Spinal Fusion with Surgical Implantation of Harrington Rods
Once an adolescent’s scoliosis curvatures have progressed greater than 40 to 50 degrees with no end of the progression in sight, most doctors typically recommend surgery to correct correct the curvatures by fusing the spine with metal rods and/or bone grafts. Surgery may also be recommended for adults curvatures that occur in certain areas of the thoracic and lumbar spine when patients suffer from pain or health consequences of the internal organs being crushed.
Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed, so it is generally considered only as a last resort, when all other attempts to halt the progression of the curvatures have failed. The operation can take any where from six hours to 12 hours depending on the severity of the curvatures. Surgery is most commonly performed through very large incisions up and down the middle of the back, known as a posterior approach. For less common, very rigid, or severe curves, additional surgery may be required through the front or side of the body, which means the patient is cut open on both the front and back sides of their body and additional internal medicine surgeons are needed to move the internal organs around to gain access to the spine from the front side.
Although sterilization techniques are utilized extensively throughout the lengthy procedure the fact that the spine must be left open for many hours at a time means the risk of infection is dramatically increased. Additionally, the post op hospitalization generally lasts several days and overall activities are severely restricted for several months.
The spine is then fused with two metal rods that are hooked or screwed to the vertebra to attach them to the spine to provide as much correction as possible. A portion of the spine will also usually be surgically fused together to hold the correction in place. The patient’s ability to bend or move the back following surgery is usually significantly and permanently altered as the instrumentation is left in the body, even after the bones have fused. In addition to supporting the fused area, instrumentation also applies force to the spine to help correct the deformity. This surgery will straighten the abnormal spinal curves considerably, at least for a while following the surgery.
The long term corrections of scoliosis with surgical intervention statistics were indeed grim. Each year one third of all spinal surgeries are performed on scoliosis patients with 20,000 Harrington rod implantation surgeries. Also, every year about 8,000 people who underwent this surgery in their youth for the correction of their scoliosis become legally defined as permanently disabled for life!
Out of the scientific Journal of Pediatric Rehabilitation comes perhaps the most comprehensive study ever published on the surgical treatment of scoliosis:
“Pediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even when the curvature remains stable. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, the outcome was fair or poor…. [S]uccessful surgery still does not eliminate (the neurological causes) of the spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood. For most patients there is little or no improvement in pulmonary function…. The rib deformity is eliminated only by rib resection which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse in patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible spinal deformities is long overdue.” [Emphasis added]
Impact of Spine Surgery on Signs and Symptoms of Spinal Deformity
Pediatric Rehabilitation, 2006 Oct-Dec; 9(4):318-36
Although surgical procedures have greatly improved over the past couple of decades, it still remains one of the most complicated, risky and costly surgical procedures; therefore, it is viewed in most medical circles at the treatment of last resort, when all other attempts have failed. While many adult with moderate or severe cases of scoliosis develop pain as as result of their curvatures because of the challenges and risks involved with surgery they are often turned down for surgery as they are found not good surgical candidates.
Fortunately, there are other effective, evidence based non-surgical, non-pharmaceutical treatments for scoliosis such as the Schroth Method, SpineCor Bracing, Active Release Techniques, Vestibular therapy and Traction De-rotation therapy to name a few. These treatments are all active, neurologically based treatments that are complimentary to each other and when provided in a comprehensive scoliosis program treatments have been found to be extremely effective at halting the progression of scoliosis.
We recommend that patient’s ask their doctor to be referred for alternative scoliosis treatments before considering surgery.
Avoided Surgery with Scoliosis Treatment Alternatives