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.

FULL OF LIES AND SCAREMONGERING: "Scoliosis: The Untold Truth"

There is an article which you may have seen doing the rounds on various Scoliosis fora at the moment. It is called "Scoliosis: The Untold Truth" and it is mainly being posted up by chiropractors from the CLEAR Institute. It appears on many CLEAR Institute websites and is also being passed around Facebook.

This article is full of falsehoods and misrepresented information taken from articles and studies in various medical journals, and has been written to scare people away from having surgery. They have cherry-picked statistics that look frightening, and often ignored the conclusions of aticles which appear positive towards surgery. Quite frankly, whoever wrote it is utterly despicable and unethical. I shall now take this article apart, piece by piece.

Scoliosis: The Untold Truth

Scoliosis is estimated to affect 4.5% of the general population. In a nation of approximately 300 million people, this means that over 13 million cases of scoliosis exist, and almost 500 more are diagnosed each day – about 173,000 every year. According to some studies, the average scoliosis patient will suffer a 14-year reduction in their average life expectancy. This means that if by some miracle we could eliminate scoliosis completely, this would add 168 million years of health and productivity to our society. Clearly this is not a minor issue, but an epidemic, and one that should be taken very seriously.

This quotation supposedly comes from Idiopathic Scoliosis: Long-term follow-up & prognosis in untreated patients, published in the Journal of Bone and Joint Surgery, June 1981. This study refers to people who had untreated Adolescent Idiopathic Scoliosis way back in 1932-1948. However, it should be noted that nowhere does it actually say that life expectancy is decreased by 14 years for these patients. This statistic has simply been made up - the phrase "life expectancy" doesn't even appear in the article.

The article does show what can happen if patients are left untreated; severe curves can progress and compromise the lungs and heart, eventually causing premature death in the most severe cases. This is what happened in days gone by. However, the "average" adolescent today will have treatment and be offered surgery if necessary and will NOT need to worry about their life expectancy.

There are no scoliosis experts. If there were, there would be no scoliosis patients. Please consider all the information you get carefully, evaluate the alternatives, and then make a conscious and deliberate decision on its validity. For too long, professional jealousy and ego have dominated all facets of the healthcare profession. It is time to refocus on the real reason our profession exists – without any patients, there would be no doctors. Let us place the health and well-being of those who have been entrusted to our care before any personal considerations, and work together to find the most effective cure for every condition.

Just because there is no cure as yet for Scoliosis does not mean that there are no Scoliosis experts. There are doctors with a huge amount of expertise in treating spinal deformities. Pretty much all of them belong to the Scoliosis Research Society.

Every year in the United States, roughly 20,000 Harrington rod implantation surgeries are performed on patients with scoliosis, at an average cost of $120,000 per operation.

Incorrect - the Harrington Rod is no longer used. It has not been routinely used in the United States, or in most other first world countries, for at least 20 years. The Harrington Rod was the first rod that was specifically invented for scoliosis surgery, and it has now been superceded by more modern instrumentation. Problems that were associated with Harrington Rods have now been addressed in the design of today's hardware, and no longer occur.

One-third of all spinal surgeries are performed on scoliosis patients. Every year, about 8,000 people who underwent this surgery in their youth for the correction of their scoliosis are legally defined as permanently disabled for the rest of their lives. Even worse, follow-up x-rays performed upon these individuals reveal that, an average of 22 years after the surgery was performed, their scoliosis has returned to pre-operative levels.

This statistic is supposedly taken from Radiologic Findings and Curve Progression 22 Years After Treatment for Adolescent Idiopathic Scoliosis: Comparison of Brace and Surgical Treatment With Matching Control Group of Straight Individuals, published in Spine Journal, March 2001.

This study was a follow-up investigation for patients with AIS treated between 1968 and 1977; 156 patients underwent surgery with fusion using Harrington rods, and 127 were treated with brace. The conclusion states: "Although more than 20 years had passed since completion of the treatment, most of the curves did not increase. The surgical complication rate was low. Degenerative disc changes were more common in both patient groups than in the control group [who did not have scoliosis]". It is therefore impossible to correlate this with the claims being made above; the journal article actually says completely the opposite.

The Harrington rods inserted into these individuals’ spines will either bend, break loose from the wires, or worse, break completely in two, necessitating further surgical intervention and removal of the rod. Once the rod is removed, corrosion (rust) is found on two out of every three.

Whilst Harrington Rods are no-longer used, there are many, many people today who are happily going about their lives with these rods in situ. The above statement claims that the rods WILL bend or break, but this simply is not true. Rods do break, but this is relatively rare - especially for the rods of today, which are extremely strong. As for corrosion - rods are only removed if there is a problem (ie they have broken) so one would expect these removed rods to display some wear. It is unlikely to be "rust", however, since that would require exposure to air.

After the operation is performed, the average patient suffers a 25% reduction in their spinal ranges of motion. Non-fused adult scoliosis patients do not have this same impairment. This flatly contradicts the claim that having a steel rod fused to your spine will not affect your mobility, physical activities, or quality of life.

Obviously, having a spinal fusion means that the fused portion of the spine can no longer move. In reality, however, most patients find that they barely notice any loss of motion. This is especially true of those with thoracic fusions, because the thoracic spine actually has very little movement. Even a lumbar fusion does not mean a huge loss of mobility, however; members of various scoliosis fora report that even people fused to L4 are still able to bend to touch their toes. If you are at all worried about how active you will be after surgery, go and ask on the scoliosis fora - you will find people who are still happily dancing, rock climbing, cycling, horse riding, kayaking and taking part in all of the activites they enjoyed before their fusion. Having a fused spine is really not as restrictive as you might imagine.

These facts are never shared with the patient prior to the surgery. Parents do not choose the Harrington rod implantation procedure because it is the best choice for their son or daughter, but rather because they are misled into believing that it is the only choice. However, many studies suggest that the side effects of the surgery are worse than the side effects of the scoliosis itself.

ALL surgeons are obliged to inform their patients of the the risks of surgery and the effects of spinal fusion. It is ludicrous to suggest otherwise. Note that the author is still referring to Harrington Rods......this article was definitely not written by someone who is very knowledgeable about current scoliosis treatment!

The author then goes on to quote from another bunch of journal articles, many of which are old and outdated:

“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

The "40% of all people who had surgery end up defined as legally handicapped" quote is a favourite of the scaremongerers. Note, once again, it refers to people who had surgery many years ago with the Harrington Rod. It isn't relevent today because the problems that used to happen with Harrington fusions have been addressed.

“[Complications] include the syndrome of inappropriate antidiuretic hormone, pancreatitis, superior mesenteric artery syndrome, ileus, pneumothorax, hemothorax, chylothorax and fat embolism. Urinary tract infections, wound infection and hardware failure are not addressed.” [They were not addressed because happened so often!]

Medical Complications in scoliosis surgery, Curr Opin Pediatr 2001 Feb;13(1):36-4

There are risks with any surgery, but these risks are usually tiny and most post-op complications are minor ones such as UTIs from the catheter. More serious complications are very rare. Your surgeon will discuss these with you. If you are worried, ask him for statistics - they should put your mind at rest.

“Frequency of pain was not reduced… pulmonary function did not change… 40% had minor complications, 20% had major complications, and… there was 1 death [out of 45 patients]. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to the patient.

Results of Surgical Treatment of Adults with Idiopathic ScoliosisJ Bone Joint Surg AM 1987 Jun;69(5) :667-75 Sponseller, Nachemson et al

This article (dating from 24 years ago!) is specifically about ADULTS having surgery rather than young healthy adolescents. The article states that in adults, the objective of surgery was to alleviate established problems that they were already having - such as pain and respiratory problems. They were not healthy to start with. In addition, the adults usually have a more rigid deformity, making the surgery more difficult and the outcomes less successful.

The surgeries were performed between 1972 and 1982 (ie between 28-38 years ago!). This is historical data!

The article actually states, "Standardised gradations of pain and function showed improvement over-all. Functional impairment due to the scoliosis was lessened, and the ability to perform the common activities of daily life was improved". Pain was correlated to the age and occupation of the person. The death was due to a pulmonary embolism.

The study is concerned with adults who had AIS but had not had surgery when younger, and were now having problems later in life due to the severity of their scoliosis. That's something to think about.

“Corrosion was seen on many of the rod junctions (66.2%) after long-term implantation.” Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation Int Orthop 2001;25(2):66-0 “The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.” [e.g., whether fused in the front or back of the spine, surgery will not improve cardiopulmonary function.]

Corrosion of spinal implants retrieved from patients with scoliosis, Akazawa T, Minami S, Takahashi K, Kotani T, Hanawa T, Moriya H.Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan. J Orthop Sci. 2005;10(2):200-5.

I have discussed corrosion above. Surgery is not usually intended to improve pulmonary function, but rather to preserve it. However, in very severe cases of scoliosis pulmonary function may well be improved as spinal deformity is removed and pressure removed from the lungs. Evidence for this may be seen in the journal articles Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy by J Nepple and Lawrence Lenke, published in The Spine Journal July 2009 and Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment by K Pehrsson, A Danielsson, and A Nachemson, published in Thorax (International Journal of Respiratory Medicine) 2001;56:388-393.

“Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life.” [So, if a 50 degree Cobb angle is corrected by surgery to 25 degrees, it will return to its pre-operative condition of 50 degrees after roughly twenty years.]

Radiologic findings and curve progression 22 years after treatment for AIS Spine 2001 Mar 1;26(5):516-25

This study has already been discussed above; it is a follow-up investigation for patients with AIS treated between 1968 and 1977. The deterioration of the curves was 3.5° for all the surgically treated curves, and the conclusion reads: Although more than 20 years had passed since completion of the treatment, most of the curves did not increase. Nowhere does it say that curves will return to their pre-operative size. I don't know where the author of the "Untold Truth" got their statistics from but they don't add up when you read the conclusion of this study!