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X-Ray Showing broken Harrington Rod
Scoliosis
Surgery: the Untold Truth
Scoliosis
Correction questions?
Email:
ScoliosisCorrection@gmail.com
or
Call
Dr. Hersh: 860-727-8820
or 860-524-8955
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Scoliosis Surgery: the Untold Truth
Scoliosis is estimated
to affect 4.5% of the general population. In a nation of
approximately 300 million people, this means that over 13
million cases of scoliosis exist, and almost 500 more are
diagnosed each day – about 173,000 every year. According
to some studies, the average scoliosis patient will suffer
a 14-year reduction in their average life expectancy1.
This means that if by some miracle we could eliminate
scoliosis completely, this would add 168 million years of
health and productivity to our society. Clearly this is
not a minor issue, but an epidemic, and one that should
be taken very seriously.
There are no scoliosis
experts. If there were, there would be no scoliosis patients.
Please consider all the information you get carefully, evaluate
the alternatives, and then make a conscious and deliberate
decision on its validity. For too long, professional jealousy
and ego have dominated all facets of the healthcare profession.
It is time to refocus on the real reason our profession
exists – without any patients, there would be no doctors.
Let us place the health and well-being of those who have
been entrusted to our care before any personal considerations,
and work together to find the most effective cure for every
condition.
Please do not hesitate
to copy and distribute the information on this page to all who
might benefit from it, but under no condition should you
sell it for a profit.
Every year in the
United States, roughly 20,000 Harrington rod implantation
surgeries are performed on patients with scoliosis, at an
average cost of $120,000 per operation2.
One-third of all spinal surgeries are performed on scoliosis
patients. Every year, about 8,000 people who underwent
this surgery in their youth for the correction of their
scoliosis are legally defined as permanently disabled for
the rest of their lives. Even worse, follow-up x-rays
performed upon these individuals reveal that, an average
of 22 years after the surgery was performed, their scoliosis
has returned to pre-operative levels3. The Harrington rods
inserted into these individuals’ spines will either bend,
break loose from the wires, or worse, break completely in
two, necessitating further surgical intervention and removal
of the rod. Once the rod is removed, corrosion (rust) is
found on two out of every three4. After the operation
is performed, the average patient suffers a 25% reduction
in their spinal ranges of motion5. Non-fused adult
scoliosis patients do not have this same impairment.
This flatly contradicts the claim that having a steel rod
fused to your spine will not affect your mobility, physical
activities, or quality of life. These facts are never shared
with the patient prior to the surgery. Parents do not
choose the Harrington rod implantation procedure because
it is the best choice for their son or daughter, but
rather because they are misled into believing that it is
the only choice. However, many studies suggest that the
side effects of the surgery are worse than the side effects
of the scoliosis itself.
Surgery or Alternative Treatment: Dr. Hersh explains
your choices.
Consider the titles & conclusions
of the following Scoliosis studies:
Treating Scoliosis in Young Unneeded
Journal of the
American Medical Association (JAMA), Stuart Weinstein, MD,
University of Iowa, 2003.
“Many with curvature
of spine go on to lead normal lives. Many adolescents diagnosed
with spine curvatures can skip braces, surgery or other
treatment without developing debilitating physical impairments,
a 50 year study suggests.” Long-term results of quality
of life in patients with idiopathic scoliosis after Harrington
instrumentation and their relevance for expert evidence.
Gotze C, Slomka A, Gotze
HG, Potzl W, Liljenqvist U, Steinbeck J.
Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8
“CONCLUSION:
Forty percent of operated treated patients with idiopathic
scoliosis were legally defined as severely handicapped persons
16.7 years after the surgery.”
Medical Complications
in scoliosis surgery
Curr Opin Pediatr
2001 Feb;13(1):36-41
“[Complications]
include the syndrome of inappropriate antidiuretic hormone,
pancreatitis, superior mesentaric artery syndrome, ileus,
pnemothorax, hemothorax, chylothorax and fat embolism. Urinary
tract infections, wound infection and hardware failure are
not addressed.” [They were not addressed because happened
so often!]
Results of Surgical
Treatment of Adults with Idiopathic Scoliosis
J Bone Joint Surg
AM 1987 Jun;69(5) :667-75 Sponseller, Nachemson et al,
“Frequency of
pain was not
reduced… pulmonary
function did not change… 40% had minor complications, 20%
had major complications,
and… there was
1 death [out of 45 patients]. In view of the high rate of
complications, the limited gains to be derived from spinal
fusion should be assessed and clearly explained to the patient.”
Corrosion of
spinal implants retrieved from patients with scoliosis
Akazawa T, Minami S, Takahashi
K, Kotani T, Hanawa T, Moriya H.
Department of Orthopedic Surgery, Graduate School of Medicine,
Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan.
J Orthop Sci. 2005;10(2):200-5.
“Corrosion was
seen on many of the rod junctions (66.2%) after long-term
implantation.” Scoliosis curve correction, thoracic volume
changes, and thoracic diameters in scoliotic patients after
anterior and posterior instrumentation Int Orthop 2001;25(2):66-0
“The correlation between the change in Cobb angle and the
thoracic volume change was poor for both groups.” [e.g.,
whether fused in the front or back of the spine, surgery
will not improve cardiopulmonary function.]
Radiologic findings
and curve progression 22 years after treatment for AIS
Spine 2001 Mar 1;26(5):516-25
“Initial average
loss of spinal correction post-surgery is 3.2 degrees in
the first year and 6.5 after two years with continued
loss of 1.0 degrees per year throughout life.” [So, if a
50 degree Cobb angle is corrected by surgery to 25 degrees,
it will return to its pre-operative condition of 50 degrees
after roughly twenty years.]
Prospective
Evaluation of Trunk Range of Motion in AIS Undergoing Spinal
Fusion
Spine 2002 Jun
15;27 (12) :1346-54 Engsberg et al, Wash U, St. Louis, MO
“Whereas range of motion was reduced in the fused regions
of the spine, it was also reduced in un-fused regions [emphasis
added]. The lack of compensatory increase at un-fused regions
contradicts current theory.” Health-related quality of life
in patients with AIS; a matched follow-up at least 20 years
after treatment with brace (BT) or surgery (ST)
European Spine
Journal 2001; Aug; 10(4): 278-88
“49% of surgically-treated
patients admitted limitation of social activities due to
their back.”
New Research on Scoliosis Surgery
Out of the scientific
Journal of Pediatric Rehabilitation comes perhaps the most
truthful and 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 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
Hawes, M.
Paul Harrington,
known for inventing the surgery that implants metal rods
in
scoliotic spines, stated in 1963 that, "metal does not cure
the disease of scoliosis,
which is a condition involving much more than the spinal
column.”
Good Questions & Honest Answers about Scoliosis
You may contact
Dr. Hersh by email:
ScoliosisCorrection@gmail.com
 
These x-rays show Harrington
rods that bent and broke while still inside the patient’s
body. Many surgeons will refuse to operate on this condition,
leaving the patient with few options to alleviate their
pain & suffering.
New Research, New Possibilities for Scoliosis
On September 14th,
2004, an article was published in BMC Musculoskeletal Disorders
entitled, “Scoliosis treatment using a combination of manipulative
and rehabilitative therapy,” by Mark Morningstar, D.C.,
Dennis Woggon, D.C., and Gary Lawrence, D.C. In this study,
twenty-two scoliosis cases with Cobb angles ranging from
15 to 52 degrees were treated with an experimental rehabilitation
protocol involving specific spinal adjustments, exercise
therapy, and vibratory stimulation. Three subjects were
dismissed from the study for non-compliance. After 4-6 weeks
of treatment, the nineteen scoliosis patients who remained
had experienced an average reduction in their Cobb angle
of 62%. Individually, reduction varied from 8 to 33 degrees.
None of the patients’ Cobb angles increased. The conclusion
of the study was that these results warrant further testing
of this new protocol. Since this study, we have attempted
to understand exactly why such positive results were achieved,
and our research has led us to the following theories:
- Scoliosis is caused by a
dysponesis between the motor-sensory input/output
from the upper trunk to the lower. This dysponesis
is in turn caused by a unilateral impairment of the
spino-cerebellar loop, which is located in the area
between the atlas and the first cervical vertebra. Supporting
this theory is the fact that 100% of scoliosis patients
have a problem with proprioception (orientation
of the body in time and space), and 100% of scoliosis
patients have a loss of the cervical lordosis resulting
in forward head posture. Scoliosis patients are often
unable to touch their chins to their chests; this is
due to a flexion mal-position of C0 and C1. Correcting
this
subluxation restores the neuro-musculoskeletal proprioceptive
function to the patient. However, the postural aspect
must still be corrected for the correction of the Cobb
angle to progress.
- Exercise rehabilitation therapy is mandatory
to reverse the scoliosis. Without patient
compliance, no amount of care can help. It is necessary
to retrain the postural muscles of the body. Vibratory
stimulation overrides the body’s proprioceptive signals
and
mechanoreceptors, thus facilitating retraining
of the postural muscles.
- Cobb angles over 30 degrees cannot be reduced
in the same manner as Cobb angles under 30 degrees.
The muscles contract more on the convexity of the curve,
rather than the concavity, as is the case with angles
under 30 degrees. Normal laws of biomechanics do not
apply in patients with Cobb angles of more than 30 degrees!
These theories have led to the composition of a treatment
protocol for scoliosis patients that, so far, has had
universal success in compliant patients. While surgery
may be necessary in some cases, such as when the patient
exhibits non-compliance with mandatory exercise rehabilitation
protocols, this information should be encouraging
to parents of children with scoliosis who are debating
whether or not to schedule the Harrington rod implantation
surgery for their son or daughter. We encourage
you to delay the surgery until all other non-surgical
options have been exhausted. Long-term ramifications
of the Harrington surgery have been so unfavorable that
the new recommendations are to remove the rods after
four years4. Little to nothing is known
about how the build-up of scar tissue and the disruption
of the spinal pathology will affect the patient in the
future once the rods have been removed.
Before
After
Before
After
Before & After
of 55 yr old patient
Typical Scoliosis Posture
 (right
head tilt, left upper cervical angle, left lower cervical
angle, right high shoulder, right dorsal-upper dorsal angle,
right dorsal-lower dorsal & lumbo-dorsal angle, left lumbo-sacral
angle, right hip anterior & superior, left hip posterior
& inferior. Also forward head posture, superior optical
orbits, left dominant eye)
Recommendations
for Scoliosis Treatment
 One
component is universally lacking in nearly all forms of
scoliosis treatment today: the effect of the cervical spine
in determining spinal pathology, gait, stance, and overall
posture. The head controls all components of the spine below
it, much like how the engine controls the direction of a
train. Without regard for which direction the locomotive
is heading in, how is it possible to control the boxcars
behind it? The
very first aspect that must be addressed
in scoliosis correction is the cervical spine; specifically,
correcting the forward head posture by restoring the cervical
lordosis and normal ranges of motion in the cervical spine,
especially between the atlas and the first cervical vertebra.
Precision x-rays are mandatory; a C0-C1 flexion malposition
will manifest most readily with lateral cervical views in
neutral, flexion, and extension. Follow-up x-rays should
be performed roughly every three months as objective proof
of improvement; should the patient’s progress plateau or
regress, additional rehabilitation or alterations to the
protocol may be required.
Obviously thoracic and lumbar
views are necessary to measure the Cobb angle, but stay
away from full-spine views! The rate of distortion is too
high to allow for consistency and accuracy when comparing
measurements between pre- and post- x-rays. Balance and
proprioception also play an important role in the rehabilitation
of the scoliotic patient. A neurological short leg will
always be found at first; this imbalance should be corrected
with specific spinal adjustments. Once the patient is balanced,
proprioceptive retraining exercises can be prescribed to
maintain the correction.
 One
method of reducing forward head posture and retraining postural
muscles is deceptively simple: by blocking the superior
half of the lens on a pair of glasses, and instructing the
patient to wear them for at least twenty minutes, the postural
muscles of the neck are retrained to better hold the cervical
lordosis in place. Various spinal weights may be placed
on the head and/or hips to activate the weakened postural
muscles. Also, whole-body vibration therapy (WBV) has been
scientifically proven to be extremely effective at proprioceptive
re-education. Do NOT make the mistake of trying to "push"
a scoliosis out of the spine!
This type of adjustment
is foreign to the body, and will be resisted. Most scoliosis
braces are ineffective or even harmful because they do exactly
this. A scoliotic spine must be visualized and corrected
three-dimensionally; the
lateral curve will not reduce until
the spine has been de-compressed and de-rotated.
Adjusting
the apex of the curve, whether into the concavity or the
convexity, will inevitably make the situation worse. Traction
– pulling – is far more effective because it is a subtler,
gentler force, and one that is less readily resisted by
the body. Dr. Clayton Stitzel has developed a chair that
incorporates cervical decompression with lateral thoracic
and lumbar traction, and also addresses the rotational aspect
of the scoliosis simultaneously. This passive exercise therapy
can be performed by the patient at the clinic or at home.
Works Cited
- Idiopathic Scoliosis: long-term follow-up & prognosis
in untreated patients J Bone Joint Surg Am 1981 Jun;63(5):702-12
- The estimated cost of school scoliosis screening
Spine 2000 Sep 15;25(18):2387-91 Yawn & Yawn
- Radiologic findings and curve progression 22 years
after treatment for AIS Spine 2001 Mar 1;26(5):516-25
- Corrosion of spinal implants retrieved from patients
with scoliosis J Orthop Sci 2005;10(2):200-5
- The Effect of Scoliosis Fusion Surgery on Spinal
Ranges of Motion: a Comparison of Fused & Nonfused Patients
with Idiopathic Scoliosis Spine 2006;31(3):309-314
- The etiology of Adolescent Idiopathic Scoliosis
Am J Orthop 2002 Jul;31(7):387-95
- Adolescent Idiopathic Scoliosis: the effect of brace
treatment on the incidence of surgery Spine 2001 Jan
1;26(1):42-7
- Long-term results of quality of life in patients
with idiopathic scoliosis after Harrington instrumentation
and their relevance for expert evidence Z Orthop Ihre
Grenzgeb 2002 Sep-Oct;140(5):492-8
- The Search for Idiopathic Scoliosis Genes Spine
2006;31(6):679-81
- The Ste-Justine Adolescent Idiopathic Scoliosis
Cohort Study Spine 1994 Jul 15;19(14):1573-81
- Long-term follow-up of patients with untreated scoliosis:
a study of mortality, causes of death, and symptoms
Spine 1992 Sep 17;(9):1091-6
- Back pain and disability after Harrington rod fusion
to the lumbar spine for scoliosis Spine 1992 Aug 17;(8
Suppl):S249-53
- Results of surgical treatment of adults with idiopathic
scoliosis J Bone Joint Surg Am 1987 Jun;69(5):667-75
- Thoracic Scoliosis and restricted neck motion: a
new syndrome? Eur Spine J 1998;7:155-57.
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