Scoliosis surgery: Friend or Foe?

There is no medically necessary reason for scoliosis surgery.   Sounds crazy right?  I mean, how could a scoliosis spine that is twisted and wrapped around itself not crush the lungs, heart, intestines, liver, and/or every other organ in one’s body?  Well, the medical facts are clear that is somehow doesn’t and won’t pose a life threatening risk to the patient if the severe scoliosis of spine developed after the age of 5 years old (the lungs are fully mature by the age of 5 and thus the risk of developing an actual life threatening condition called “cor pulmonale” is eliminated).  Believe it or not this isn’t even new information.  It has been common knowledge that scoliosis surgery isn’t medically necessary among orthopedic surgeons for decades.  Only  recently has a respected scoliosis spine researcher, Dr. Has Rudolf Weiss, come forward and published an comprehensive review of the medical necessity for scoliosis  surgery.  Here were his findings from this 2008 scoliosis surgery study published in the Journal of Disability and rehabilitation.

“The study found "no evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view...... Until such evidence exists, there can be no medical indication for surgery. The indications for scoliosis surgery are limited for cosmetic reasons in severe cases and only if the parent and family agree with this."

The indications for scoliosis surgery are limited for cosmetic reasons in severe cases (which is a whole other debate) and ONLY if the parents and family agree with this; which in my experience they don’t, because they are generally under the assumption the scoliosis surgery is medically necessary to save the patient’s life; Which it isn’t in cases of adolescent idiopathic scoliosis.

So how did all of this get started anyway?  Well the first scoliosis surgery was performed in 1865 (yes, that’s right, the same year the civil war ended!) and it didn’t go well.  The post-operative results were terrible, which lead to what many experts consider to be the first recorded instance of medical surgeons disputing in print & in court, and ending in one of the most famous orthopedic lawsuits in history: Guerin vs. Malgaigne. This defamation trial ended in Malgaigne's favor (the anti- scoliosis surgery doctor).

The first American doctors performed scoliosis surgery in 1914 and the procedure was becoming relatively routine by 1941.  Dr. Paul Harrington came to fame with the “Harrington Rod” scoliosis surgery in 1950’s and 1960’s.  The blood loss from this 8-12 hour marathon scoliosis surgery has huge and death of the patient was a real concern.  Unfortunately the rods kept breaking and by the 1970’s scoliosis surgery used 2 Harrington rods instead of one. 

By the 1980’s a new hook and pedical screw system has been developed that dramatically increased the amount of correction a scoliosis surgery could achieve, but it also dramatically increased the amount and severity of complications associated with scoliosis surgery. 

Some of the complications of scoliosis surgery include…

“Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while pneumonia, mild pleural effusion, UTI, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications.”

Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation, Scoliosis. 2009 May 7;4:11.

The poor long-term results of scoliosis surgery, coupled with the significant risks of scoliosis surgery prompted a top scoliosis surgery researcher to state:

“Scoliosis surgery… is a major undertaking with significant risks, and rather than reinstituting normality, replaces one abnormality (a flexible, curved spine) with another (a rigid, straighter spine).”  Goldberg et al in 2001.