Monday, February 28, 2011
Posterior Fusion Scoliosis Surgery video#post2877
Posterior Fusion Scoliosis Surgery video#post2877
This can be a tough one to watch. Squeemish eyes should not view this video. Scoliosis surgery is a risky procedure with poor long-term chronic pain outcomes. It is not medically necessary and only indicated for cosmetic reasons.
This can be a tough one to watch. Squeemish eyes should not view this video. Scoliosis surgery is a risky procedure with poor long-term chronic pain outcomes. It is not medically necessary and only indicated for cosmetic reasons.
Scoliosis of spine: Scoliosis brace treatment
The first scoliosis brace attempts date back to as early as 400 A.D. and have been applied in every conceivable manner (without success) since then. The first metal scoliosis brace we constructed by Ambrose Pare in 1575 and again, didn’t work. Since then scoliosis brace makers have continued to innovate without success. Hard scoliosis brace, soft scoliosis brace, night time scoliosis brace, flexible scoliosis brace, rotational scoliosis brace, traction scoliosis brace; in the end each attempt has prove to be as feeble as the last (not due to lack of effort, application, or funding).
The main problem with scoliosis brace treatment isn’t application, but rather process. As it turns out, treating a condition that is primarily a neurological condition like it is primarily a skeletal spine problem doesn’t work too well (shocking….sarcasm). This very simple understanding of idiopathic scoliosis makes almost 3500 years of scoliosis brace treatment completely obsolete and practically worthless.
In fact, Axial Bio-Tech (developers of the Scoliscore genetic test) did a comparison study of brace treated and un-treated scoliosis patients and found absolutely no difference between the two groups long-term treatment outcomes, even when compared genetically. Scoliosis brace treatment has absolutely no effect on the natural course of the idiopathic scoliosis condition. Essentially scoliosis brace treatment and doing nothing have exactly the same effect….None.
So why do orthopedic doctors and some mis-guided chiropractors continue to prescribe a worthless and obsolete protocol like scoliosis brace treatment. Well the long answer is “this is the way we do things around here” syndrome and the short answer is financial gain.
Thousands of academic reputations and careers are based on the faulty logic that scoliosis brace treatment works and is effective, so to do an about face and reverse one’s position on the topic (even in the face of over-whelming evidence) would be career suicide for most.
The other motivation (financial gain) is a less complicated explanation, but probably more compelling. Scoliosis brace treatment generate hundreds of millions of dollars worldwide every year and you know what they stay about not finding the solution, when there is good money in prolonging the problem.
So how do we break out of this never-ending cycle of scoliosis brace treatment failure? Well, the good news is that we probably don’t have to; prognostic idiopathic scoliosis technology (Scoliscore genetic testing for idiopathic scoliosis, the scoliosis blood test, ect) will probably spell the death of scoliosis brace treatment all by itself.
These new technologies will provide a “heads up” to parents and patients in regards to their child’s idiopathic scoliosis condition and long before scoliosis brace treatment is indicated, so the scoliosis treatment market will naturally move towards more pro-active scoliosis treatment solutions like the Early Stage Scoliosis Intervention program we feature on this website. In fact, preliminary flowcharts and treatment models that focus on Scoliscore genetic testing for idiopathic scoliosis that completely eliminate scoliosis brace treatment and scoliosis surgery have already been developed and are being tested as you read this right now.
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.
Saturday, February 26, 2011
The Current System of Scoliosis Management in the United States is Not Supported by EBM
A "guest blog" by Dr. Josh Woggon.
Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"
It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.
The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.
The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.
One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same as evidence of no effect." (Tarnow-Mordi & Healy 1999)
When the standards of EBM are applied to scoliosis brace treatment (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in adolescent idiopathic scoliosis. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"
When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)
Interestingly enough, exercises have been shown to have the most evidence to support their use in the scoliosis treatment, yet there are no medical scoliosis centers in the United States that currently utilize these methods.
"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)
"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)
"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)
On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of the CLEAR Institute treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).
Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org
Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"
It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.
The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.
The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.
One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same as evidence of no effect." (Tarnow-Mordi & Healy 1999)
When the standards of EBM are applied to scoliosis brace treatment (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in adolescent idiopathic scoliosis. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"
When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)
Interestingly enough, exercises have been shown to have the most evidence to support their use in the scoliosis treatment, yet there are no medical scoliosis centers in the United States that currently utilize these methods.
"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)
"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)
"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)
On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of the CLEAR Institute treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).
Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org
Friday, February 25, 2011
The case against surgical intervention for scoliosis in adolescent patients.
The case against surgical intervention for scoliosis in adolescent patients.
Scoliosis surgery in adolescent idiopathic scoliosis patients isn't medically necessary and has proven poor long-term outcomes. In fact, a 50 year follow up study showed the majority of untreated patients had a higher quality of life than scoliosis surgery patients just 16.9 years after the procedure. Not good.
We need a better way. Work is under way to develop a neuro-muscular rehab based scoliosis spine treatment that is out-performing every single scoliosis brace in existance and will eventually eliminate the "need" for scoliosis surgery in the future. The CLEAR Institute is leading the way and combined with the advent of genetic testing for scoliosis (Scoliscore) can actually start working towards a cure for the condition by eliminating environmental factors in patients with an elevated genetic predisposition.
Exciting new work in the field of eipgenetics is also providing promise of being able to "turn off" active scoliosis genes that will hopefully result in reducing the elevated genetic predisposition for future generations.
Scoliosis surgery in adolescent idiopathic scoliosis patients isn't medically necessary and has proven poor long-term outcomes. In fact, a 50 year follow up study showed the majority of untreated patients had a higher quality of life than scoliosis surgery patients just 16.9 years after the procedure. Not good.
We need a better way. Work is under way to develop a neuro-muscular rehab based scoliosis spine treatment that is out-performing every single scoliosis brace in existance and will eventually eliminate the "need" for scoliosis surgery in the future. The CLEAR Institute is leading the way and combined with the advent of genetic testing for scoliosis (Scoliscore) can actually start working towards a cure for the condition by eliminating environmental factors in patients with an elevated genetic predisposition.
Exciting new work in the field of eipgenetics is also providing promise of being able to "turn off" active scoliosis genes that will hopefully result in reducing the elevated genetic predisposition for future generations.
Thursday, February 24, 2011
Would current treatment even pass evidence based medicine standards?#post2857
Would current treatment even pass evidence based medicine standards?#post2857
Scoliosis brace treatment has been around since the dawn of man and the first scoliosis surgery was performed in 1865, so both treatments pre-date the era of "Evidence Based Medicine". Which makes one wonder, based on the current research data for bracing and surgery, would they even pass the basic standards of care for scoliosis treatment today?
Scoliosis brace treatment has been around since the dawn of man and the first scoliosis surgery was performed in 1865, so both treatments pre-date the era of "Evidence Based Medicine". Which makes one wonder, based on the current research data for bracing and surgery, would they even pass the basic standards of care for scoliosis treatment today?
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