Scoliosis surgery - is it a cure?
First and as usual, I want to say I like Fix's blog site. I am a bit worried that he might be taking some comments personally. I just hope that isn't the case.
Second, I would like to discuss this issue... is surgery a cure?
Fix disagrees with calling surgery a cure and equates fusion surgery with multiple daily insulin injections for Type I diabetes. Thus he is saying fusion surgery is a treatment as opposed to a cure.
I disagree with this equation for a few reasons.
First, there is NO equivalence between multiple daily insulin injections for Diabetes and a single surgical fusion. If only one injection was required in one's life, then the comparison might be relevant.
Second, if fusion surgery in fact:
1. returns some patients to a state where there curve is stabilized over their lifetime (see item 2),
2. they have the same incidence of ALL back issues as a person without scoliosis over their life (this of course assumes no pseudoarthrosis which is of course rare with the new instrumentation and in fact so rare that 95% of kids need no physical restrictions whatsoever to avoid a pseudoarthrosis),
and
3. they don't have to do a thing more or less than anyone without scoliosis to maintain it,
would that be better described as a "treatment" or a "cure?"
While hairs can be split, I think when you are at the point where the claim at least is that a patient is expected to have no higher incidence of ANY back problem over and above the general population, then I call that a "cure" and can still claim intellectual honesty.
So I guess I'm left with the question... if this pans out (same incidence of all future back issues as the general population which we learn from Linda is ~85%) then would you consider that a "cure?"
Or is the problem that nobody believes that could possibly be the case and so don't want to label it a "cure?"
The latter has some ground to stand on as we do not have long-term studies with the modern instrumentation. But the former does not have any ground to stand on as far as I can tell.
First and as usual, I want to say I like Fix's blog site. I am a bit worried that he might be taking some comments personally. I just hope that isn't the case.
Second, I would like to discuss this issue... is surgery a cure?
Fix disagrees with calling surgery a cure and equates fusion surgery with multiple daily insulin injections for Type I diabetes. Thus he is saying fusion surgery is a treatment as opposed to a cure.
I disagree with this equation for a few reasons.
First, there is NO equivalence between multiple daily insulin injections for Diabetes and a single surgical fusion. If only one injection was required in one's life, then the comparison might be relevant.
Second, if fusion surgery in fact:
1. returns some patients to a state where there curve is stabilized over their lifetime (see item 2),
2. they have the same incidence of ALL back issues as a person without scoliosis over their life (this of course assumes no pseudoarthrosis which is of course rare with the new instrumentation and in fact so rare that 95% of kids need no physical restrictions whatsoever to avoid a pseudoarthrosis),
and
3. they don't have to do a thing more or less than anyone without scoliosis to maintain it,
would that be better described as a "treatment" or a "cure?"
While hairs can be split, I think when you are at the point where the claim at least is that a patient is expected to have no higher incidence of ANY back problem over and above the general population, then I call that a "cure" and can still claim intellectual honesty.
So I guess I'm left with the question... if this pans out (same incidence of all future back issues as the general population which we learn from Linda is ~85%) then would you consider that a "cure?"
Or is the problem that nobody believes that could possibly be the case and so don't want to label it a "cure?"
The latter has some ground to stand on as we do not have long-term studies with the modern instrumentation. But the former does not have any ground to stand on as far as I can tell.
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