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  • Journal article focusing on surgical complications

    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.
    Last edited by Back-out; 06-10-2010, 11:26 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  • #2
    Originally posted by Back-out View Post
    That in itself, says the authors are outliers, as otherwise they'd have had access to symposium notes and restreicted 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.
    This is gray literature which is even more questionable (not even peer-reviewed) than the peer-reviewed journal articles of which a majority are false themselves. So at this point, gray literature isn't really worth reading and nor is much of the peer-reviewed literature because it isn't controlled.

    Here's my response to that article that I posted on the other thread also...

    This is garbage.

    It deals mostly, if not exclusively, with historical use instrumentation. I scanned the dates and titles of the references and that's what seems to dominate though I didn't do an exhaustive review.

    It is irrelevant to modern instrumentation and techniques.

    This journal is notorious for publishing misleading articles because they have an agenda of attacking surgery in place of providing positive evidence for conservative and alternative treatments.

    And the record for the older instrumentation is still far better than for any conservative and certainly for any alternative treatment. It's easy to lose sight of that.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

    Comment


    • #3
      Weiss makes decent money - he can afford to research the topic thoroughly.

      Comment


      • #4
        Originally posted by hdugger View Post
        Weiss makes decent money - he can afford to research the topic thoroughly.
        And yet he doesn't. Quite clearly.

        He declares no conflict but I think at this time he was employed at the Schroth institute. That is a huge conflict, no? And he is still in the field now despite leaving the Schroth institute so there is still a conflict he should have declared. I mean unless he has taken to riding his reiners full time.

        He should busy himself with ponying up POSITIVE evidence for PT and bracing. Publishing nonsense about historical instrumentation is transparently a "Look at the Wookie" maneuver to hide the lack of evidence for the treatments that he profits from. Recall Schroth is a still a fringe treatment even in Germany. There is a reason for that.
        Sharon, mother of identical twin girls with scoliosis

        No island of sanity.

        Question: What do you call alternative medicine that works?
        Answer: Medicine


        "We are all African."

        Comment


        • #5
          Weiss uses the same tactics that evolution deniers use. So he is not in good company.
          Sharon, mother of identical twin girls with scoliosis

          No island of sanity.

          Question: What do you call alternative medicine that works?
          Answer: Medicine


          "We are all African."

          Comment


          • #6
            One cannot help noting that even Linda Racine and David Wolpert need or have had revision surgery. Personally, I was much taken aback after my first (and so far, only) surgical consults at being told by rwo of three surgeons to expect more surgery - and probably within ten years, likely much sooner...

            It is perhaps unfair of me that I am looking farther and temporarily, at least, rejecting those surgeons. They may actually only be the virtuous bearers of bad tidings! Perhaps they thought "she seems like a grown-up; she can take the Truth". If so, how wrong they were! I'm a weenie and moreover I'm a broke weenie without a good social support network (even if - haha - the thought of more surgery, at worst, a frank revision - didn't scare me S*LESS!)

            But it DOES!

            Maybe I just have to come to terms with this, though, especially considering my demographic - namely: long fusion (14+ segments), lumbar area the worst and over 60. Also (I suspect), I'm in a worse prognostic category because of severe complicating spinal conditions such as DDD, flatback and spondylothistesis. Oh crap!

            Anyhow, please take potshots at the article, and I hope your aim is good as it's been a real downer for me. I just HATE the degree of uncertainty that appears to attach to outcomes, as I make decisions probabilistically including an estimated margin or error attached to that prediction. The error rating alone, seems to be so high here, I hardly dare proceed!
            Not all diagnosed (still having tests and consults) but so far:
            Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
            main curve L Cobb 60, compensating T curve ~ 30
            Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

            Comment


            • #7
              Bring 'em on, Sharon. I'm an apologist for neither article nor authors.

              However, what I got out of it, unmistakeably, is that based on publicly available research, NO ONE CAN STATE WITH CONFIDENCE THAT COMPLICATIONS ARE NOT EXPECTABLE. That is, complications serious enough to result in the (eventual, at least) need for more surgery.

              MAN, do I hope I'm wrong! Conflict of interest, I'm afraid, is not enough of an argument, though, nor is "Bad reputation" for the journal. That's ad hominem "corporatizing" the individual of the journal too. Please attack their arguments, especially that "unknowability" one. That's the killer. Now, maybe surgeons know more - I dare say they do.

              But what can we little worms of patients know?
              Not all diagnosed (still having tests and consults) but so far:
              Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
              main curve L Cobb 60, compensating T curve ~ 30
              Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

              Comment


              • #8
                I hope Linda comments.

                And if pointing out conflict of interest is somehow wrong then why do all the journals require it?

                Some things are wrong by their nature. Evolution denial, holocaust denial, etc., etc. It is CORRECT to attack them though not to silence them. The open criticism is what matters.

                Everyone is entitled to their own opinions. They are not entitled to their own facts. The perennial struggle.
                Sharon, mother of identical twin girls with scoliosis

                No island of sanity.

                Question: What do you call alternative medicine that works?
                Answer: Medicine


                "We are all African."

                Comment


                • #9
                  Originally posted by Pooka1 View Post
                  I hope Linda comments.

                  And if pointing out conflict of interest is somehow wrong then why do all the journals require it?
                  No, it's not wrong, It's simply inadequate as a rebuttal. This is not a double blind study, but a literature review. Did they eliminate any sources, improperly characterize them, or make mistakes in either statistical analysis or conclusions?

                  Some things are wrong by their nature. Evolution denial, holocaust denial, etc., etc. It is CORRECT to attack them though not to silence them. The open criticism is what matters.

                  Everyone is entitled to their own opinions. They are not entitled to their own facts. The perennial struggle.
                  "Wrong" as used above sounds like a judgmental word, though I suppose you could claim that you are using it in the sense of "incorrect". Perhaps it is your inclusion of the claims of Holocaust deniers, which are demonstrably morally wrong, in addition to being factually inaccurate. However, factual inaccuracy seems to qualitatively under-characterize the mistakes underlying Holocaust denial. You are flirting with "Godwin's Law".

                  I do not think we dare put merely contesting the knowability of outcomes in scoliosis surgery in that category. What exactly do we have to counter the claim that they ARE, in fact, unknowable, except for two NIH studies conducted in only TWO institutions?

                  And, of course, the anecdotal evidence on this site, which is wholly unexplored in any measurable fashion (and which has been shown to be subject to enormous response bias).

                  I wish this were NOT so!
                  Last edited by Back-out; 06-10-2010, 10:21 PM.
                  Not all diagnosed (still having tests and consults) but so far:
                  Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                  main curve L Cobb 60, compensating T curve ~ 30
                  Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                  Comment


                  • #10
                    Pooka
                    It deals mostly, if not exclusively, with historical use instrumentation. I scanned the dates and titles of the references and that's what seems to dominate though I didn't do an exhaustive review.
                    No, it doesn't.
                    Not all diagnosed (still having tests and consults) but so far:
                    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                    main curve L Cobb 60, compensating T curve ~ 30
                    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                    Comment


                    • #11
                      Originally posted by Back-out View Post
                      One cannot help noting that even Linda Racine and David Wolpert need or have had revision surgery. Personally, I was much taken aback after my first (and so far, only) surgical consults at being told by rwo of three surgeons to expect more surgery - and probably within ten years, likely much sooner...
                      I'm no surgery fan, but 2 out of 3 revisions within 10 years sounds *very* high to me. I haven't seen anything nearly that high in the research - even the worst numbers were more like 25%.

                      Comment


                      • #12
                        Originally posted by hdugger View Post
                        I'm no surgery fan, but 2 out of 3 revisions within 10 years sounds *very* high to me. I haven't seen anything nearly that high in the research - even the worst numbers were more like 25%.
                        They didn't say "revisions". Could be they meant "touch-ups". And besides, as I pointed out above, my demographic's prognostics are probably the worst.

                        Note, I AM looking else-where for now too. One might uncharitably call that "doctor-shopping". I do not plan to advertise how many surgeons I've consulted from here on out - besides on this site.

                        Anyhow, as far I'm concerned "from your lips to God's ears", etc!
                        Not all diagnosed (still having tests and consults) but so far:
                        Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                        main curve L Cobb 60, compensating T curve ~ 30
                        Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                        Comment


                        • #13
                          Spine surgeons have never hidden their high rates of complications. They publish them so that patients are informed about their treatment options, and can therefore make fully informed decisions. On the other hand, Weiss has never published a long-term follow-up to Schroth. Why is he spending all his time trying to convince people that surgery is so bad instead of trying to prove that Schroth is good? I can guess the answer to that, so no need to answer.

                          Yes, I'm going to have to have more surgery, as will a bunch of other people. I've never seen the medical community try to hide that fact. Have you?

                          Did Dave Wolpert say he needed more surgery? He didn't mention it to me, and I don't recall seeing it here.

                          --Linda
                          Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                          ---------------------------------------------------------------------------------------------------------------------------------------------------
                          Surgery 2/10/93 A/P fusion T4-L3
                          Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                          Comment


                          • #14
                            And, by the way, why do we have to start a new thread for something like this? There's another thread in which this would have fit. PLEASE try to find a thread to continue instead of starting half a dozen new threads daily.
                            Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                            ---------------------------------------------------------------------------------------------------------------------------------------------------
                            Surgery 2/10/93 A/P fusion T4-L3
                            Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                            Comment


                            • #15
                              Linda, I DID link this article there, However, different authors , different methodologies and different publications need to be addressed separately. I hope they can be debunked, at least in part, based on statistics and conclusions.

                              They are far from identical even if (IF!) their authors share an element of cheap sensationalism in their intrinsic motivation. They cannot be tarred with the same brush.

                              However, perhaps both articles belong in the research sub-forum, Perhaps you could move them there, so they can be debated, but without demoralizing new patients. I believe we need to address the issue of lack of outcomes research and the impossibility of informed decision-making such as exists in cancer treatment (a comparison, I explore in the other thread)

                              I think they should be moved and, in fact, I request it.
                              Last edited by Back-out; 06-10-2010, 11:34 PM.
                              Not all diagnosed (still having tests and consults) but so far:
                              Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                              main curve L Cobb 60, compensating T curve ~ 30
                              Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                              Comment

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