This is a bit like rohrer's article only the focus is on things that can go wrong, specifically. It is also based on a survey of PubMed reports published.
http://www.scoliosisjournal.com/content/3/1/9
As I said elsewhere, I've been sitting on it for fear of being too discouraging (for a good while, in fact).
I know those who, like me, suffer intractable pain and severe dysfunction, may not be able to be as conservative as these authors might be indirectly advocating, However, this study DOES give one pause. Note, the results studied date largely from ~2000.
I think the primary point is incontrovertible, whatever the authors' motives may be - that such research is much under-reported, that reporting is fairly random and that to a large extent, no one really knows the long term complication rates. Looking far out, is virtually impossible (certainly, no one has been trying either!), as older patients especially, fall prey to other ills and it's easy to forget what contributory role their major surgery may have played.
Doesn't mean it's not worth having a go at it, but it's worth knowing the uncertainty factor. I have great hopes that Lawrence Lenke's six year tenure as in-coming head of the SRS will change this dearth of stats, It was leadership such as his (for all I know he initiated this change too) that led the SRS to require its members to report on DEATHS among their patients. Meaning, at first surgery, as I understand this article,
Up until a few years ago, surgeons didn't have to report on mortality rates and most (I gather) did NOT - not, pubicly!
This is a point I was arguing in a different thread (from one angle) - that in the field of spinal surgery, especially complex spinal surgery, there is a strong motive NOT to report openly. This is, after all, THE most lucrative field in surgery and there is a lot of ego and jockeying for turf.
Not that aren't more modest, dedicated physicians in the field! However, looking as a psychologist, at who chooses this branch of medicine (and surgery, more broadly), I'd have to say the pre-selection bias favors ego and agressiveness.
Also (NOT related to the points of this article) - sadly - there is a great deal of corruption in this field, specifically in regards to marketing surgical parts, especially those that are in effect, inventions.
Don't be thrown by the elderly textbooks citedl; they are only there to give background. Having glanced around Amazon today at Scoli bks, I see the newest textbooks cost many hundreds of dollars - some up to $800. That's a drop in the bucket for a scoliosis surgeon (and tax-deductible to boot) but certainly beyond the budget of most researchers who need to rely on PubMed.
That in itself, says the authors are outliers, as otherwise they'd have had access to symposium notes and restricted publications such as are found on for pay reference sites like Elsevier. Disconfirmations welcome, especialy ones looking at detail and body of the arguments or at statistical weakness, if any.
http://www.scoliosisjournal.com/content/3/1/9
As I said elsewhere, I've been sitting on it for fear of being too discouraging (for a good while, in fact).
I know those who, like me, suffer intractable pain and severe dysfunction, may not be able to be as conservative as these authors might be indirectly advocating, However, this study DOES give one pause. Note, the results studied date largely from ~2000.
I think the primary point is incontrovertible, whatever the authors' motives may be - that such research is much under-reported, that reporting is fairly random and that to a large extent, no one really knows the long term complication rates. Looking far out, is virtually impossible (certainly, no one has been trying either!), as older patients especially, fall prey to other ills and it's easy to forget what contributory role their major surgery may have played.
Doesn't mean it's not worth having a go at it, but it's worth knowing the uncertainty factor. I have great hopes that Lawrence Lenke's six year tenure as in-coming head of the SRS will change this dearth of stats, It was leadership such as his (for all I know he initiated this change too) that led the SRS to require its members to report on DEATHS among their patients. Meaning, at first surgery, as I understand this article,
Up until a few years ago, surgeons didn't have to report on mortality rates and most (I gather) did NOT - not, pubicly!
This is a point I was arguing in a different thread (from one angle) - that in the field of spinal surgery, especially complex spinal surgery, there is a strong motive NOT to report openly. This is, after all, THE most lucrative field in surgery and there is a lot of ego and jockeying for turf.
Not that aren't more modest, dedicated physicians in the field! However, looking as a psychologist, at who chooses this branch of medicine (and surgery, more broadly), I'd have to say the pre-selection bias favors ego and agressiveness.
Also (NOT related to the points of this article) - sadly - there is a great deal of corruption in this field, specifically in regards to marketing surgical parts, especially those that are in effect, inventions.
Don't be thrown by the elderly textbooks citedl; they are only there to give background. Having glanced around Amazon today at Scoli bks, I see the newest textbooks cost many hundreds of dollars - some up to $800. That's a drop in the bucket for a scoliosis surgeon (and tax-deductible to boot) but certainly beyond the budget of most researchers who need to rely on PubMed.
That in itself, says the authors are outliers, as otherwise they'd have had access to symposium notes and restricted publications such as are found on for pay reference sites like Elsevier. Disconfirmations welcome, especialy ones looking at detail and body of the arguments or at statistical weakness, if any.
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