Spinal Fusion Statistics

[PLR]

Our son has been recommended for spinal fusion surgery. To help us get a feel for what that might mean, I've been looking for scholarly papers that provide statistics on fusions. I'd love to know, out of all fusions ever done:

• patient age
• patient sex
• reason for surgery (e.g. idiopathic scoliosis)
• surgery details (e.g. types of instrumentation)
• how many had immediate problems, including problem type
• how many had problems in 1 year, 5 years, 10 years, etc., including problem type
• how many had no problems

etc.

If you aware of any such studies, please post.

I'd guess this would be a very common question - sorry if it's been asked & answered before. I've looked some through pubmed etc. and I'll continue looking. Hopefully someone else has already gone through this search.

Summary of our son's situation:
diagnosed with Chiari malformation, Summer of 2006, age 8
decompression surgery, Oct 06
diagnosed with progressing spinal curve, 50 degrees, Fall 2008
currently not experiencing any symptoms

Thank You

[Pooka1]

Hi. Welcome.

I'm not sure the universe of fusion surgeries is going to be AT ALL relevant to your son's situation. I don't even think the non-Chiari fusions (i.e., AIS, Marfan's etc.) in kids are necessarily relevant but what do I know?

What will be most relevant are surgeries for Chiari done with modern instrumentation at a particular bone age.

Good luck.

[PLR]

Hi Pooka

Right, I'm really mostly interested in surgeries closest to my son's situation (11 year old male, Chiari, etc.) but I sort of expect I'd have even less luck finding something that narrowly focused. I'm really surprised I haven't found statistics for a broader set of criteria though...

Best Wishes

[Pooka1]

I'm guessing there are at least some outcome papers for Chiari in kids of various bone ages but I don't know that.

I think the best bet is to ask a few surgeons who have done numerous Chiari fusions with modern instrumentation. But maybe they don't specialize at that level (Chiari vice AIS vice Marfans). Then you just need that many more opinions.

Now that you bring it up, I wonder what percentage of kids' fusions are attributable to AIS vice Chiari vice Marfans vice etc.. I'm guessing the largest group wll be AIS but I don't know that.

Again, good luck.

[marmyte]

PLR i don't want to appear negative because i think the research you're trying to do for your son is great, but i doubt that you'll get the information you want. spinal fusion surgery in its current incarnation is relatively new (i'm not sure where she heard it, it may have been my surgeon who told us, but my mum said that orthopaedics is 20 years behind every other surgical genre in terms of development) - the current instrumentations and techniques have been used widely since the mid 90s and ok that's now over 10 years, but if you consider that most patients are in their teens, those people aren't all that old now! this worried my parents a lot about my surgery: that long term effects aren't really known but you kind of just have to jump off that cliff.

most people weigh up the benefits of having surgery vs the costs of doing nothing and when you look at it like that, it's a no brainer.

as i said, i doubt the papers you are looking for exist, though i'm sure they're in development. studies about what patients are like at 1 year post op (and even 2 to 5 years) would be largely useless in my opinion, because some people will only have finished fusing at a year, you wouldn't expect to see a drastic difference between then and the day of the surgery (in terms of it having a negative impact on their life, it would generally only be positive at that point).

most fusions for AIS are done on girls, JIS is more prevalent in boys and i'm not sure what the stats are for infantile and congenital scoliosis in terms of gender. patient age... well that's a huge variety. some people are diagnosed with AIS but don't have surgery until they are in their 50s for whatever reason.

sorry i can't be of any more help but like i said, i don't think the research you require in the format you're looking for will be available. however, between the members of this forum there are many experiences available. you will, of course, be able to ask your son's doctor how many surgeries he/she has performed on cases similar to your son's and get an idea from that information.

[Karen Ocker]

Scoliosis fusions have been done for over 40 years.

I had an old original, uninstrumented fusion in 1956!!!!. It served me well over 40+ years ---and then had a successful revision 6+ years ago. Scoliosis surgery is over 40 years old---but techniques and instrumentation are now far superior.

[Snoopy]

PLR,

Welcome!

I'm not sure you'll find the studies you are looking for, but have you tried the SpineKids forum? It is similar to this forum, but is visited mostly by kids/teens and a few adults. I know there are several kids on that forum with Chiari malformations and have had surgery. If nothing else, you might find some of the information helpful. Good luck.

Mary Lou

[Pooka1]

(snip)Scoliosis surgery is over 40 years old---but techniques and instrumentation are now far superior.

You're not kidding.

About 95% of kids need no physical restrictions whatsoever to get a good fusion with the new instrumentation.

That's AMAZING.

[txmarinemom]

Our son has been recommended for spinal fusion surgery. To help us get a feel for what that might mean, I've been looking for scholarly papers that provide statistics on fusions. I'd love to know, out of all fusions ever done:

• patient age
• patient sex
• reason for surgery (e.g. idiopathic scoliosis)
• surgery details (e.g. types of instrumentation)
• how many had immediate problems, including problem type
• how many had problems in 1 year, 5 years, 10 years, etc., including problem type
• how many had no problems

etc.

If you aware of any such studies, please post.

PLR, it's highly unlikely that study exists.

There is a broad study on older instrumentation Linda Racine listed not long ago, but that's as close to what you're seeking as I believe you'll find. There are a few studies out there on AIS fusion surgery, but not really long-term results.

Spinal fusion hardware and techniques have changed so much over the years, data in a long-term study would become practically irrelevant before compiled. Comparison of fusion surgery results with no instrumentation, fusion surgery with Harrington rods, Luque wires, CD systems, Moss-Miami, ISOLA, TSRH, etc., etc. would be pointless. The different generations of hardware are like apples to oranges, although I know plenty of people with just about all types that have had issues - and those who haven't. Anecdoctal, not science.

Also, it's rare to see a study list the *exact* type of hardware installed. For that matter, many people *here* don't know what they have inside them.

The best thing you can do is read these forums for real stories. BTW, you said your son has Chiari, which pretty much disqualifies a patient for inclusion in any broad study - especially mixed with AIS/JIS patients. ACM patients aren't a majority among fusion patients: Most studies that *are* done on fusion are done on AIS/JIS fusion surgery.

Good luck to y'all.

Regards,
Pam

[Beckymk]

You're not kidding.

About 95% of kids need no physical restrictions whatsoever to get a good fusion with the new instrumentation.

That's AMAZING.

I know the people at our church have had this reaction when they find out that Carolyn has no brace & has already been up & about.

Especially the secretary that had this fusion done when she was a kid & said she had to stay flat on her back for 6 months & I believe in a cast.

It really is freaky to think they get this back surgery and then they have them up & walking within days! Carolyn is almost 4 weeks and we have already been to the mall a few times (she can do about 2 hours).

As for the studies, I will be of no help because basically we just jumped for the surgery. Carolyn's was idopathic but her dad has the scoliosis & we could see what she would be like without the surgery (not that it's really stopped him much other than a few things).

[LindaRacine]

Hi PLR...

Even if such a study existed (I'm sure it doesn't), it could be meaningless to you. What you really want to know are the outcomes of your surgeon, on children of similar age to your son, and who had essentially the same fusion. Outcome studies are really great, but if your surgeon is a hack, they're of no use. It could also be the other way around (where the outcomes were poor, but your surgeon is much better).

Good luck!

Regards,
Linda

[rtremb]

PLR

This is one article you might find interesting.

http://www.pubmedcentral.nih.gov/art...medid=18826571

I am not wanting to comment on the content. The article gives some views for and against surgery. This was originally posted onto this site late last year by another member of this forum.

Ruth

[Pooka1]

PLR

This is one article you might find interesting.

http://www.pubmedcentral.nih.gov/art...medid=18826571

I am not wanting to comment on the content. The article gives some views for and against surgery. This was originally posted onto this site late last year by another member of this forum.

This article leaves much to be desired in the writing and editing departments for the "con" surgery side. I don't think it is a peer-reviewed journal based on this article.

The "con" surgery side is listing old articles (1941!!!) that are IRRELEVANT to modern surgical techniques and instrumentation. I question the editing and peer review (if any and I doubt it).

The most important point is that there is no alternative to surgery. Surgery is the only proven option at this point. So you can attack surgery but you can't put up something in its place. What other group pushing counterfactual information does that remind you of???

Surgery clearly cures the signs and symptoms of scoliosis. It did for my daughter. Moreover, there are indications the earlier you get surgery, the LESS problems you have down the road. This article needs to be retracted by the journal in my opinion.

[txmarinemom]

PLR

This is one article you might find interesting.

http://www.pubmedcentral.nih.gov/art...medid=18826571

I am not wanting to comment on the content. The article gives some views for and against surgery. This was originally posted onto this site late last year by another member of this forum.

An pro/con surgery debate co-authored by H.R. Weiss, citing (deliberately?) antiquated references is a useless tool in making an informed decision on whether to operate.

Yes, Ruth, this article has been posted before. If you'll recall, it's the one that caused so much uproar with ridiculous statements like:

"Health-related signs and symptoms of idiopathic scoliosis cannot be changed by surgery." and " ... the indication for spinal fusion surgery is for cosmetic reasons, only. "

Both statements are absolute nonsense.

The ONLY treatment for scoliosis that can affect health-related issues (organ impingement with higher curves, for example) is fusion surgery. Period.

And spinal fusion is purely cosmetic???

Fusion surgery is performed to address pain, prevent progression, stabilize the spine to avoid damage/further damage, prevent or reduce organ impingement, and a multitude of other very NOT cosmetic reasons.

I can assure you *I* didn't have it done because I didn't like the way I looked, and I find that statement as insulting as I did the first time someone drug it out (not surprisingly, by a Schroth proponent who refuses to reveal his seemingly vested interests).

The obvious bias and/or ignorance represented in this article are quite possibly part of why many here are so dubious of Schroth.

Regards,
Pam

[LindaRacine]

The most important point is that there is no alternative to surgery. Surgery is the only proven option at this point.

Really? Are there randomly controlled studies? ;-)