According to lead author, Daniel Green, M.D., "Fusion for adolescent idiopathic scoliosis using the newer generation spine implants appears to spare junctional disc degeneration and allows patients ten years out to have a relatively normal pain free lifestyle."
Scoliosis is a condition where a person’s spine is unnaturally curved. The condition can be classified as congenital (caused by vertebrae defects at birth), idiopathic (arising after birth and caused by unknown factors) or neuromuscular, where it is a secondary symptom of another condition. Starting in the late 1990s, surgeons started using techniques to fuse the spinal column together, making the previously used Harrington rods obsolete. Spinal fusion is a procedure where physicians “weld” parts of the spine together, so the vertebral column heals into a single rigid unit.
Modern surgical techniques are superior to the Harrington rods surgery because it allows for spinal correction to follow a more natural, physiological course. However, there haven’t been any long-term studies that evaluating how patients who underwent the surgery have fared. To correct this, investigators conducted a pre- and post- operative MRI analysis in patients who underwent the surgery with modern techniques.
The researchers examined all spinal fusions performed by four senior scoliosis surgeons at HSS between 1991 and 1997. Patients were included in the study if they had idiopathic scoliosis, were 21 years or younger and had surgery involving an incision made from the back versus the front or side. Patients had to have fusion of the spine in their lower back.
Of the examined patients, thirty-three potential study participants were located and 20 agreed to participate. These patients returned for physical examination by an orthopedic surgeon that included an MRI. Doctors recorded their medical history with extra attention to level and location of pain and whether or not the patient was taking pain medication. Doctors compared the new MRIs to the ones taken ten years earlier, before the surgery.
The researchers also discovered that patients had good functional scores and could maintain their balance well. No patients reported significant lower back pain. No patients also took pain relief medications for their pain, with the exception of four patients who occasionally took NSAID medications.
The investigators believe the study results are good news for patients. Dr. Green also suggested that the results may cause worry for investigators and companies who are trying to engineer surgeries for scoliosis that do not involve spinal fusion. He concludes, "There is a lot of research and investment being done looking for new technologies that do not use fusion. This study would suggest that there is a challenge for those trying to do that because the patients doing fusion are doing well."