DÄ internationalArchive11/2011Treatment Was Uncritically Reported

Correspondence

Treatment Was Uncritically Reported

Dtsch Arztebl Int 2011; 108(11): 189. DOI: 10.3238/arztebl.2011.0189a

Weiß, H

LNSLNS

The selective review provided by Trobisch and colleagues is unbalanced with regard to the weighting given to the described therapeutic measures.

The evidence for the conservative treatments is played down (“no level I evidence” for treatment with a brace, “no independent studies” for Schroth therapy), but on the other hand surgical treatment is discussed entirely without a critical approach.

For physiotherapy, level I evidence is available and for brace treatment, level II evidence is available, whereas surgery is supported merely by weak retrospective level III studies with a low response rate of less than 55% in some cases. No conclusion can be drawn from such studies.

Figure 4 shows radiographs from an 8-year-old child (the curvature angle was incorrectly measured), who in Germany would have been spared surgery and instead would have been adequately treated using a brace—and not only in my own practice. End results for the described surgical procedure are not yet available, and it will be interesting to see what will happen to the curvature when the child enters the pubertal growth spurt at age 10–12. It is important to point out that the staples cannot be easily removed should this become necessary.

Unfortunately the authors did not make any mention of how surgery related complications should be dealt with, which, according to some reviews (1, 2) are in excess of 40% in the long term.

DOI: 10.3238/arztebl.2011.0189a

Dr. med. Hans-Rudolf Weiß

Alzeyer Str. 23

55457 Gensingen, Germany

hr.weiss@skoliose-dr-weiss.com

1.
Asher MA, Burton DC: Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 2006 Mar 31; 1(1): 2. MEDLINE
2.
Weiss HR, Goodall D: Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis 2008; 3: 08. MEDLINE
3.
Trobisch P, Suess O, Schwab F: Idiopathic scoliosis. Dtsch Arztebl Int 2010; 107(49): 875–84. VOLLTEXT
1.Asher MA, Burton DC: Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 2006 Mar 31; 1(1): 2. MEDLINE
2.Weiss HR, Goodall D: Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis 2008; 3: 08. MEDLINE
3.Trobisch P, Suess O, Schwab F: Idiopathic scoliosis. Dtsch Arztebl Int 2010; 107(49): 875–84. VOLLTEXT