May 2009

CLEAR Institute Monthly Newsletter



Chiropractic Leadership, Educational Advancement, & Research

May 2009 Newsletter Content

What's in a Number?

New Research on Scoliosis Surgery
Dr. Dennis Woggon Speaks to Parker about Scoliosis





What's in a Number: The Arbitrary Nature of Standards in Scoliosis


Have you ever wondered why a Cobb Angle of 10 degrees or higher is considered a scoliosis? Or why brace treatment typically does not begin until this number reaches 20 degrees, and surgery is recommended at 40-45 degrees? It may surprise you to learn that these numbers are, in fact, completely arbitrary, are based mainly upon practical & financial considerations, and there is no scientific evidence to support what is basically the general opinion of the medical community.

In a paper written by William Kane in 1977 (Clin Orthop Relat Res, 1977 Jul-Aug;(126):43-6), he proposes the standards of 10 & 20 degrees, "which are admittedly arbitrary and may be contested" (although nobody did). He goes on to state, "Scoliosis of 20 degrees in an immature individual is deserving of treatment. Immature individuals with curves approaching 20 degrees are at risk and should be observed regularly. In my opinion [emphasis added], this means any immature individual with a curve over 10 degrees."

So what was this opinion based upon? Not science, unfortunately, but rather the laws of economics: "The consequences of a public pronouncement that the scoliosis rate is 160 per 1000 are considerable. With a total population of 26,400,000 [individuals aged 10-15 in the US & Canada] it would mean that 330,000 people in the United States have scoliosis and that it is as prevalent as hypertension or diabetes mellitus. Since we should take at least 1 X-ray annually of the skeletally immature population affected with scoliosis, that is 422,400 in the United States and Canada, and since it costs at least $20 per film, it would mean that that bill alone would come to $8.4 million dollars per year."

The American Academy of Family Physicians states that, "Current consensus is that surgery should be performed for curves greater than 40 to 45 degrees when there is growth remaining." They provide two references for this statement (one from 1977, one from 1999), but an in-depth review of these articles finds no real evidence in the either one as to why this is the current consensus. It is merely writers' opinions used to justify surgery, and not a reference based upon science.

The truth of the matter is that scoliosis is much more than a number. It involves much more than simply the spinal column, and requires that the physician address the physiology & function of the entire patient. There is no reason to wait until the Cobb Angle measures 20, 30, or 40 before initiating treatment, and the success of treatment should not be measured solely by the decrease in Cobb Angle. Inserting a metal rod into the spine will reduce the Cobb Angle; however, it also reduces quality of life, ranges of spinal motion, and even life expectancy (Weiss et al., 2008), so patients who undergo scoliosis surgery are, in essence, trading a number for their ability to live, to move, and to survive.




New Research on Scoliosis Surgery


An article published in the journal Scoliosis entitled, "Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature" in 2008 examines the published research on this procedure, and comes up with some startling findings. Consider the following statements made by the authors:

"Early hopes that spinal fusion could be used to leave the patient with a mild residual deformity were not successful as a third of patients lost all postoperative correction within 1 to 10 years of surgery."

"In each spinal surgery case there is an irreversible loss of the normal active range of motion in the spinal column, including the non-fused segments. When compared with control subjects, the ability of surgical patients to side flex was reduced by 20-60%."

"A higher degree of correction results in a higher rate of degenerative osteoarthritis and the high stress on the rigid spine means that even low impact can cause serious injuries."

"The life expectancy of patients with a complex neuromuscular condition was significantly reduced by spinal surgery. Another study involving adults with a less than 60% vital capacity measure, 20% had died within 1 year post surgery. In a survey further highlighting these complications, 21% were contributed to be secondary to spinal fusion surgery."



The conclusion of the authors was: "Scoliosis surgery has a varying but high rate of complications. A medical indication for scoliosis surgery cannot be established in view of the lack of evidence found within this review."

(Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature, Scoliosis 2008;3:9)

If you or a friend or family member is considering undergoing spinal fusion surgery for treatment of your scoliosis, an excellent research article was recently published the debates the pros & cons of this expensive operation. You can access the full text of this article for free by clicking here.





Dr. Dennis Woggon Speaks to Parker about Scoliosis


Dr. Dennis Woggon, author, founder and director of CLEAR (Chiropractic Leadership, Educational Advancement & Research) Institute and Scoliosis Seminars – CLEAR Solutions, spoke to students, staff, and faculty at Parker College of Chiropractic about scoliosis. Dr. Woggon has been practicing for more than 34 years and has lectured internationally on spinal biomechanics in countries including the United States, Canada, Mexico, France, Greece, and Russia.

Dr. Fabrizio Mancini, president of Parker College of Chiropractic, introduced Dr. Woggon while explaining that there wasn’t much funding for scoliosis research before Dr. Woggon. “Dr. Woggon is a vital part of scoliosis research and education,” said Dr. Mancini. “He has traveled all over the world teaching how chiropractic can help this scoliosis epidemic.”