Response to Weiss HR, Moramarco M: “Indication for surgical treatment in patients with adolescent idiopathic scoliosis – a critical appraisal” (Patient Saf. Surg. 2013, 7:17)

Excerpt

In a letter to the editor published recently in the Journal (Weiss HR and Moramarco M, Patient Saf. Surg. 2013, 7:17), the authors provide an anecdotal selection and interpretation of the current literature on complication rates, revision surgery rates and outcomes of surgical treatment for adolescent idiopathic scoliosis (AIS). They conclude that AIS is a “relatively benign” disease state and the “long-term outcome of surgery for AIS creates a more negative end result over the course of a lifetime than the natural history of the condition itself.” The authors’ interpretation of the literature is unfortunate and misguided, and, as a consequence, provides a biased, single-sided view of the AIS disease state and attempts to refute surgery as a viable treatment option for patients affected with AIS. With any disease state, treating physicians should strive to remain open minded and educated as to the current literature regarding the diagnosis, treatment options and treatment outcomes, and should integrate this information into their practice and share this information with the patients and families that they treat in a factual and unbiased manner. This in turn will facilitate educated discussions between the patient and the physician so that the treatment that is mutually agreed upon is consistent with the existing science and reflects the patient’s desires. The article does not provide a current literature review of the literature. The majority of the basic science, natural history and treatment outcomes literature sited in this “review article” does not reference the original manuscripts, but instead refers to review articles previously written by the senior author (HRW). These review articles carry the same tone and biased data interpretation as the current article, therefore the reader is unable to directly reference the true source of the information, prohibiting an independent interpretation of the information provided. In light of the aims of this review, however it is worth truly investigating what the current literature reports regarding the health impact of AIS and the outcomes following treatment. Loner, et al. compared the health-related quality of life (HRQOL) measures for patients with Scheuermann's kyphosis (SK), AIS, and normal adolescent populations using the SRS-22 outcomes instrument and Visual Analogue Pain Scale (VAS). [1] patients affected with spinal deformity reported worse baseline HRQOL scores for all domains except mental health. AIS patients reported greater difficulty with activities, worse self-image and worse total SRS-22 scores than normal controls. Pellegrino et al. performed a prospective observational study to assess patient quality of life before and after surgical treatment of AIS and evaluate the association between quality of life and curve magnitude, curve correction, and type of instrumentation used in surgery. At one year follow up, SRS-30 and SF-36 scores improved significantly. The greatest changes occurred in the Self-Image and Satisfaction with Management domains of the SRS-30 survey. Total SRS-30 scores were significantly improved at 6- and 12-month follow-up, as were sub-scores in the general health, vitality, and social functioning domains of SF-36 [2]. These results are consistent with previous data indicating AIS has a measurable, negative impact on HRQOL when patients with AIS are compared to controls, and that surgical treatment of AIS can improve reported HRQOL [3‐14]. …