Abstract
BackgroundAlthough there is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS) itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information. The main indication for surgical treatment in patients with AIS, is cosmetic. However spinal surgery may, along with other negative side effects, actually cause postoperative clinical deterioration. This complication of surgery has not yet been described in international literature.Case presentationA 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated.This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain.ConclusionScoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.
Highlights
There is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS) itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information
Patient Safety in Surgery 2007, 1:7 http://www.pssjournal.com/content/1/1/7 tain limit, other parameters than progression may play an important role for the individual patient [2,3]
Only a small percentage of the population of AIS patients operated on suffer in respect of their physical appearance enough to justify this very risky procedure, which may not even lead to any clinical improvement (Fig. 1 and 2)
Summary
The procedure or treatment option that leads to the best possible clinical appearance and balance should to be chosen. Patients should be informed that surgery will not improve their health status. Clinical deterioration due to surgery is not yet introduced in the literature as a complication of scoliosis surgery. This complication should be presented to the patient when advising patients on treatment options, so that consent in the pre-surgical stages is sufficiently informed and to prevent such cases as the one presented within this paper. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to patients before the procedure is undertaken [14]. In one study 40% of the patients treated surgically as adults
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