The "40% with Harrington Rods are legally defined as handicapped" chestnut

The following is a favorite quote of some "alternative practitioners" who want to scare people off surgery:

“Forty percent of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons 16.7 years after the surgery."
Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Journal of the American Medical Association (JAMA), Stuart Weinstein, MD, University of Iowa, 2003. Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J.Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8


Sounds scary, right? Except, it isn't really, not when one learns the context of this quote.

The Weinstein study that is referred to is this one:

Health and Function of Patients with Untreated Idiopathic Scoliosis: A 50 Year Natural History Study Stuart L Weinstein, MD; Lori A. Dolan, MA; Kevin F. Spratt, PhD; Kirk K. Peterson, MD; Mark J. Spoonamore, MD; Ignacio V. Ponseti, MD JAMA 2003;289(5):559-567

It does not refer at all to patients who have had surgery. The whole article is concerned with people who had untreated scoliosis. It does refer to disability; it states that 39% of these people felt they had a disability compared to 30% of the non-scoliotic control group. It also makes reference to other studies, of which the following may be of interest: "Horel showed that patients with scoliosis did not represent a disproportionate number of disability pensions" and "Danielsson and Nachemson, in comparing previously braced patients and patients who had undergone surgery....found little evidence to suggest that either patient group was significantly impaired relative to their peers. Another recently reported follow-up of more than 20 years found no difference in quality of life, including back pain and function, between adolescent idiopathic scoliosis patients who had undergone surgery and those who remained untreated".

As stated above, this study does not refer to disability rates in people with Harrington fusions at all.


The actual study which is relevant is the following (originally published in German):

Long-term Results of Quality of Life in Patients with Idiopathic Scoliosis after Harrington Instrumentation and their Relevance for Expert Evidence Gotze C, Z Orthop Ihre Grenzeb 2002 Sep-Oct:140(5):492-8


The aim of this study is stated as follows: "The expert evidence of operated patients with idiopathic scoliosis is determined by functional and pulmonary restriction. The degree of deformity and the extent of fusion is crucial for grading disability. In a retrospective study on the quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22-40 years) with idiopathic scoliosis treated with Harrington instrumentation the grading was registered."

Note that this is a discussion about disability grading. In Germany, people with physical impairments are graded according to the "Severely Handicapped Act 1996" for employment purposes, to ensure that they are not discriminated against because of disability. There are various grades, or percentages, of disability. For "Spinal Injury" these grades are as follows:

10%: low functional effects (deformity, low-grade recurrent or persistent restriction of movement)

20&: moderate functional effects in one vertebral segment of the spine (deformity, often recurrent or persistent severe restriction of movement, instability)

30-40%: severe functional effects in two vertebral segments

50-70%: particularly severe effects (eg stiffening of large parts of the spine; lasting immobilisation by orthosis, including the three sections of the spine (eg Milwaukee brace), severe scoliosis of 70 degree Cobb angle or greater

80-100%: severe limitation in walking and inability to stand


As we can see, being legally defined as "50% handicapped" simply means that you have a spinal fusion OR are wearing a large brace such as the Milwaukee. It DOES NOT mean that you are crippled. You do not necessarily need to be suffering from any side-effects at all from having had that surgery or wearing that brace; the law has simply been made to protect you from discrimination in employment. ANYONE with a Cobb Angle of 70% or greater is automatically graded as 50%, whether they have had surgery or not! I would imagine that there are many, many people who are "legally defined as 50% handicapped" in Germany who are happily living their lives and not giving a second thought to the fact that they had scoliosis surgery or have a fairly large curve. Sadly, this has been seized upon by ignorant scaremongering "alternative practitioners" and is posted, out of context, all over their websites.