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Spinal Fusion Effective for Treatment of Scoliosis: Article Reprint from 1958
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Posted on: 11/30/1999
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This article is a reprint of an article that appeared in 1958, reviewing the effectiveness of different methods of treating scoliosis. Surgery for scoliosis has evolved and been refined over the years since the first spinal fusion was done by Dr. Hibbs in 1911. This study examined the outcomes of 266 patients with idiopathic scoliosis (unknown reason) or paralytic scoliosis (caused by something external). The patients were treated from 1947 to 1956 and most were followed for 2 to 8 years.
Of the 266 patients, 130 had idiopathic scoliosis, 116 were female. The average age at time of fusion was almost 14 years old. The youngest patient was 9, the oldest 40. The outcome of these patients was generally positive. On average, the patients showed an average gain of 40 percent in angle curvature (of the spine). Cosmetically, 78 percent of the patients were found to have good results in their appearance. The patients had undergone 1 of 3 types of spinal fusions: the early type, which was first done in 1948, Cobb method, which was first done in 1952, and articular-facet fusion, which was first done in 1953. The success of the surgeries varied. The early method had a 56 percent rate of defective bone grafts, while the Cobb method only had a 7 percent rate. Originally, the articular-facet fusions had a higher rate at 15 percent, but at one point, doctors began using bone grafts from the patients themselves and then this rate dropped to 7 percent.
The researchers also looked at the incidence and the effect of pseudoarthritis, bones that don't join properly, among these patients. The findings showed that the patients with idiopathic scoliosis had fewer incidences of pseudoarthritis than did the other group. Among all patients, 135 separate incidences of pseudoarthritis were found, more in some patients than in others.
For the 136 patients with paralytic scoliosis, 81 were female, and the youngest was 3 years old while the oldest was 20. The average gain for this group was 44 percent. Cosmetically, the average gain was 49 percent. Overall, an average of 78 percent of patients reported a "good result."
Among the patients in the paralytic scoliosis group, the patients who had the early type of fusion showed pseudoarthritis in 65 percent. The Cobb-type fusions showed 36 percent, and the articular-facet fusions showed 14 percent, once the surgeons began using the patients' own bones for grafting.
The author concluded that the surgeries provided good cosmetic and functional results if the proper fusion is done and a solid fusion results.
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References:
John H. Moe, MD. A Critical Analysis of Methods of Fusion for Scoliosis: An Evaluation in Two Hundred and Sixty-six Patients. In Clinical Orthopedics & Related Research. July 2007. Vol. 460. Pp. 21-28.
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