Regarding likely outcome on pain

[mamamax]

Long term? You want long term?

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=3

CONCLUSION: When compared to a control group of equal sex, age, weight, and height, adolescent idiopathic scoliosis patients had a slightly higher incidence of back pain. When compared to the control group using short form-36 evaluation, the patients had statistically equal scores in all 8 domains. Most patients were able to perform most activities of daily living.

http://www.ncbi.nlm.nih.gov/pubmed/1...m&ordinalpos=9

CONCLUSION: We evaluated long-term QOL in patients treated surgically for scoliosis, and found that it was not impaired, particularly in the case of patients with idiopathic or congenital scoliosis. Larger preoperative Cobb angle and positive sagittal balance at the most recent follow-up were related to poor outcome in QOL as assessed by the SRS-22.

http://www.ncbi.nlm.nih.gov/pubmed/1...&ordinalpos=88

CONCLUSION: Radiologic results, patient satisfaction, and mean scores for quality of life and back function were excellent after CD instrumentation for AIS, but a considerable number of patients had treatment for back problems.

http://www.ncbi.nlm.nih.gov/pubmed/1...ordinalpos=122

Results of about 10 years of follow-up these patients treated with TSRH instrumentation suggest that the method is efficient for the correction of frontal and sagittal plane deformities and trunk balance. In addition, it results in a better life-quality.

As far as I'm concerned, quoting anything that Weiss does is a great way to lose credibility. As Weiss shows, there are plenty of studies showing the complication rate of scoliosis surgery. Those studies were published by the surgeons who had the complications. They're not hiding anything. Weiss apparently can't publish his own long-term followup studies. Instead, he attacks the surgeons who have helped thousands of people every year, in an effort to deflect criticism of his methods. By only using the negative papers in his literature review, he shows that he's either jealous or on some sort of vendetta.

--Linda

Linda - Might I suggest that you write Weiss directly with these concerns which have been echoed in forum. His response would be most interesting I should think. As forum moderator, with a great deal of experience in communicating with others in the medical profession, you would be a perfect choice for this - and to do so (I would think) would prove beneficial for all :-)

[Pooka1]

Financial disclosure???

I have a question about financial disclosure...

Weiss can (probably) honestly say he has no financial interest in surgical instrumentation (if he isn't doing surgeries any more). But would he have to disclose that that he is the director of a clinic pushing alternative treatments when writing articles about surgical outcomes? I would hope so but I seriously doubt it. If so, this is another failure of the publishing process.

[Pooka1]

All we're asking for are a few follow-up studies.

You know, for a guy who is the director of a clinic pushing an alternative treatment that has been around for ~90 years, his "literature reviews" of surgical methods seem to be obvious "Look at the Wookie" moves.

Has a long term study on Schroth ever been published? I'd pay to hear Weiss address that.

[mamamax]

I have a question about financial disclosure...

Weiss can (probably) honestly say he has no financial interest in surgical instrumentation (if he isn't doing surgeries any more). But would he have to disclose that that he is the director of a clinic pushing alternative treatments when writing articles about surgical outcomes? I would hope so but I seriously doubt it. If so, this is another failure of the publishing process.

He is no longer director of that Clinic and has gone into private practice. Let me take a look around and see if I can find the new director for us. I heard that the new one is heavily involved with several large medical facilities.

[mamamax]

The current director:

Administrative Responsibility

Dipl.-Kfm. Peter Schmitz, Director
(Phone 00 49 67 51 / 8 74 – 161 / Fax - 170)

http://www.skoliose.com/Html/Englisch.htm

[Pooka1]

I stand corrected.

It seems Weiss holds some patents on various braces...

http://www.koob-scolitech.com/Hans-Rudolf_Weiss.php

Patent application and trademarks: Chêneau Light brace, kyphologic brace, spondylogic brace, USO

One would hope he starts publishing short- and long-term results for those braces instead of using ancient papers to shoot down modern surgical techniques.

http://www.youtube.com/watch?v=18w6R...eature=related

[LindaRacine]

I stand corrected.

It seems Weiss holds some patents on various braces...

http://www.koob-scolitech.com/Hans-Rudolf_Weiss.php

SpineCor vs. natural history - explanation of the results obtained using a simple biomechanical model.

Weiss HR.

Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr. 2, 55566 Bad Sobernheim, Germany. hr.weiss@asklepios.com

In the recent peer reviewed literature the SpineCor is described as an effective method of treatment for patients with scoliosis. However until recently no prospective controlled end-result study is presented comparing the results obtained with this soft brace to natural history. The objective was to determine whether the results obtained by the use of the SpineCor are better than natural history during pubertal growth spurt. The method employed prospective comparison of the survival rates of SpineCor treatment vs. natural history with respect to curve progression during pubertal growth spurt. 12 Patients with Cobb angles between 16 and 32 degrees (at average 21 degrees) during pubertal growth spurt are presented as a case series treated with the SpineCor. Survival rate of this sample is described and compared to natural history (SRS brace study 1995). All girls treated in both studies were at risk for being progressive with the first clinical signs of maturation (Tanner 2-3). During the pubertal growth spurt most of the patients (11/12) with SpineCor progressed clinically and radiologically as well (at least 5 degrees). Progression could be stopped changing SpineCor to the Chêneau brace in most of the sample described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees, after an average observation time of 21.5 months 31 degrees. At 24 months of treatment time 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 72 months follow-up time 8 % of the patients with the SpineCor survived with respect to curvature progression. Survival proportion in the SpineCor sample, though was 0.08, while in the natural history cohort it was 0.34. The SpineCor treatment during pubertal growth spurt seems to lead to a worse outcome than observation only. The use of a simple biomechanical model explains that in the brace the compression forces exceed the lateral forces used for the corrective movement. Therefore SpineCor does not seem to be indicated as a treatment during pubertal growth spurt.

Does it surprise ANYONE that Weiss would find an issue with a competitive brace?

[mamamax]

Let me be the first to say it ....

No!

And furthermore, he was not trained to the level of proficient, or to treat unsupervised in the application of the Spinecor brace.

I keep meaning to write someone a letter about that :-)

Hope the controversy (along with that of Wong) produced some changes in the peer review process of Scoliosis Journal! And in the process of who the manufacturer sells braces to.

Outside of this - I do have a great deal of respect for Drs. Weiss & Wong in their areas of expertise - Spinecor, simply is not one of those areas.

[Ballet Mom]

The SpineCor treatment during pubertal growth spurt seems to lead to a worse outcome than observation only.[/U] The use of a simple biomechanical model explains that in the brace the compression forces exceed the lateral forces used for the corrective movement. Therefore SpineCor does not seem to be indicated as a treatment during pubertal growth spurt.[/INDENT]

Does it surprise ANYONE that Weiss would find an issue with a competitive brace?

It doesn't suprise me that he came to this result. I came to the same opinion, just from reading the results of the spinecor on the people on this board for the past few years and seeing the huge forces that were acting on my daughter's spine during her major growth spurt.

I really think that the Spinecor would best be used in the juvenile cases, switching to a more robust brace prior to the adolescent growth spurt, and hopefully to minimize pain in adult patients. It would be nice if there was an MD around who could tie this all together.

[mamamax]

It doesn't suprise me that he came to this result. I came to the same opinion, just from reading the results of the spinecor on the people on this board for the past few years and seeing the huge forces that were acting on my daughter's spine during her major growth spurt.

I really think that the Spinecor would best be used in the juvenile cases, switching to a more robust brace prior to the adolescent growth spurt, and hopefully to minimize pain in adult patients. It would be nice if there was an MD around who could tie this all together.

There are many braces (even for adults I find as time goes on) and there are many cases. It would be nice if we could know without arduous trial and error, which would benefit who best. And yes, it would be nice to have an an MD around who could tie it all together!

[RitaR]

Hey Pooka,
Have you already had surgery? I was wondering the reference of pain before surgery, which I have tons of horrible pain all day every day with lots of numbndess and tingling and lots of muscle spasms, versus pain postop immediately after surgery. I'm thinking it can't get much worse and besides that pain after surgery will go away - this just drags on day after day. Ugh! We become tired after a while.
Thanks for your insight.

[Pooka1]

Hey Pooka,
Have you already had surgery? I was wondering the reference of pain before surgery, which I have tons of horrible pain all day every day with lots of numbndess and tingling and lots of muscle spasms, versus pain postop immediately after surgery. I'm thinking it can't get much worse and besides that pain after surgery will go away - this just drags on day after day. Ugh! We become tired after a while.
Thanks for your insight.

Hi Rita,

I am here as a parent of two kids with scoliosis who required fusion. I may soon be on here as a patient (no scoliosis) if my lumbar pain pushes me to the point of getting another radiograph.

I have no trained insight in this field other than general scientific method. That said, some things in this field stand out so much that anyone with scientific training can spot them a mile away.

As I understand it, many, if not most, adult scoliosis patients get surgery for pain. The rest get it I presume for progression and lung impairment.

You should get some opinions from surgeons about the likelihood of your pain being decreased or eliminated with surgery versus PT or Spinecor or something else.

My impression from the testimonials is that you can expect less and even much less pain but some here certainly did not get that result. Only a surgeon can advise you on that.

Good luck

[mamamax]

The current director:

Administrative Responsibility

Dipl.-Kfm. Peter Schmitz, Director
(Phone 00 49 67 51 / 8 74 – 161 / Fax - 170)

http://www.skoliose.com/Html/Englisch.htm

Anyone coming up with anything on this guy? I can't find anything that isn't written in German! Would be nice to know something about the new Director and if his vision includes studies with long term follow up.

[LindaRacine]

Long-term? We have long-term!

http://www.ncbi.nlm.nih.gov/pubmed/2...&ordinalpos=11

Revision Rates Following Primary Adult Spinal Deformity Surgery: Six Hundred Forty-Three Consecutive Patients Followed-Up to Twenty-Two Years Postoperative.

Pichelmann MA, Lenke LG, Good CR, O'Leary PT, Sides BA, Bridwell KH.

From the Department of Orthopaedic Surgery, Investigation performed at Washington University School of Medicine, St. Louis, MO.

STUDY DESIGN.: Retrospective study. OBJECTIVE.: To analyze the prevalence of and reasons for unanticipated revision surgery in an adult spinal deformity population treated at one institution. SUMMARY OF BACKGROUND DATA.: No recent studies exist that analyze the rate or reason for unanticipated revision surgery for adult spinal deformity patients over a long period. METHODS.: All patients presenting for primary instrumented spinal fusion with a diagnosis of adult deformity at a single institution from 1985 to 2008 were reviewed using a prospectively acquired database. All surgical patients with instrumented fusion of >/=5 levels using hooks, hybrid, or screw-only constructs were identified. Patient charts and radiographs were reviewed to provide information as to the indication for initial and any subsequent reoperation. A total of 643 patients underwent primary instrumented fusion for a diagnosis of adult idiopathic scoliosis (n = 432), de novo degenerative scoliosis (n = 104), adult kyphotic disease (n = 63), or neuromuscular scoliosis (n = 45). The mean age was 37.9 years (range, 18-84). Mean follow-up for the entire cohort was 4.7 years, and 8.2 years for the subset of the cohort requiring reoperation (range, 1 month-22.3 years). RESULTS.: A total of 58 of 643 patients (9.0%) underwent at least one revision surgery and 15 of 643 (2.3%) had more than one revision (mean 1.3; range, 1-3). The mean time to the first revision was 4.0 years (range, 1 week-19.7 years). The most common reasons for revision were pseudarthrosis (24/643 = 3.7%; 24/58 = 41.4%), curve progression (13/643 = 2.0%; 13/58 = 20.7%), infection (9/643 = 1.4%; 9/58 = 15.5%), and painful/prominent implants (4/643 = 0.6%; 4/58 = 6.9%). Uncommon reasons consisted of adjacent segment degeneration (3), implant failure (3), neurologic deficit (1), and coronal imbalance (1). Revision rates over the follow-up period were: 0 to 2 years (26/58 = 44.8%), 2 to 5 years (17/58 = 29.3%), 5 to 10 years (7/58 = 12.1%), >10 years (8/58 = 13.8%). CONCLUSION.: Repeat surgical intervention following definitive spinal instrumented fusion for primary adult deformity performed at a single institution demonstrated a relatively low rate of 9.0%. The most common reasons for revision were predictable and included pseudarthrosis, proximal or distal curve progression, and infection.

[Pooka1]

That second paper came out several months later though maybe not long enough for the authors to include the first paper in their review. If they did include the first paper, I'd like to see what they say about why the different revision rates.

It could be more smokers as they mention or it could be something else. I'd like to see revision rate plotted against average Cobb angle and also against average number of years the surgeon has been operating at the time of initial surgery.

Or it could be something simpler... the intrinsic variability of the underlying condition which controls the overall result is so high that you have to look at a few hundred patients to get a true picture. Or you might have to look at a few thousand. It seems like just another manifestation of the universal sampling problem. I mean it's not like the literature is air-tight or anything.

------------

ETA: I was confused... the lower revision rate paper came out after the higher rate one. So it would be interesting to see if the second paper authors comment on the first paper.