that patients are better off receiving absolutely no treatment than choosing surgical intervention. A long-term follow us study at the University of Iowa concluded, "Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns." (1) Whereas an approximately 17 year follow up of surgically treated patients found, "40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons" and "The psychological health status is significantly impaired."(2)
How could this happen in the age of "evidence based medicine"? How can we drive remote control cars on the surface of Mars, but can't find a non-surgical way to treat an age old condition like scoliosis of the spine? I purpose that it is due in large part to a lack of open dialog and a safe place to discuss the problems plaguing the current treatment system and the sharing of ideas that could lead us into the future. Until recently scoliosis treatment forums have been dominated by pre and post surgical treated patients with general lip service and a single chat room given to anyone searching for a non-surgical scoliosis treatment solution. A non surgical forum created to provide the over-whelming majority of scoliosis patients whom won't choose surgical intervention as a treatment choice, a place to learn, converse, and share ideas is certainly needed. A place for patients, parents, and scoliosis doctors whom dream of a better way to treat scoliosis to come together and discuss different alternative options and new ideas for treating scoliosis without the constant assault from surgical advocates claiming surgery is the only way.
Dr Brian T Dovorany
1. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV.
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
2. 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 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
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