Is there an indication for surgery in patients with spinal deformities? - A critical appraisal.
Hans-Rudolf Weiss, Xiaofeng Nan, Matthew A Potts
PMID 34859161WHAT IT FOUND
No high-quality evidence was found to support a general indication for spinal surgery in adolescent idiopathic scoliosis or Scheuermann’s kyphosis based only on Cobb angle.
Reported complications can be severe and long-term harms are unclear.
Key findings
01The search found no reviews containing prospective controlled or randomised controlled outcome studies to support spinal surgery for spinal deformities.
02There is no general indication for spinal surgery in patients with spinal deformities based only on Cobb angle.
03Reported complications after surgery included severe blood loss, infection, chronic pain, neurological damage and death; mid- to long-term complication rates were estimated at 25% to 48%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, and the authors say a current systematic review with meta-analysis is needed. The search was limited to PubMed and the Cochrane database and was carried out by the first author. Because few systematic reviews were found, comprehensive narrative reviews were accepted, including articles with follow-up beyond 2 years. The appraisal used the CASP checklist, which the paper describes as a qualitative checklist without a score. Complication rates varied widely between articles, and some long-term complications may not be attributable to the original surgery.
The easy way to misread this
Do not read this as proof that spinal surgery is always harmful or never needed. The review found no high-quality evidence for a general Cobb-angle indication and says each case must be reviewed individually.