surgery for scoliosis

Scoliosis SurgeryScoliosis SurgeryIs it a cure for the disease?

Dr. Clayton Stitzel, 1-866-627-3009, [email protected], http://www.treatingscoliosis.com/

Medical Scoliosis Care

Until curvatures progress to 25° or more,physicians prescribe “observation only.”

At 25°, bracing has been used to stabilize progression, and it’s efficacy continues to be examined.

Spinal fusion is recommended for skeletally immature patients when curvatures progress to 40° - 45° and for mature patients with curvatures > 50°.

Incidence of Curvature Progression in Idiopathic Scoliosis Patients Treated With Scoliosis Inpatient Rehabilitation”, Hans-Rudolf Weiss, Pediatric Rehabilitation, 2003, Vol. 6, No 1, 23-30


Scoliosis surgery is only indicated Scoliosis surgery is only indicated for cosmetic improvementfor cosmetic improvement

Dr. Han Weiss, director of the Schroth clinic in Germany, published a highly regarded article in a 2008 edition 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 surgery are limited for cosmetic reasons in severe cases and only if the parent and family agree with this."


The natural history of scoliosis: curve progression of untreated curves of different etiology, with early (mean 2 year) follow up in surgically treated curves Med J Malaysia 2001 Jun;56 Suppl CL37-40 Chauh, Kareem, Selvakur, Oh, Borhan, Harwant Orthopedic Unit, Universiti Putra Malaysia

The mean age surgery was 14.15

Preoperative curve was 71.61 degrees

Postoperative curve was 43.78Dr. Clayton Stitzel, 1-866-627-3009, [email protected], http://www.treatingscoliosis.com/

Repair of Adult Scoliosis Effective Long TermLaurie Barclay, MD Medscape Medical News 2003. © 2003 Medscape

Feb. 28, 2003 — Repair of adult scoliosis is effective in providing pain relief, functional restoration, and patient satisfaction over the long term, according to a case series published in the February issue of Spine. This is the first report of long-term follow-up evaluation in adults since the advent of modern segmental instrumentation.

"Increasing attention has been directed to the problem of treating the adult with idiopathic scoliosis," write Gary S. Shapiro, MD, from the Hospital for Special Surgery in New York City, and colleagues. "Untreated scoliosis in the adult can lead to painful spinal osteoarthritis, progressive deformity, spinal stenosis with radiculopathy, muscle fatigue from coronal and sagittal plane imbalance, and the psychological effects of living with a visible deformity."

This case series included 16 adults who underwent elective anterior and posterior surgical reconstruction for idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low-back pain. Minimum follow-up was two years.

Overall, 94% of the study subjects were satisfied with the surgery. All patients with balance problems had restoration or improvement of coronal and sagittal balance. There was significant improvement in radiographic and clinical findings, and in long-term outcome data from the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire.

Ten patients had major complications, and eight of them required additional surgery. Two had minor complications. Limitations of this study include the small number of subjects, strict inclusion criteria applying to only a small fraction of the adult population with scoliosis, and lack of computed tomography data.

"Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis," the authors write. "Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient."

Spine. 2003;28:358-363


Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence

Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J.Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

Klinik und Poliklinik fur Allgemeine Orthopadie des Universitatsklinikums Munster, Germany. [email protected]

AIM: The expert evidence of operated patients with idiopathic scoliosis is determined by functional and pulmonary restriction. The degree of deformity and the extent of fusion is crucial for grading disability. In a retrospective study on the quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22 - 40 years) with idiopathic scoliosis treated with Harrington instrumentation the grading was registered. METHOD: An average of 16.7 years after the surgery, these data were correlated with the type and size of curve and to the extension of fusion. RESULTS: A significant correlation between the grading disability and the extent of fusion (P = 0.53) or the size of curve (p = 0.4) could not be proven. CONCLUSION: Despite good long-term outcomes, 40 % of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons.


Back pain and disability after Harrington rod fusion to the lumbar spine for scoliosis.

Paonessa KJ, Engler GL.Spine 1992 Aug;17(8 Suppl):S249-53Norwich Orthopedic Group, Connecticut.

Back pain questionnaires were completed by a study group of 103 idiopathic scoliosis patients fused with Harrington rods from L3 or lower and a control group of 29 patients fused to L2 or above. Minimum time to follow-up examination was 2 years. The study group had a higher rate of secondary surgeries for complications or late disc disease below the fusion, a higher back pain score, more difficulties with normal daily activities, needed more regular pain medications, and had more episodes of back pain. Patients older than 30 years at surgery had more of these problems if fused to L3 or more caudally. The amount of remaining lumbar lordosis correlated significantly with the difficulty of normal daily activities. Dr. Clayton Stitzel, 1-866-627-3009,

[email protected], http://www.treatingscoliosis.com/

Results of surgical treatment of adults with idiopathic scoliosis.J Bone Joint Surg Am 1987 Jun;69(5):667-75Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.

The outcome of surgical treatment of idiopathic scoliosis in forty-five adults was studied with special attention to pain, function, self-image, and pulmonary function. All of the patients were more than twenty-five years old at operation and had been followed for more than three years. Every patient who was operated on by one of us (J. E. H.) and who met these criteria was evaluated. The magnitude of the curves averaged 66 degrees. 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. Functional impairment due to the scoliosis was lessened, and the ability to perform the common activities of daily living was improved, but no important changes in occupation or recreational activity were recorded. Correlations of pain or function, or both, and the changes in either, were found with only two parameters: age at follow-up and physical occupation. Pulmonary function, as measured, did not change. Eighteen (40 per cent) of the patients had a minor complication and ten (20 per cent), a major complication; there was one death, due to pulmonary embolism, of a patient who was excluded from the series. 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.


Prospective Evaluation of Trunk Range of Motion in AIS Undergoing Spinal Fusion

Spine 2002 Jun 15;27 (12) :1346-54 Engsberg et al, Wash U, St. Louis, MO

“Whereas range of motion was reduced in the fused regions of the spine, it was also reduced in unfused regions. The lack of compensatory increase at unfused regions contradicts current theory.”


Medical Complications in scoliosis surgery. Curr Medical Complications in scoliosis surgery. Curr Opin Pediatr 2001 Feb;13(1):36-41Opin Pediatr 2001 Feb;13(1):36-41

They include the syndrome of inappropriate antidiuretic hormone, pancreatitis, superior mesentaric artery syndrome, ileus, pnemothorax, hemothorax, chylothorax and fat embolism.

Urinary tract infections, wound infection and hardware failure are not addressed.


Scoliosis curve correction, thoracic volume changes, and Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and thoracic diameters in scoliotic patients after anterior and posterior instrumentation. Int Orthop 2001;25(2):66-0posterior instrumentation. Int Orthop 2001;25(2):66-0

The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.


The prevalence of disc aging and back pain after The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A fusion extending into the lower lumbar spine. A matched MR study 25 years after surgery for AIS. Acta matched MR study 25 years after surgery for AIS. Acta radiol 2001 Mar;42(2):187-97radiol 2001 Mar;42(2):187-97

There were significantly more degenerative disc changes, disc height reduction and end plate changes in the lowest unfused disc in the patient group compared to the control group.

This level correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.


Health-related quality of life in patients with AIS: a Health-related quality of life in patients with AIS: a matched follow-up at least 20 years after treatment with matched follow-up at least 20 years after treatment with brace (BT) or surgery (ST). Eur Spine J 2001 brace (BT) or surgery (ST). Eur Spine J 2001 Aug;10(4):278-88Aug;10(4):278-88

Both ST and BT patients had a slightly, but significantly, reduced physical function.

49% of ST and 34% of BT admitted limitation of social activities due to their back.


Paul Harrington, known for inventing the 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”.

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.


Anterior Release: An anterior discectomy was preformed with a 15-blade on the left side if the thoracic spine.


Anterior Release: A rongeur is used to complete the discectomy and obtain an anterior release of the curve.


Anterior Instrumentation: After the anterior discectomy is preformed, screws are then placed into the left side of the thoracic vertebral body to connect the anterior spinal column to the precontoured rod.


Anterior Instrumentation and Derotational Maneuver: The rod is precontoured to the alignment of a normal spine in the frontal and sagittal plane. After the rod is inserted to the screws, it is derotated to correct the curve. In effect, the spinal deformity is reduced to the rod. Dr. Clayton Stitzel, 1-866-627-3009,


Anterior Release and Instrumentation: Much of the thoracic spinal deformity has been corrected after the anterior release and application of instrumentation.


Posterior Instrumentation: A hook is placed under the laminae of a thoracic vertebra. Instead of screws, multiple hooks will be placed through the laminae to connect the posterior spinal column to the precontoured rods. Sublaminar hooks are placed in different directions depending on the need for segmental compression or distraction. Dr. Clayton Stitzel, 1-866-627-3009,


Posterior Instrumentation: The precontoured rod is then placed into the multiple sublaminar hooks.


Posterior Instrumentation and Derotational Maneuver: Similarly to the anterior procedure, the precontoured rod is derotated to correct both the frontal and sagittal deformities.


Posterior Spinal Fusion and Instrumentation: After final placement of 2 rods with cross-links to increase the stability of the instrumentation, much of the thoracic and lumbar deformities has been corrected.


Posterior AP Radiograph demonstrating a correction of the thoracic curve from 60 to 22 degrees postoperatively, and from 78 to 15 degrees postoperatively.


Dr. Clayton Stitzel, 1-866-627-3009, /[email protected], http://www.treatingscoliosis.com

Corrosion of spinal implants retrieved from patients with scoliosis.

Akazawa T, Minami S, Takahashi K, Kotani T, Hanawa T, Moriya H.

Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan.J Orthop Sci. 2005;10(2):200-5.

Spinal implants retrieved from 11 patients with scoliosis were examined. All the implants were posterior instrumentation systems made of 316L stainless steel and composed of rods, hooks, and crosslink connectors. Corrosion was classified into grades 0 to 3 based on macroscopic findings of the rod surface at the junction of each hook or crosslink connector. Grade 0 was defined as no sign of corrosion, grade 1 as surface discoloration, grade 2 as superficial metal loss, and grade 3 as severe metal loss. The depths and characteristics of metal loss areas were examined. Spinal implants showed more corrosion after long-term implantation than after short-term implantation. Corrosion was seen on many of the rod junctions (66.2%) after long-term implantation, but there was no difference between the junction at the hook and those at the crosslink connector. It is thought that intergranular corrosion and fretting contributed to the corrosion of implants. The current study demonstrated that corrosion takes place at many of the rod junctions in long-term implantation We recommend removal of the spinal implants after solid bony union.


Pre Treatment Post Treatment

CLEAR Institute method is a non-surgical scoliosis treatment alternative


Treatment (Mix, Fix, Set)Treatment (Mix, Fix, Set)

Scoliosis Chiropractic Care◦Warm-up (Mix)◦Adjustment (Fix)◦Rehabilitation (Set)

Maybe a little chocolate therapy


Warm up (MIX)Warm up (MIX)Wobble chairCervical TractionCore Stimulation

(ligaments) & Muscle Stimulation


Adjustments (FIX)Adjustments (FIX)

#1 PRIORITY: Restore cervical lordosis

Adjust Anterior & Posterior Hip

Rehabilitation (SET) Rehabilitation (SET)

Proprioceptive neuromuscular re-education & rehabilitation

Head weightsHip weightsTight rope

exercise


Resources for parents and Resources for parents and kidskids

Websites on scoliosis

◦www.clear-institute.org/freeinfo◦www.fixscoliosis.com◦www.scoliosis-world.com


surgery for scoliosis

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