Is Surgery really necessary?

Currently there is mostly no indication for surgery.

See:

  1. Hawes M. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr. Rehabil 2006 Oct–Dec;9(4):318-39.
  2. Weiss HR, Goodall D. The treatment of adolescent idiopathic scoliosis (AIS) according to present evidence. A systematic review. Eur J Phys Rehabil Med 2008 Jun;44(2):177-93.
  3. Westrick ER, Ward WT. Adolescent idiopathic scoliosis: 5-year to 20-year evidence-based surgical results. J Pediatr Orthop 2011 Jan–Feb;31(1 Suppl):S61-8.
  4. Bettany-Saltikov J, Weiss HR, Chockalingam N, Taranu R, Srinivas S, Hogg J, Whittaker V, Kalyan RV Surgical versus non-surgical interventions in patients with adolescent idiopathic scoliosis (Protocol 2013).

 

Untreated patients with Idiopathic Adolescent Scoliosis do function well as revealed in an 50 years follow-up.

See:

  1. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003 Feb;289(5):559-67.
  2. Asher MA, Burton DC: Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 1(1):2.2006 Mar 31.

 

Long-term complications (including re-surgery) are estimated to exceed the 50% level.

See:

  1. Weiss HR, Moramarco M, Moramarco K. Risks and long-term complications of adolescent idiopathic scoliosis surgery versus non-surgical and natural history outcomes. Hard Tissue 2013 Apr 30;2(3):27.
  2. Weiss HR, Goodall D. Rate of complications in scoliosis surgery—a systematic review of the Pub Med literature. Scoliosis 2008 Aug;39.
  3. Mueller FJ, Gluch H. Cotrel-dubousset instrumentation for the correction of adolescent idiopathic scoliosis. Long-term results with an unexpected high revision rate. Scoliosis. 2012 Jun 18;7(1):13. doi: 10.1186/1748-7161-7-31.

What can patients do following surgery for spinal fusion?

After they have undergone surgery to fuse their spine, patients believe that they now have no further need for physiotherapy exercises.

This is often a mistake because the non-fused spinal segment and its associated trunk segments may slip back into a scoliotic pattern if posture and movement are unfavourable because scoliotic posture and movement patterns persist in the consciousness of patients who have undergone surgery. They are not suddenly corrected with surgery. It is therefore important that patients learn specific exercises to achieve correct posture and to provide them with corrected stability below and above the fused segment. The mobile segments in these locations are often overloaded, and this may cause painful symptoms.

Of course, to avoid loosening the implant, the fused spinal segment must not be mobilised. Nevertheless it is necessary to perform exercises to correct posture in order to stabilise the non-fused segments. After spondylodesis, too, loss of correction may occur but this can be largely offset by appropriate exercises.

The journal Krankengymnastik (Zeitschrift für Physiotherapie) 1996, vol. 48, no. 2 includes a profusely illustrated article in German by Christa Lehnert-Schroth entitled "Krankengymnastische Behandlung von Patienten mit operativ versteifter Skoliose" [Physiotherapy for patients with surgically fused scoliosis]. The muscles and joints of the shoulders and arms as well as those of the hips and legs need to function properly because these are the starting point for performing the appropriate Schroth stabilisation exercises.

As well as postural correction, patients who have undergone surgical fusion of the spine also need their often defective respiratory function to be improved.

 

 

 

 

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