Written and reviewed for scientific and factual accuracy by Dr. Austin Jelcick, PhD and Dr. Matthew Janzen, DC
At Scoliosis Care Centers by Janzen and Janzen Chiropractic, we understand that scoliosis surgery is a lifelong and life-changing decision. That’s why we make it our mission to treat scoliosis with a comprehensive non-surgical and non-invasive methodology.
Spinal Fusion Surgery Is Not a Quick Fix
Scoliosis surgery is often mistaken and misunderstood as a quick-fix when even surgical correction of scoliosis is limited by the flexibility (and underlying nerve tension) of the patients’ spine. Many people are surprised to learn that scoliosis surgery often cannot make the spine completely straight as the spine can be over corrected resulting in neurological issues or paralysis. This risk of over correction is precisely why surgeons actively monitor the spinal cord and nerves during surgery in case their corrections are too severe 1.
Many people also find it very surprising to learn that the amount of force applied by the surgeon in an attempt to straighten the spine can be very large. The average amount of force applied during surgery was found to be 121 pounds of force! The actual range varies of course, ranging from 20 pounds of force all the way a staggering 229 pounds of force depending on where in the scoliosis curve the surgeon is attempting to straighten it (ie. the apex of the curve) 2.
Considering that the intervertebral spaces (where the discs are) can be reduced or even closed as a result of the surgical correction, resulting in bone on bone contact; and understanding that the regions of the spine that are surgically fused are expected to only have <1 degree of intervertebral movement 3; it is easy to see that surgery is a serious decision that makes permanent structural changes to the spine and should not be viewed lightly. While every case of scoliosis is different, based on our experience, surgery involving spinal fusion can be viewed as a last resort, not a go-to quick fix or solution for the majority of idiopathic scoliosis patients; as other opportunities often exist to correct the scoliosis curve, thus avoiding scoliosis surgery.
What are your scoliosis treatment goals? What is your ideal treatment outcome?
Avoiding scoliosis surgery is an achievable goal for a majority of idiopathic scoliosis patients when action is taken soon enough. But why is avoiding surgery a goal? To help answer this, let’s first think about what every parent must ask themselves when their child is diagnosed: What scares me about my child having a curved spine, and what are my treatment goals?
The obvious answer is likely going to be to have a straighter spine. However, this begs the question why does a straight spine matter? If we dig deeper, the ultimate goal for any parent (and their child) is usually to ensure that they have a fantastic quality of life as an adult; for the child to grow up to be a happy, healthy, “normal” adult with no pain, mobility issues, or other limitations due to their scoliosis.
With this being our treatment goal, how our treatment gets us here is of paramount importance and should be reflected upon. If surgery fuses bone; removes muscle, connective tissue, and joints; and directly limits mobility while not completely straightening the spine; is the surgical treatment option truly helping us to achieve the goal of a healthy adulthood?
You can listen to what our current and past patients have to say by watching the full video about avoiding scoliosis surgery here: Scoliosis Videos. Alternatively, you can read the transcribed version of the video below:
Avoiding Scoliosis Surgery Video Transcript
[Carole]
My parents didn’t know anything about scoliosis. And at the time, at school, there was a doctor coming and checking on these guys’ back. He checked my back and he said “Uh oh, you should see an orthopedist”, and that’s how it started. And I went to see an orthopedist, and the orthopedist said: “okay you have 12, that’s nothing we’re going to see how it looks like, let’s see you in six months”. Six months later I was at 25. When I was 14 I had reached more than 50 degrees and they decided to operate. I had the surgery.
[Tonya]
Well so he was never actually treated for scoliosis. He ended up having a couple of work accidents in the logging industry that led him to have surgeries and now he’s not good at all. But my aunt, which is his sister, her curve, indecently enough is the exact curvature of Kaitlyn’s to the number. I mean both curves, same spot, same degree before she had her surgery. Yeah–which scared me a lot. So because you know it just… I keep going back to how hard it’s been for my aunt and how many surgeries she’s had. I mean she literally a year ago went to open the refrigerator door and when she did that, one of the rods snapped. She said it sounded like a shotgun went off in her head and she dropped to the ground because those were her supports you know, and now it’s broken. So she had to go in for another surgery.
[Scott]
Is the surgery ever a consideration for you? I mean what do you want to… how far are you willing to take this? What’s going to be the driving factor in deciding how you do things?
[Aimee]
I guess I don’t even let my mind go there. It’s just of course if that were our last option on earth we would do it. I just kind of live day by day like let’s do the best we can. And I don’t think that… I mean we’ve been told so many things by doctors what’s going to happen if we don’t do this or that or this… and nobody knows you know. I think that we just keep going down this path and then you know. What we would like for it to happen is that she get through puberty and we’d be able to hold it you know.
[Darci]
What I think is critical is that this is not fast food you can’t get a fast fix.
[Melissa]
Surgery’s not a quick fix. People think it looks like a quick fix. There’s all sorts of Facebook pages out there and everything about kids having surgery and it’s a tough six weeks but then you go back to your normal life well that’s just not true. That’s not the reality you know. Even if you do a tethering surgery that’s not the reality. It seems like a quick easy fix but the research tells you it’s not. I think people just… or they’ll listen to one doctor. People aren’t comfortable. I’m comfortable being a nurse questioning a physician every day and just maybe my personality. People get one thing they’re told or they’re scared and so they just they don’t get a second opinion. She’s adamant, “do you want surgery?”
[Melissa]
And so if she doesn’t want surgery—surgery, it seems like an easy out it really does. It seems like we could go get fixed. We have an appointment we’re canceling at UCSF on October 4th that we could go, and it seems really easy just to do a vertebral tethering or something. But the truth of the matter is in two years when those are breaking and we’re having more surgeries and we are on narcotics every four hours, I just I want to avoid that if we can.
[Baylee]
No
[Kaitlyn]
So I mean I didn’t want surgery so I had to do something else
[Tonya]
I cannot do that to Caitlin yeah
[Tonya]
I said you know what I don’t have anything to lose why, why not just try it and hope that it works. And then we will have prevented surgery you know. I mean I I looked up, I did research on on the rods, on the tethering you know. I mean I was doing it all I was taking her to PT in Alaska. She did dry needling. I mean we were doing everything that everybody said we needed to do, other than the surgery.
[Aimee]
I know that we’re in the right place and things aren’t easy. It’s a struggle every day, it’s hard on her, but the alternative is not even an option. and I know that there’s not a group that would be more committed to not letting her fail.
[Dan]
By background I’m a scientist. I’m a thermal nuclear physicist. So I know nothing about scoliosis or anything but I know about what is the scientific language and we have seen and I could say dozens and dozens and dozens of places around the world on the internet talking about scoliosis etcetera. And all of them were like yeah you know if you use that kind of toothbrush – a toothbrush and whatever and that kind of exercise well you could say that pray it might help. I’m exaggerating of course but, but that, that’s the way it felt in terms of vocabulary, in terms of language, in terms of I would say non-professionalism. When we saw the video made by Dr. Matt, suddenly it was full of scientific language, full of humility, full of doubt, full of we don’t know. We make hypotheses, we do measurements to try and prove the hypotheses, to try to test the hypothesis and the more we do measurements, the more we refine the hypothesis and the more we refine the hypotheses the more we do more measurements to check if the new hypothesis is better or not. And the whole explanation of the cable that is holding the spine, and with the experiment that shows that when you pull the spine forward when you retain the cable actually the spine has no other choice than to bend, the whole thing made complete sense. And when we arrived here it was it was just even better than our wildest dream.
[Tonya]
It’s been a tough one.
[Melissa]
I think it’s hard when we’re such a society that looks for the quick fix, the easy fix, that medicine is the answer to everything, that surgeons can fix anything. That’s just not true, it’s not, and the research shows it’s not true. If you take the time to look at the problems after, the disability rate, the research shows that within ten years of a spinal fusion most people are on permanent disability. So that means she could never contribute to society, work, anything like that. So there’s just so many things to look into. I just encourage people to. It’s hard though, when you have a surgeon saying you need surgery, you need to do it now. That’s what we were told, we’ve done everything we can do. We’ve tried the brace, we tried a body cast it was still getting worse, and here we are at 40 degrees.
[Darci]
It’s the best fix. It is the healthiest fix, in my opinion. It doesn’t scar– it doesn’t scar in the body. You don’t have to have multiple surgeries. You don’t have to have rejections and infections and whatever and limited mobility, but yet it takes time. And we live in a world right now where they want fast results, fast food, and if you’re looking for that, you know that wasn’t what I was looking for. I was looking for a long-term solution without invasive measures and this is what we got.
[Melissa]
You know it just seemed like it’s so much less invasive.
[Carole]
And that’s how we end up here, and so far Liora is doing great. It’s a hard work, it is hard work.
[Kaitlyn]
It’ll get easier, obviously it’s gotten easier for me. It was really difficult in the beginning, but you get through it. It’s better than not, it’s better than surgery so yeah.
[Melissa]
So it’s gonna be a long process. She’s gonna be a long timer here. Dr. Matt might have to walk her down the aisle I don’t know.
[Tonya]
That was it, I talked to Jocelyn, she really reassured me that you know try this. See if we can help you know and I mean she was pretty certain that, that they could help.
References
- An, Howard S.; Singh, Kern (2016): Synopsis of spine surgery. Third edition. Stuttgart: Thieme.
- Fairhurst, H.; Little, J. P.; Adam, C. J. (2016): Intra-operative measurement of applied forces during anterior scoliosis correction. In Clinical biomechanics (Bristol, Avon) 40, pp. 68–73. DOI: 10.1016/j.clinbiomech.2016.10.014.
- Little, J. Paige; Izatt, Maree T.; Labrom, Robert D.; Askin, Geoffrey N.; Adam, Clayton J. (2013): An FE investigation simulating intra-operative corrective forces applied to correct scoliosis deformity. In Scoliosis 8 (1), p. 9. DOI: 10.1186/1748-7161-8-9.