Surgery is no cure.

[mamamax]

Surgery Past/Present/Future

Thank you Linda. Such is the nature of true scientific study i suppose. With surgical techniques, by the time we have a 10 year study, new techniques have been developed? A bit bothersome, to me - and making a decision towards surgery based on long term studies not really possible. Personally, i would have to rely more on a leap of faith than i would long term evidence of any technique i would choose today. Would have to say the pedicle screws look promising but certainly more time is required before deeming them a success (i.e., how will these same patients fare when they are 70 or 80. We do need techniques that will give near perfect correction (vs 50-70 %) while allowing excellent range of motion - and is what we look for in the future.

In 1969, i broke my neck in a car accident. A wonderful neurosurgeon named Richard King Neal III (now retired) - literally saved my life. When he saw my xrays he broke out in a cold sweat - one of the vertebra was cutting through my spinal chord, near 50% he told me later (i realize some may not believe this, but it is true). Anyway he fused 5-6 using bone from my hip, entering from the front (anterior?). At 3 month follow up, he was amazed that i had full range of motion to move my head from left to right & up and down. Forty years later .. have never had a problem.

Maybe one day - we will have surgical techniques allowing for similar spinal range of motion without future complication. Certainly, this is what we need to truly improve quality of life.

My question is - is this what selective fusion attempts to do (offer greater range of motion)?

[Pooka1]

(snip good points)

With surgical techniques, by the time we have a 10 year study, new techniques have been developed? A bit bothersome, to me - and making a decision towards surgery based on long term studies not really possible.

Yes but the newer techniques aren't usually created in a vacuum, going off on a complete tangent though some are. They are designed to improve the previous ones in specific ways I imagine.

For example, we had the Harrington rods. Though many patients had no problems, a certain number had a similar problem (flatback syndrome). So the next generation of instrumentation was designed to hopefully avoid that problem as far as I know.

The techniques build on what was learned from the previous generation. At some point, it gets pretty good hopefully.

My one kid, we didn't have a choice due to documented rapid progression. And she was also in big need of a cosmetically better outcome than she had at 58* and torqued around like crazy. I assume these surgeries are never covered by insurance for cosmesis alone but I wonder if she would have wanted it just for that reason. I don't know... depends on how much worse it would get and how bad it made her feel.

My sub-surgical kid is just damn lucky to have almost no rotation and so her curve is not noticeable to the uneducated eye. But she does wish her back looked like her sister's looks now at 5* and virtually no rotation.

[FixScoliosis]

Weiss is no Quack

So is then safe to say that when HR Weiss wrote:

"CONCLUSIONS: No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that 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 patient and the family agree with this." pubmed

which is quite similar to what Bridwell says and therefore does not deserve to be called or considered a quack?

[Pooka1]

So is then safe to say that when HR Weiss wrote:

"CONCLUSIONS: No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that 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 patient and the family agree with this." pubmed

which is quite similar to what Bridwell says and therefore does not deserve to be called or considered a quack?

No that Weiss quote is most definitely quacky and can be shown to be false in several instances. It differs from the Bridwell quote.

Also, can you cite the controlled study on surgical treatment of setting broken arms bones? Weiss needs to do that unless he admits a randomized controlled trial doesn't need to be done there. Then he has to say why not.

I would like to know how other orthopedic surgeons view Weiss. Anybody know?

[LindaRacine]

No that Weiss quote is most definitely quacky and can be shown to be false in several instances. It differs from the Bridwell quote.

Also, can you cite the controlled study on surgical treatment of setting broken arms bones? Weiss needs to do that unless he admits a randomized controlled trial doesn't need to be done there. Then he has to say why not.

I would like to know how other orthopedic surgeons view Weiss. Anybody know?

Apparently increasing pain, loss of function, and severely limited pulmonary function take a back seat to cosmesis. Quack Quack

The surgical cost of treating scoliosis is nothing when compared to putting us all on long-term disability for the rest of our lives.

Sharon, I think most scoliosis specialists don't spend any amount of time thinking about attacks from alternative practitioners. They have pretty full plates already.

[mamamax]

So is then safe to say that when HR Weiss wrote:

"CONCLUSIONS: No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that 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 patient and the family agree with this." pubmed

which is quite similar to what Bridwell says and therefore does not deserve to be called or considered a quack?

Speaking of the referenced paper, which is: an observation of all available Pub Med literature ~

His opinion is based upon a review of Pub Med literature evidence which (he states through observation) does not reveal evidence that surgery is superior to natural history (in terms of outcome parameter and rate of progression using only prospective controlled studies that have considered treatment vs natural history).

This paper was written in 2008 - if his observation of the published material was not accurate (or grossly inaccurate), i'm pretty sure someone would have written a rebuttal by now? Why do we not see this rebuttal?

I don't see Weiss (MD Orthopaedic Surgeon) as a Quack. Actually several decades ago, before the advent of Harrington rods, surgeons often recommended non surgical methods for their scoliosis patients (many had great success - a pity it was not well documented). I see Weiss (and others like Rivard/Collard) as carrying on with such work and making up for the lack of earlier documentation. I don't know what other orthopaedic surgeons may think of HR Weiss but certainly many cite his work - and often.

I see this paper (as stated), as an observation of published material in the Pub Med library - if rebuttal is justified ... where is it?

pubmed

[LindaRacine]

Speaking of the referenced paper, which is: an observation of all available Pub Med literature ~

His opinion is based upon a review of Pub Med literature evidence which (he states through observation) does not reveal evidence that surgery is superior to natural history (in terms of outcome parameter and rate of progression using only prospective controlled studies that have considered treatment vs natural history).

This paper was written in 2008 - if his observation of the published material was not accurate (or grossly inaccurate), i'm pretty sure someone would have written a rebuttal by now? Why do we not see this rebuttal?

I don't see Weiss (MD Orthopaedic Surgeon) as a Quack. Actually several decades ago, before the advent of Harrington rods, surgeons often recommended non surgical methods for their scoliosis patients (many had great success - a pity it was not well documented). I see Weiss (and others like Rivard/Collard) as carrying on with such work and making up for the lack of earlier documentation. I don't know what other orthopaedic surgeons may think of HR Weiss but certainly many cite his work - and often.

I see this paper (as stated), as an observation of published material in the Pub Med library - if rebuttal is justified ... where is it?

pubmed

Maxene...

You can't have it both ways. If there's no evidence that surgery is better than natural history, than there certainly is no evidence that any alternative works. So, I assume you'll be discontinuing your treatment. Right? After all, since the one thing that the Spinecor is known to help, pain, is of no substance.

[mamamax]

Linda ~The point i'm trying to make is .. this paper is a review of Pub Med literature and based only on that (the documented literature) - the study is then taken a step further and confined to observation of: outcome parameter and rate of progression using only prospective controlled studies that have considered treatment vs natural history.

Essentially Weiss is stating that if surgery is superior to natural history (meeting the above criteria within the literature in the Pub Med library) then ... documentation (in the Pub Med library) is woefully lacking.

To read some of these papers is rather like trying to interpret state or federal statutes. And you are correct, truly superior documentation is lacking in both areas. I believe SOSORT was created to help make up for this - am i correct?

I will continue on with my Spinecor treatment, it is serving me well, which is substance enough for me. Nothing like personal observation.

[LindaRacine]

Essentially Weiss is stating that if surgery is superior to natural history (meeting the above criteria within the literature in the Pub Med library) then ... documentation (in the Pub Med library) is woefully lacking.

Yes, because thankfully, there's a shortage of parents who are wacky enough to withhold surgery from their kids with curves > 50 degrees.

[hope404]

???

"no evidence that surgery is better then natural history"

Is it possible that Laura Ingalls was walking(happily) around the prairie with a 50 degree curve and did not know it???

Are we all too obsessed about the numbers??? What if we didn't have xray?


The human body has an incredible ability to adapt...one arm...one leg...one eye...one tooth

Our doctor told us he can't count the times a 60-70 year old person will walk in the office with a 50 degree curve and have ZERO signs or symptoms and will not have known.

No doubt highly..progressive, rapidly, moving curves have to be STOPPED.
But is some of our anxiety, PERFECTION based....braces for teeth were unheard of 60 some odd years ago. Now your lucky to meet someone with UNPERFECT teeth.

Personally, I want my daughter perfect and I don't want that little hump on her back. I want her to have a straight, beautiful back.

But maybe the surgeon is just making the point that in many cases (that aren't highly progressive) a full happy healthy life can be lived ...

[txmarinemom]

This paper was written in 2008 - if his observation of the published material was not accurate (or grossly inaccurate), i'm pretty sure someone would have written a rebuttal by now? Why do we not see this rebuttal?

Has is occurred to you that maybe real orthopedic surgeons think he's a quack, and a rebuttal isn't worth their time? This is the man who claimed scoliosis surgery is cosmetic ONLY, and I KNOW *that's* incorrect.

I don't see Weiss (MD Orthopaedic Surgeon) as a Quack. Actually several decades ago, before the advent of Harrington rods, surgeons often recommended non surgical methods for their scoliosis patients (many had great success - a pity it was not well documented). I see Weiss (and others like Rivard/Collard) as carrying on with such work and making up for the lack of earlier documentation. I don't know what other orthopaedic surgeons may think of HR Weiss but certainly many cite his work - and often.

Just curious where you saw Weiss listed as an orthopedic surgeon ... I've never even seen him referred to as an M.D. - only Dr.

"Many" had great success with non-surgical approaches? Really. Let's hear more detail about that, please? If it wasn't well-documented, how are you able to claim "many" had success?

"Many" cite his work, and often? I'd like to see those details, as well, if you're willing to make the claim.

I see this paper (as stated), as an observation of published material in the Pub Med library - if rebuttal is justified ... where is it?

pubmed

Mamamax, I think you underestimate the veracity of everything that's "published material in the PubMed library". Just because it's there doesn't mean it's accurate ... and again, why would REAL doctors argue with a person clueless enough to claim surgery is cosmetic?

[Pooka1]

This paper was written in 2008 - if his observation of the published material was not accurate (or grossly inaccurate), i'm pretty sure someone would have written a rebuttal by now? Why do we not see this rebuttal?"

Maybe for the same reason many scientists won't debate creationists. Actually I'm betting that is the reason.

I question whether that article was peer-reviewed.

I see this paper (as stated), as an observation of published material in the Pub Med library - if rebuttal is justified ... where is it?

Occasionally, I will come across a really bad paper in my field. Sometimes I just toss it. Sometimes I point out the problems in the margins for my own amazement and marvel at it. If I keep the paper to amaze others, I label it with "UGH" across the top. I only have a few such papers.

That Weiss paper is sloppy in its thinking, pretends that out of date references are relevant today, and has typos.

Most lay people will not realize that his conclusions are based on decades old information and so are irrelevant today. If that is a peer-reviewed pub then it could be exhibit A in why most published research results are false. The entire bracing literature except a few papers (controlled studies) is Exhibit B.

That paper is Exhibit A why he is likely marginalized within the orthopedic community.

[Pooka1]

I will continue on with my Spinecor treatment, it is serving me well, which is substance enough for me. Nothing like personal observation.

No actually personal observation is very faulty for known reasons.

That's why we have science.

[Pooka1]

Our doctor told us he can't count the times a 60-70 year old person will walk in the office with a 50 degree curve and have ZERO signs or symptoms and will not have known.

Yes 50*. But how many people have walked in there with a much higher curve and didn't know it?

No doubt highly..progressive, rapidly, moving curves have to be STOPPED.
But is some of our anxiety, PERFECTION based....braces for teeth were unheard of 60 some odd years ago. Now your lucky to meet someone with UNPERFECT teeth.

Then why do insurance companies kick out all that money for "cosmetic" back surgery when they refuse to pay for other cosmetic surgery?

But maybe the surgeon is just making the point that in many cases (that aren't highly progressive) a full happy healthy life can be lived ...

Apparently, if you are above 50* at maturity, you likely won't have that full happy healthy life to live.

[mamamax]

Has is occurred to you that maybe real orthopedic surgeons think he's a quack, and a rebuttal isn't worth their time? This is the man who claimed scoliosis surgery is cosmetic ONLY, and I KNOW *that's* incorrect.



Just curious where you saw Weiss listed as an orthopedic surgeon ... I've never even seen him referred to as an M.D. - only Dr.

"Many" had great success with non-surgical approaches? Really. Let's hear more detail about that, please? If it wasn't well-documented, how are you able to claim "many" had success?

"Many" cite his work, and often? I'd like to see those details, as well, if you're willing to make the claim.



Mamamax, I think you underestimate the veracity of everything that's "published material in the PubMed library". Just because it's there doesn't mean it's accurate ... and again, why would REAL doctors argue with a person clueless enough to claim surgery is cosmetic?

Pam ~

To answer your questions/statements: It has occurred to me that if Weiss's statements were grossly inaccurate, that they would not have gone unchallenged or without rebuttal. Furthermore the referenced paper is about documentation .. if one reads it with a keen eye.

One of the many places that Dr. Weiss is listed as both medical doctor and surgeon is at the SOSORT Foundators page: http://sosort.tleonardi.eu/cms.php?table=page_history

As for success with non surgical approaches - Joe O'Brien just referred to that i see (in Setting The Record Straight) ... think you are capable of doing the research on that Pam, if you are really interested. You can also search Pub Med and Scoliosis Journal to see where Dr. Weiss is quoted.

Don't think i am underestimating anything ... i am reading the referenced paper with a keen eye - rather than through an emotional perspective.

Tell us Pam .. are you still threatening legal action against Dr. Joseph O'Brien? http://www.scoliosis.org/forum/member.php?u=114