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Surgery For Scoliosis
1. Scoliosis SurgeryScoliosis Surgery
Is it a cure for the disease?
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
2. Medical Scoliosis Care
Until curvatures progress to 25° or more,physicians prescribe
“observation only.”
At 25°, bracing has been used to stabilize progression, and it’s
efficacy continues to be examined.
Spinal fusion is recommended for skeletally immature patients
when curvatures progress to 40° - 45° and for mature patients
with curvatures > 50°.
Incidence of Curvature Progression in Idiopathic Scoliosis Patients Treated With Scoliosis
Inpatient Rehabilitation”, Hans-Rudolf Weiss, Pediatric Rehabilitation, 2003, Vol. 6, No 1, 23-30
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
3. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
4. Scoliosis surgery is only indicatedScoliosis surgery is only indicated
for cosmetic improvementfor cosmetic improvement
Dr. Han Weiss, director of the Schroth clinic
in Germany, published a highly regarded
article in a 2008 edition 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 surgery are limited for
cosmetic reasons in severe cases and only if
the parent and family agree with this."
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
5. The natural history of scoliosis: curve progression of
untreated curves of different etiology, with early (mean 2
year) follow up in surgically treated curves
Med J Malaysia 2001 Jun;56 Suppl CL37-40
Chauh, Kareem, Selvakur, Oh,
Borhan, Harwant Orthopedic Unit, Universiti Putra
Malaysia
The mean age surgery was 14.15
Preoperative curve was 71.61 degrees
Postoperative curve was 43.78
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
7. 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
Klinik und Poliklinik fur Allgemeine Orthopadie des Universitatsklinikums Munster,
Germany. chrgoetze@uni-muenster.de
AIM: The expert evidence of operated patients with idiopathic scoliosis is
determined by functional and pulmonary restriction. The degree of deformity and
the extent of fusion is crucial for grading disability. In a retrospective study on the
quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22 -
40 years) with idiopathic scoliosis treated with Harrington
instrumentation the grading was registered. METHOD: An average of 16.7
years after the surgery, these data were correlated with the type and size of
curve and to the extension of fusion. RESULTS: A significant correlation
between the grading disability and the extent of fusion (P = 0.53) or
the size of curve (p = 0.4) could not be proven. CONCLUSION: Despite
good long-term outcomes, 40 % of operated treated patients with
idiopathic scoliosis were legally defined as severely handicapped
persons. Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
8. Back pain and disability after Harrington rod fusion
to the lumbar spine for scoliosis.
Paonessa KJ, Engler GL.
Spine 1992 Aug;17(8 Suppl):S249-53
Norwich Orthopedic Group, Connecticut.
Back pain questionnaires were completed by a study group of 103 idiopathic
scoliosis patients fused with Harrington rods from L3 or lower and a control group
of 29 patients fused to L2 or above. Minimum time to follow-up examination was 2
years. The study group had a higher rate of secondary surgeries for
complications or late disc disease below the fusion, a higher back
pain score, more difficulties with normal daily activities, needed
more regular pain medications, and had more episodes of back pain.
Patients older than 30 years at surgery had more of these problems
if fused to L3 or more caudally. The amount of remaining lumbar
lordosis correlated significantly with the difficulty of normal daily
activities.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
9. Results of surgical treatment of adults with idiopathic
scoliosis.
J Bone Joint Surg Am 1987 Jun;69(5):667-75
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.
The outcome of surgical treatment of idiopathic scoliosis in forty-five adults was
studied with special attention to pain, function, self-image, and pulmonary function. All
of the patients were more than twenty-five years old at operation and had been
followed for more than three years. Every patient who was operated on by one of us
(J. E. H.) and who met these criteria was evaluated. The magnitude of the curves
averaged 66 degrees. Standardized gradations of pain and function showed
improvement over-all, but significant impairment remained. There was a reduction
in the levels of peak and constant pain, but no change in the frequency
of peak pain after operation. The number of patients who were pain-free
after surgery was not increased. Functional impairment due to the
scoliosis was lessened, and the ability to perform the common activities
of daily living was improved, but no important changes in occupation or
recreational activity were recorded. Correlations of pain or function, or
both, and the changes in either, were found with only two parameters:
age at follow-up and physical occupation. Pulmonary function, as
measured, did not change. Eighteen (40 per cent) of the patients had a
minor complication and ten (20 per cent), a major complication; there
was one death, due to pulmonary embolism, of a patient who was
excluded from the series. In view of the high rate of complications, the
limited gains to be derived from spinal fusion should be assessed and
clearly explained to patients before the procedure is undertaken.
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
10. 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 unfused regions. The lack of compensatory
increase at unfused regions contradicts current
theory.”
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
11. Medical Complications in scoliosis surgery. CurrMedical Complications in scoliosis surgery. Curr
Opin Pediatr 2001 Feb;13(1):36-41Opin Pediatr 2001 Feb;13(1):36-41
They 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.
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
12. Scoliosis curve correction, thoracic volume changes, andScoliosis curve correction, thoracic volume changes, and
thoracic diameters in scoliotic patients after anterior andthoracic diameters in scoliotic patients after anterior and
posterior instrumentation. Int Orthop 2001;25(2):66-0posterior 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.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
13. The prevalence of disc aging and back pain afterThe prevalence of disc aging and back pain after
fusion extending into the lower lumbar spine. Afusion extending into the lower lumbar spine. A
matched MR study 25 years after surgery for AIS. Actamatched MR study 25 years after surgery for AIS. Acta
radiol 2001 Mar;42(2):187-97radiol 2001 Mar;42(2):187-97
There were significantly more
degenerative disc changes, disc
height reduction and end plate
changes in the lowest unfused disc
in the patient group compared to
the control group.
This level correlated to lumbar pain
intensity as well as to the
diminished lumbar lordosis.
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
14. Health-related quality of life in patients with AIS: aHealth-related quality of life in patients with AIS: a
matched follow-up at least 20 years after treatment withmatched follow-up at least 20 years after treatment with
brace (BT) or surgery (ST). Eur Spine J 2001brace (BT) or surgery (ST). Eur Spine J 2001
Aug;10(4):278-88Aug;10(4):278-88
Both ST and BT patients had a
slightly, but significantly, reduced
physical function.
49% of ST and 34% of BT admitted
limitation of social activities due to
their back.
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
15. Paul Harrington, known for inventing the surgery
that implants metal rods in scoliotic spines, stated
in 1963, "metal does not cure the disease of
scoliosis, which is a condition involving much more
than the spinal column”.
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.
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
16. Anterior Release: An
anterior discectomy
was preformed with a
15-blade on the left side
if the thoracic spine.
Dr. Clayton Stitzel, 1-866-627-
3009, drstitzel@clear-
institute.org,
http://www.treatingscoliosis.co
m/
17. Anterior Release: A
rongeur is used to
complete the
discectomy and
obtain an anterior
release of the curve.
Dr. Clayton Stitzel, 1-866-627-
3009, drstitzel@clear-
institute.org,
http://www.treatingscoliosis.co
m/
18. Anterior Instrumentation:
After the anterior
discectomy is preformed,
screws are then placed
into the left side of the
thoracic vertebral body
to connect the anterior
spinal column to the
precontoured rod.
Dr. Clayton Stitzel, 1-866-627-
3009, drstitzel@clear-
institute.org,
http://www.treatingscoliosis.co
m/
19. Anterior Instrumentation
and Derotational
Maneuver: The rod is
precontoured to the
alignment of a normal
spine in the frontal and
sagittal plane. After the
rod is inserted to the
screws, it is derotated to
correct the curve. In effect,
the spinal deformity is
reduced to the rod. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
20. Anterior Release and
Instrumentation: Much
of the thoracic spinal
deformity has been
corrected after the
anterior release and
application of
instrumentation.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
21. Posterior Instrumentation:
A hook is placed under the
laminae of a thoracic
vertebra. Instead of
screws, multiple hooks will
be placed through the
laminae to connect the
posterior spinal column to
the precontoured rods.
Sublaminar hooks are
placed in different
directions depending on
the need for segmental
compression or distraction. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
22. Posterior Instrumentation:
The precontoured rod is
then placed into the
multiple sublaminar
hooks.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
23. Posterior
Instrumentation and
Derotational Maneuver:
Similarly to the anterior
procedure, the
precontoured rod is
derotated to correct
both the frontal and
sagittal deformities.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
24. Posterior Spinal Fusion
and Instrumentation:
After final placement of
2 rods with cross-links
to increase the stability
of the instrumentation,
much of the thoracic
and lumbar deformities
has been corrected.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
25. Posterior AP Radiograph
demonstrating a
correction of the thoracic
curve from 60 to 22
degrees postoperatively,
and from 78 to 15 degrees
postoperatively.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
26. Dr. Clayton Stitzel, 1-866-627-3009,
/drstitzel@clear-institute.org,
http://www.treatingscoliosis.com
27. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
28. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
29. Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
30. 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.
Spinal implants retrieved from 11 patients with scoliosis were examined. All the
implants were posterior instrumentation systems made of 316L stainless steel and
composed of rods, hooks, and crosslink connectors. Corrosion was classified into
grades 0 to 3 based on macroscopic findings of the rod surface at the junction of each
hook or crosslink connector. Grade 0 was defined as no sign of corrosion, grade 1 as
surface discoloration, grade 2 as superficial metal loss, and grade 3 as severe metal
loss. The depths and characteristics of metal loss areas were examined. Spinal implants
showed more corrosion after long-term implantation than after short-term implantation.
Corrosion was seen on many of the rod junctions (66.2%) after long-term
implantation, but there was no difference between the junction at the hook and those
at the crosslink connector. It is thought that intergranular corrosion and fretting
contributed to the corrosion of implants. The current study demonstrated that corrosion
takes place at many of the rod junctions in long-term implantation We recommend
removal of the spinal implants after solid bony union.
Dr. Clayton Stitzel, 1-866-627-
3009, drstitzel@clear-
institute.org,
http://www.treatingscoliosis.co
m/
31. Pre Treatment Post
Treatment
CLEAR Institute method is a non-surgical scoliosis treatment alternative
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
32. Treatment (Mix, Fix, Set)Treatment (Mix, Fix, Set)
Scoliosis Chiropractic Care
◦ Warm-up (Mix)
◦ Adjustment (Fix)
◦ Rehabilitation (Set)
Maybe a little chocolate therapy
Dr. Clayton Stitzel, 1-866-627-3009, drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
33. Warm up (MIX)Warm up (MIX)
Wobble chair
Cervical Traction
Core Stimulation
(ligaments) &
Muscle
Stimulation
Dr. Clayton Stitzel, 1-866-627-
3009, drstitzel@clear-
institute.org,
http://www.treatingscoliosis.co
m/
36. Resources for parents and kidsResources for parents and kids
Websites on scoliosis
◦www.clear-institute.org
/freeinfo
◦www.fixscoliosis.com
◦www.scoliosis-world.com
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/