Article for adults considering surgery

[rohrer01]

I came across this article doing some research for myself. I thought I would share it with those of you who are considering surgery for the first time. It's about surgical outcomes for adult scoliosis patients.

http://thejns.org/doi/pdf/10.3171/2009.12.FOCUS09254

[Shari]

I read that article twice, and I'm still not sure I agree w/ it 100%. I am very curious what others here think about it. Linda R. what do you think??? I wonder what people who are thinking about having this surgery, what do you think???

Perplexed,
Shari

[titaniumed]

You would think that they would be a little more specific on complications. I mean, outcomes really have quite a bit to do with complications, don’t they? There needs to be more data.

Interesting how average age in 1981 was 30.

Ed

[Pooka1]

You would think that they would be a little more specific on complications. I mean, outcomes really have quite a bit to do with complications, don’t they? There needs to be more data.

If most or even all of the complications are short-term and have resolved then there would be no connection between complications and outcome.

I think we know separately that the major complication that affects long term outcome is probably neurological injury. But we also know that the rate of these injuries, especially with real-time cord monitoring, is extremely low and that many of these injuries resolve.

The other major complication like infection and pseudoarthrosis are all resolved eventually as far as I know. They are not insoluble except maybe in the cases where the bone density will not allow a fusion I suppose.

So I think long-term outcome at least is largely unrelated to complication rate as a general rule (rare permanent neuro injuries are the exception). Linda will dope-slap me if I'm wrong.

[Confusedmom]

Shari,

For those of us in the "considering" camp, this article, like all of them, is helpful but limited. I agree that most complications seem resolvable (except death), and I'm glad to see that there are positive outcomes in terms of curve reduction and improved disability.

What I STILL don't get is this idea that you do the surgery for "progression" even without significant pain. Because, it seems like from the literature, you have a decent chance of ending up with MORE chronic pain post-surgery, especially for lower curves.

Still looking for a study on outcomes of the lumbar region vs. natural history...

Evelyn

[jrnyc]

if there are more problems than scoli to be operated on at the same time...like disc disease, then the hope is that there will be LESS pain....that is the goal...after surgery...because more problems will be resolved...

jess

[rohrer01]

I'm not saying I agree or disagree with the article. It is what it is. It is just a collection of a bunch of data already published. They have a very large sample population, though. I agree that they aren't very clear on what constitutes a "complication" and how the complications affect outcome. It doesn't say what kind of scoli cases these docs were undertaking either. If the doc seems to have a "high" complication rate, such as Bridwell, it may "look" bad without anyone knowing the facts. I think Bridwell and Lenke ONLY take more difficult cases, so of course "complication" rates will be higher. I would not let these figures scare anyone out of surgery. I just posted it because, for me at least, it is a sobering reminder of the seriousness of what I am considering having done.

[LindaRacine]

Total garbage. The studies go back to 1950. The surgery that is being done today has very little in common with surgeries between 1950 and 1990.

[txmarinemom]

Total garbage. The studies go back to 1950. The surgery that is being done today has very little in common with surgeries between 1950 and 1990.

Thank you, Linda. I decided to sit on it for a day ... and your assessment is still more gentle.

You just can't lump all those studies in together, rohrer. It *isn't* what it is.

[Back-out]

While we're at it, but I'll also turn this into a separate thread, I"ve been holding onto it, afraid to post it for fear of being too discouraging.

http://www.scoliosisjournal.com/content/3/1/9

[Pooka1]

While we're at it, but I'll also turn this into a separate thread, I"ve been holding onto it, afraid to post it for fear of being too discouraging.

http://www.scoliosisjournal.com/content/3/1/9

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.

[Back-out]

This is garbage.

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.

I replied to your other contentions on the dedicated thread I did post.

However, while it is legitimate to claim that strictly in terms of attacking a structural problem, surgery is more effective (if it is) than other modalities, the point being made here is that the long-term consequences of surgery are both unknown and unknowable - at present. Yet surgery is inherently far more dangerous than ANY alternate methodology. (If not, please indicate how! Seriously)

One might well legitimately claim that improved quality of life for X number of years justifies the losses...There are many arguments that can be put forth, including the intolerability of known pain against even the slightest possibility of permanently reduced (i.e. tolerable) pain - or even the temporary reduction of pain combined with hope!

Truly, this is quite a legitimate argument. It is essentially the kind of benefit cancer patients are choosing when they opt for painful, dangerous therapies EVEN for cancers which are aggressive and well advanced, with a very low probability of cure (or even substantial remission).

However, cancer patients are presented with careful documentation of the odds of various treatments including side effects and chances of cure, along with a probability of error, as best it can be determined even for new treatments.

But (and this is the elephant in the room) we have no such opportunity for informed decision-making. We consult individual surgeons and are required (there's a choice?) to decide whether or not we believe HIM based on - what? TRUST!

Now there's Science at work (heavy - but sad - sarcasm).

Scoliosis patients are presented with no such statistics. All evidence is anecdotal, at best . True longitudinal studies are needed. Anything longitudinal will necessarily include older treatment modalities, which in scoliosis surgery will mean that reports are given for older instrumentation and surgical techniques too (SO DENOTED). Hey, fifteen- twenty years ago isn't antique. Furthermore, patients back then were told their treatments were state of the Art too - and far more trouble-free than anyone had a right to claim. The odds and possibility for certainty were grossly misrepresented by many, if not most, surgeons (I remember looking into surgery back then and this is what revisions forums report, too).

Just what makes today any different, except for our own wishful thinking?

To claim we are making informed decisions in any sense of the word, is inaccurate. We are making a leap of Faith! That we are rejecting alternates (largely by default, critiqueing them for not providing us with long term proof of efficacy) - does NOT mean our rejection is "scientific", either!

[LindaRacine]

All I want is a table of stats including all SRS surgeons (over as many years as they can produce them) including patients who die of "other" causes and pateints lost to follow-up.

It already exists. Ask your SRS doctor about it. It's been published for AIS, and hopefully will one day be published for adult scoliosis.

[LindaRacine]

From the other thread... ARGH!

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.

If you think surgeons are hiding the facts, I'm thinking you're seeing the world through Weiss colored glasses.

[Pooka1]

From the other thread... ARGH!

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.

If you think surgeons are hiding the facts, I'm thinking you're seeing the world through Weiss colored glasses.

Post of the month nomination

"Weiss colored glasses!"

He is using dishonest tactics to scare the bunnies and has no alternative. That is not honest.