There is no medically necessary reason for scoliosis surgery. Sounds crazy right? I mean, how could a spine that is twisted and wrapped around itself not crush the lungs, heart, intestines, liver, and/or every other organ in one's body? Well, the medical facts are clear that it somehow doesn't and won't pose a life threatening risk to the patient if the severe spinal deformity developed after the age of 5 years old because the lungs are fully mature by the age of 5 and thus the risk of developing an actual life threatening condition called "cor pulmonale" is eliminated. Believe it or not this isn't even new information. It has been common knowledge that scoliosis surgery isn't medically necessary among orthopedic surgeons for decades. Only recently has a respected scoliosis spine researcher, Dr. Hans Rudolf Weiss, come forward and published a comprehensive review of the medical necessity for scoliosis surgery. Here were his findings from this 2008 scoliosis surgery study published in the Journal of Disability and Rehabilitation.
The study found "no evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view... Until such evidence exists, there can be no medical indication for surgery. The indications for scoliosis surgery are limited for cosmetic reasons in severe cases and only if the parent and family agree with this.
The indications for this surgery are limited for cosmetic reasons in severe cases (which is a whole other debate) and ONLY if the parents and family agree with this; which in my experience they don't, because they are generally under the assumption the scoliosis surgery is medically necessary to save the patient's life; Which it isn't in cases of adolescent idiopathic scoliosis. Studies have indicated that decreased pulmonary function occurs in scoliosis above 60 degrees and this puts the scoliosis patient at higher risk for complications from their scoliosis but what they fail to mention is that studies also indicate that the fusion surgery for adolescent idiopathic scoliosis does not improve this pulmonary weakness once again removing medical necessity rationale.
So how did all of this get started anyway? Well the first scoliosis surgery was performed in 1865 (yes, that's right, the same year the civil war ended!) and it didn't go well. The post-operative results were terrible, which lead to what many experts consider to be the first recorded instance of medical surgeons disputing in print & in court, and ending in one of the most famous orthopedic lawsuits in history: Guerin vs. Malgaigne. This defamation trial ended in Malgaigne's favor (the anti- scoliosis surgery doctor).
The first American doctors performed scoliosis surgery in 1914 and the procedure was becoming relatively routine by 1941. Dr. Paul Harrington came to fame with the "Harrington Rod" scoliosis surgery in 1950's and 1960's. The blood loss from this 8-12 hour marathon surgery was huge and death of the patient was a real concern. Unfortunately the rods kept breaking and by the 1970's scoliosis surgeons began using 2 Harrington rods instead of one.
By the 1980's a new hook and pedical screw system has been developed that dramatically increased the amount of correction a surgeon could achieve, but it also dramatically increased the amount and severity of complications associated with surgery for scoliosis.
Some of the complications of scoliosis surgery include...
"Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while pneumonia, mild pleural effusion, UTI, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications."
Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation, Scoliosis. 2009 May 7;4:11.
The poor long-term results of scoliosis surgery, coupled with the significant risks of this type of surgery prompted a top orthopedic researcher to state:
"Scoliosis surgery... is a major undertaking with significant risks, and rather than reinstituting normality, replaces one abnormality (a flexible, curved spine) with another (a rigid, straighter spine)." Goldberg et al in 2001.
Dr Brian T Dovorany
Dr Clayton J Stitzel
No comments:
Post a Comment