Regarding likely outcome on pain

[Pooka1]

It is funny (as in odd), as you would be all over anyone on this board who used this type of statement if it had anything to do with bracing or exercise or other non-surgical treatments and yet you allow the surgeon to mislead. You should at least be consistent.

No is statement is factual. I don't know how many of his patients achieve pain elimination. Maybe many. Maybe it is similar to with kids in which case the statement is not misleading besides being factual.

[Ballet Mom]

If that is the case then someone is going to have to ask some hard questions now that the instrumentation is looking better about the wisdom of waiting to fuse if it is harder to achieve a good balance in a more rigid, more mature spine.

That is a huge leap. Explain the increasing pain after two years of the AIS patients who were fused, seeing as they would have had these more flexible spines due to age, prior to fusion.

[Pooka1]

That is a huge leap. Explain the increasing pain after two years of the AIS patients who were fused, seeing as they would have had these more flexible spines due to age, prior to fusion.

It was small and should be compared to the pain in the untreated cases as the authors state. Maybe it is far less of an increase compared to untreated kids. Who knows. The baseline matters.

And I'd like to see the cases broken out into good versus less good balance and anterior versus posterior.

The literature is very flawed. In a real sense, there is really nothing to explain because asking me to explain implies the result reported in the paper is real.

[Ballet Mom]

the literature is very flawed. In a real sense, there is really nothing to explain because asking me to explain implies the result reported in the paper is real.

lol

...........

[Pooka1]

Is there some special reason you think the results of the studies you posted are correct whereas the studies referred to in that paper showing most published research results are false?

What would that special reason be?

Basically, do you think this is straightforward or complex?

[Ballet Mom]

Is there some special reason you think the results of the studies you posted are correct whereas the studies referred to in that paper showing most published research results are false?

What would that special reason be?

Basically, do you think this is straightforward or complex?

I give up. Science is obviously useless then, seeing as it can't produce any accurate studies. It's amazing we were able to crawl out of a cave.

[Pooka1]

That isn't the conclusion I would reach starting from the same premises.

[Pooka1]

I don't disagree with what you have said. And the more times Anand comes on here without more explanation and without answering questions, the more I don't disagree. If he does it one more time without addressing this statement then I'm going to outright agree with you.

[Pooka1]

As with braces, we need to see unbiased published outcomes from as many groups as possible beyond the inventors.

Every medical publication has a financial interest disclosure section for a reason.

[LindaRacine]

I agree with you hdugger, my hackles went up immediately also. I think it's bizarre to have a surgeon (or one of his staff members) trying to drum up patients for a new surgical procedure on this forum. It would be one thing if he ever stopped to answer any questions, but he doesn't...he's merely advertising. Either this board allows advertising, or it doesn't.

When I read Anand's first post, my first reaction was to delete the thread. But, there were already responses. If I had to do it over again, I'd probably delete the thread.

And to state that he can eliminate pain is bizarre also. It is true that many patients are helped with pain, but many are not.

We don't know that many of his patients are not helped.

Also,

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

Post-surgery pain

Pain is the primary indication for re-operation [64-66]. The mechanism for increased neck and back pain after surgery is not well understood [67]. Bridwell [10] suggests that late-developing pain could be a complication of surgery, or an effect of aging, or 'perhaps a focus on the disability associated with spinal deformity and surgical treatment.' But the answer for surgeons seems to be to re-operate [68]. Among 190 patients, 19% required re-operation within 2 to 8 years after surgery [67]. For 27 patients who sought treatment 59% felt their pain had been reduced, but 41% did not feel a reduction in their pain levels, and a further 26% were very unhappy with the outcome [68]. Among 34 patients with significant post surgical pain, 56% reported reduced pain after additional surgery, while 44% did not; in the same study, 2 patients who did not have pain before surgery reported pain in the follow up [69].

Pain at the iliac graft site, first noted in 1979, has now been formally published [70,71]; of 87 patients, 24% complained of pain at the graft site, with 15% reporting severity sufficient to interfere with daily activities. As reported by the authors such problems with iliac crest grafting have been severely neglected in literature, especially problems associated with rib-resection.

That literature review is a joke. The vast majority of the papers they included were from the 90's and prior. And, they conveniently did not include any of the new, multicenter studies that have shown great outcomes. For example:

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=5

RESULTS: At 2 years, follow-up on the operative patients was 95% and for the nonoperative patients it was 45%. The demographics for the nonoperative patients who were followed up for 2 years versus those who were lost to follow-up were identical. The operative cohort significantly improved in all QOL measures. The nonoperative cohort did not improve and nonsignificant decline in QOL scores was common. At minimum 2-year follow-up, operative patients outperformed nonoperative patients by all measures. CONCLUSION: It would appear from this study that common nonoperative treatments do not change the QOL in patients with ASLS at 2-year follow-up. However, operative treatment does significantly improve the QOL for this group of patients. Our conclusions are limited by the fact that we were only able to follow-up 45% of the nonoperative group to 2-year follow-up, in spite of extensive efforts on our part to accomplish such.

And, http://www.ncbi.nlm.nih.gov/pubmed/1...&ordinalpos=11

CONCLUSIONS: Despite having started with significantly greater back pain and disability and worse health status, surgically treated patients had significantly less back pain and disability and improved health status compared with nonoperatively treated patients at the time of the 2-year follow-up evaluation. Compared with nonoperative treatment, surgery can offer significant improvement of back pain for adults with scoliosis.

With all that said, I think it's ridiculous that any doctor comes here trolling for patients. If a doctor in which I had an interest did that, I'd run the other way.

[Pooka1]

(of yet another Weiss "review" article)

That literature review is a joke. The vast majority of the papers they included were from the 90's and prior. And, they conveniently did not include any of the new, multicenter studies that have shown great outcomes. For example:

(references deleted)

If you'll recall, Weiss also reached WAAAAAAAAYYY back in history for his 2008 "debate" paper on whether surgery is called for.

This seems to be his M.O..

And not to beat a dead horse but one of the obvious jobs of a peer reviewer is to make sure the latest papers are included if relevant. That's why people in the same subfield are often asked to review papers.

So again, I question the peer review. I should put this statement in my signature to save having to repeat it over and over again. But I have decided to only put quotes from hdugger in my signature so I just have to wait until she says it or something.

[tonibunny]

Just a note on the three UK-based members of the editorial board.

Peter Dangerfield was an extremely well-respected scoliosis surgeon in the 1970s to early 1990s, but it looks like he teaches rather than practices today; he is definitely one of the older generation of consultants and he has retired from medical practice. He no longer appears on the list of registered Consultants for the UK. I would have great faith in his knowledge and experience but his age, combined with his teaching work at Liverpool University, make me wonder if he is able to devote much time to editing this journal or whether he delegates this work instead.

The other two members I have never heard of, which is perhaps surprising because I have been an active part of the scoliosis support scene in the UK for nearly ten years now.

Josette Bettany-Saltikov is a lecturer in Research Methods at Teeside University and her background is in physiotherapy. She appears to be very professional and I wouldn't doubt her skills in these areas, but she is not (as far as I am aware) a medically-qualified doctor. Maybe she concentrates on reviewing articles written by other physios.

Dr Nachiappan Chockalingam does not appear on the General Medical Council's register either. He is an academic, and is Professor of Clinical Biomechanics, Sport and Exercise at Staffordshire University. His research appears to encompass general biomechanics and does not seem to focus on the spine or on scoliosis.

[Ballet Mom]

That literature review is a joke. The vast majority of the papers they included were from the 90's and prior. And, they conveniently did not include any of the new, multicenter studies that have shown great outcomes.

I thought everyone would like my using that paper . It is, however, the only recent paper that I see that actually tries to quantify the specific pain results with percentages, at least in the abstracts.

All the latest studies pretty much say something like "This long-term follow-up of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life", which basically doesn't tell anybody about the significant disability of a portion of these cases. Perhaps now that they compare them to the general population, they can ignore them. The studies from about twenty years ago were actually much more forthright. (And yes, I'm using the Harrington rod studies for a reason).

And your other study is only for a two year time frame. There seems like there might be an issue with pain increasing after the two year mark after surgery, even a member of this board has recently had that happen, and it seems to be shown as statistically significant in the other study I mentioned. So hopefully, they'll be doing on a follow on study with these same people at a five year time frame and perhaps into the future.

Don't get me wrong, I truly hope that people are getting help with their pain through surgery, but it looks to me that lots don't. Perhaps Dr. Anand could post his own results to the board as he must have a significant number of cases and longer term results to be stating what he does.

[Pooka1]

(Anand is a paid consultant for Medtronic and receives royalties for his contributions to the design of the screws used in the minimally invasive surgeries.)

The key test is if other surgeons are intrigued enough to train on the technique. That happened with pedicle screws which I assume are used by just about everyone these days and is happening now for VBS where the list of surgeons trained in the technique is growing.

We have also seen cases like Spinecor where surgeons did apparently try it on the strength of inventor reports and then abandoned it.

It's important to remember that pedicle screw usage in spinal fusion started with one guy who may or may not have held the equipment patent. Lenke invented the system that is in at least one of my daughters. So just because one guy is pushing something doesn't automatically mean it isn't going to pan out. Caution yes, scorched earth skepticism, no. Save that skepticism for much more deserving targets is my advice.

[Pooka1]

Right I was agreeing and adding to your comments. I should have been clearer. Those comments are not directed at you because I was in agreement with you.

ETA: There is definitely misdirected scorched earth skepticism on this group in my opinion and I was addressing that issue with my comments. Your comments were on the money (no pun intended).