Latest / Scoliosis with Dr. Chris Gubbels / Before You Get Scoliosis Surgery, Watch This

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Before You Get Scoliosis Surgery, Watch This · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: If a surgeon just told you that your child needs scoliosis surgery, then the next 10 minutes could save you tens of thousands of dollars, months or years in recovery, and maybe a surgery that's not actually needed in the first place.
• 0:13
  SPEAKER_00: Hi, I'm Dr.
• 0:13
  SPEAKER_00: Chris Goobels, head scoliosis clinician here at School Light Care Denver, and I have treated hundreds of scoliosis patients over the last 18 years, and a good chunk of them came to me after having a previous scoliosis surgery.
• 0:25
  SPEAKER_00: Most of them are still in pain and still dealing with problems that no one warned them about before having surgery.
• 0:31
  SPEAKER_00: So by the end of this video, you're gonna know the real complication numbers associated with surgery.
• 0:36
  SPEAKER_00: Why a successful surgery doesn't always mean a happy patient in the end, and the exact questions you should ask your surgeon before ever committing to getting surgery.
• 0:45
  SPEAKER_00: So picture this appointment.
• 0:46
  SPEAKER_00: Maybe you've already had this appointment.
• 0:48
  SPEAKER_00: You're sitting across from someone who's done this thousands of times.
• 0:51
  SPEAKER_00: They talk about the procedure like it's just some basic routine.
• 0:55
  SPEAKER_00: Fuse a few vertebrate, straighten up the curve, and you're back to normal within a year.
• 0:59
  SPEAKER_00: Of course you're gonna trust them.
• 1:00
  SPEAKER_00: By the way, they're considered the experts in the field.
• 1:02
  SPEAKER_00: And that's exactly why most people never ask the next question.
• 1:06
  SPEAKER_00: Because the more routine a surgeon makes this sound, the less like you are to worry about the risk associated with it.
• 1:12
  SPEAKER_00: So I went ahead and pulled some of the research myself.
• 1:15
  SPEAKER_00: And what I found is routine depends entirely on what kind of scoliosis you actually have.
• 1:20
  SPEAKER_00: For example, idiopathic scoliosis, which is the scoliosis most teenagers actually get diagnosed with, runs around a 20% complication rate.
• 1:28
  SPEAKER_00: When you look at adults, adult scoliosis jumps to up to 44% complication rate.
• 1:33
  SPEAKER_00: And when you look at neuromuscular scoliosis, that runs as high as 35% complication rate.
• 1:38
  SPEAKER_00: And in one study looking specifically at adults that had surgery, that number was as high as 78%.
• 1:44
  SPEAKER_00: Which means in some of those studies, the researchers actually found that things went wrong or patients had complications, and more patients where things didn't go wrong or they didn't have any complications.
• 1:54
  SPEAKER_00: If the risks are so well documented, why do so many people blindly go through with it?
• 2:00
  SPEAKER_00: And I think that really comes down to one word, success.
• 2:03
  SPEAKER_00: You see, I think a lot of people think successful surgery means that the problem is solved and they won't have to think about it again.
• 2:08
  SPEAKER_00: For example, I had this guy come in last week and we were talking about non-surgical treatment options, but he said, if I have surgery, it's fixed.
• 2:15
  SPEAKER_00: I just really looked at it and said, no, not really.
• 2:17
  SPEAKER_00: That's not what surgery actually means.
• 2:19
  SPEAKER_00: A lot of people think that and they misunderstand that when they think about surgery because they associate an improvement in the alignment on an x-ray with something actually being corrected or fixed.
• 2:31
  SPEAKER_00: But straighter alignment is not the same thing as fixed.
• 2:34
  SPEAKER_00: For example, let's say you go through surgery, recovery happens and you go back and do the follow-up.
• 2:38
  SPEAKER_00: Your surgeon pulse will be x-rays and says exactly what every patient wants to hear.
• 2:42
  SPEAKER_00: This is a success, the curve is corrected, the hardware looks clean, and on paper, you got exactly what was promised that the surgery is holding your spine in a different position and the hardware is properly attached.
• 2:53
  SPEAKER_00: Except one thing: success on a post-surgical x-ray and success in your actual light frequently turned out to be completely different things.
• 3:01
  SPEAKER_00: You see, a surgeon typically grades his work on how well an X-ray actually looks post-surgery.
• 3:06
  SPEAKER_00: Patients grade the success whether or not they're out of pain and they can do all the things that they want to be able to do pain-free.
• 3:13
  SPEAKER_00: And the reality is how a patient grade success and how a surgeon grade success are frequently not the same.
• 3:18
  SPEAKER_00: I see this consistently in my office.
• 3:20
  SPEAKER_00: Patients come to me post-surger, the films look fine, the curve looks corrected, but they still can't bend down and touch their toes without pain.
• 3:28
  SPEAKER_00: So if surgery was technically successful, why are these patients from my office years later still dealing with chronic pain?
• 3:35
  SPEAKER_00: And this is where the conversation gets a lot more interesting.
• 3:38
  SPEAKER_00: So let's say you push through the surgery and a year out you generally feel good, assuming there's no infection or anything like that.
• 3:44
  SPEAKER_00: It's easy to assume that all the hard work is actually behind you.
• 3:47
  SPEAKER_00: Except for one thing, the most serious problems with spinal fusion typically don't show up for years later.
• 3:53
  SPEAKER_00: They typically show up after everyone stopped checking your scoliosis, including your surgeon, your family, and likely even yourself.
• 3:59
  SPEAKER_00: Here's why.
• 4:00
  SPEAKER_00: Rod breakage is common enough that one surgeon is studying actually put a bunny.
• 4:05
  SPEAKER_00: If a patient lives long enough, you can count on it happening eventually.
• 4:09
  SPEAKER_00: Then you get pseudoarthritis, is where the fusion never actually solidifies to the bone, it never actually attaches like it's supposed to.
• 4:16
  SPEAKER_00: And that shows up in over a quarter of patients in just a few years.
• 4:20
  SPEAKER_00: And those pseudoarthrosis, those non-unions, are notoriously hard to catch in the beginning.
• 4:26
  SPEAKER_00: And here's the one that I deal with most constantly.
• 4:28
  SPEAKER_00: It's called adjacent segment disease.
• 4:31
  SPEAKER_00: You see, your spine is not built to be locked in place, it's built to move.
• 4:35
  SPEAKER_00: Your spine is designed to spread movement across all 24 vertebrae and all of the joints of the spine.
• 4:41
  SPEAKER_00: And the second you fuse any of it, all that motion that's generally spread across the entire spine gets dumped into a few different segments.
• 4:50
  SPEAKER_00: And it's the segments right above and below the fusion.
• 4:53
  SPEAKER_00: That's why it's called adjacent segment disease.
• 4:56
  SPEAKER_00: So when you fuse one vertebrae or several vertebrae, the joints above and below have to take on all that extra work.
• 5:03
  SPEAKER_00: And all the movement that used to be spread out through several joints has to be done on the joints right above and below the fusion.
• 5:09
  SPEAKER_00: And that leads to what's called adjacent segment disease, where those joints break down and decay at an accelerated rate.
• 5:16
  SPEAKER_00: And that's why patients a lot of times go back for additional surgeries where they'll fuse additional segments above and below the areas that were fused.
• 5:24
  SPEAKER_00: This happens all the time when people have their thoracic spine fused and they stop right at the lumbar or upper lumbar vertebrae.
• 5:31
  SPEAKER_00: A lot of times years later, and people have to go back and they will want to fuse more of those vertebrae.
• 5:37
  SPEAKER_00: So this basically means when you have a fusion that fixes one part of your body, that's the very reason that you start to have problems later on in other parts of your body.
• 5:45
  SPEAKER_00: You see, the fact that his surgery went fine was never the end story.
• 5:49
  SPEAKER_00: It was the beginning of the next story.
• 5:52
  SPEAKER_00: And that's when I started to realize that maybe the most important conversation isn't about whether or not surgery works.
• 5:58
  SPEAKER_00: It's about whether or not someone actually needs it in the first place.
• 6:01
  SPEAKER_00: So if this comment is already changing how you're thinking about your next appointment and how you're thinking about surgery with scoliosis, be sure to hit the subscribe button and hit that bell icon.
• 6:12
  SPEAKER_00: That way you'll be notified when we release new videos related to scoliosis and the best scoliosis treatment options.
• 6:19
  SPEAKER_00: So all of the stuff we're talking about with surgeries and how things can go wrong reminds me of one of our patients at Scolicare.
• 6:25
  SPEAKER_00: And this patient actually came in with a 33 degree scoliosis.
• 6:29
  SPEAKER_00: What's interesting about her, because she was still growing, the surgeons actually decided, even though her curve was 33 degrees, that a surgery was inevitable.
• 6:38
  SPEAKER_00: So they went ahead and scheduled her for surgery, and the wait time was about a year.
• 6:42
  SPEAKER_00: So she was scheduled for a surgery, but it was a year out.
• 6:45
  SPEAKER_00: Now, the parents were not really satisfied with that prognosis.
• 6:48
  SPEAKER_00: So they started looking to see if something else could be done for, which is what actually brought them into Scully Care.
• 6:53
  SPEAKER_00: This is actually her right there, and this is her when she first came into Scully Care.
• 6:58
  SPEAKER_00: And you can see she has this 33-degree thoracal lumbar scoliosis, and you can see how her body looks deformed on the outside, and you can see the curve visible there.
• 7:07
  SPEAKER_00: So instead of doing surgery, we said, you know, let's go ahead and do a custom scoliosis brace.
• 7:12
  SPEAKER_00: We think this is treatable, we think she's actually going to respond well to treatment.
• 7:16
  SPEAKER_00: So this was actually her in the brace, and this is a corrective brace, and you can see her spine in brace, like it looks incredible.
• 7:23
  SPEAKER_00: If you look at some other videos, I talk a lot about how in brace correction is the biggest predictor of brace being successful to treat scoliosis.
• 7:31
  SPEAKER_00: So this is her before treatment, pre-treatment.
• 7:34
  SPEAKER_00: This is her after 12 months out of brace.
• 7:36
  SPEAKER_00: The curve went from 33 degrees R down to 11.
• 7:39
  SPEAKER_00: And this is her 22 months after starting treatment out of her brace.
• 7:43
  SPEAKER_00: So her curve went down to six degrees.
• 7:45
  SPEAKER_00: She was actually no longer a candidate for surgery, and the surgery was canceled.
• 7:49
  SPEAKER_00: So this is her before, this is her after 12 months, and this is her body after 22 months.
• 7:55
  SPEAKER_00: So the surgery she was told was inevitable ultimately was not inevitable.
• 8:00
  SPEAKER_00: It's just that her doctors didn't understand or were not aware that there were non-surgical treatment options that can actually be successful at reducing scoliosis, even scoliosis with a high risk of progression.
• 8:13
  SPEAKER_00: So before you accept that surgery is your only option, ask your surgeon these four questions.
• 8:18
  SPEAKER_00: One, what's your complication rate with patients with my specific and severity of scoliosis, not scoliosis surgery in general?
• 8:26
  SPEAKER_00: Two, what does success mean here?
• 8:29
  SPEAKER_00: Does that include how my back will actually feel day to day, not just right away, but down the road?
• 8:36
  SPEAKER_00: Or do we just look at what the x-rays look like?
• 8:38
  SPEAKER_00: Third, what happens to my spine 10 or 20 years from now, not just in the first year after surgery?
• 8:44
  SPEAKER_00: And four, has anyone looked at non-surgical treatment options for scoliosis like mine and of the same size as mine?
• 8:51
  SPEAKER_00: Or are we just gonna go blindly into scheduling surgery?
• 8:54
  SPEAKER_00: Asking those four questions can completely change the conversation.
• 8:57
  SPEAKER_00: In fact, I get many patients that are referred to our office in School Like Care Denver from surgical offices because patients insisted that they did not want surgery and they wanted to exhaust non-surgical treatment options first.
• 9:10
  SPEAKER_00: And it wasn't until they actually started asking questions and they started pushing to learn more about non-surgical treatment options that the surgeon ever refer them to us.
• 9:19
  SPEAKER_00: And once you've asked them the question, see there's only one place left to look.
• 9:23
  SPEAKER_00: And that's like what are the alternative options?
• 9:25
  SPEAKER_00: And for most people, the options actually a lot simpler than you expect, and that's simply get a second opinion, not from another surgeon, but from someone that actually specializes in non-surgical treatment options.
• 9:36
  SPEAKER_00: Look, if your only tool in your toolbox is a hammer, everything looks like a nail and you want to use the hammer on everything.
• 9:44
  SPEAKER_00: But you might need to find someone that has different tools in their toolbox.
• 9:47
  SPEAKER_00: Because sometimes the hammer is the appropriate tool, but many times it's not.
• 9:51
  SPEAKER_00: Here's where a lot of families get tripped up.
• 9:53
  SPEAKER_00: See, a lot of people I see to where they have tried conservative treatments.
• 9:56
  SPEAKER_00: They tell their surgeon they've tried conservative treatments, but they simply didn't work.
• 10:00
  SPEAKER_00: And at that point, they assume surgery is the only remaining option.
• 10:03
  SPEAKER_00: And that's what the surgeon said too.
• 10:05
  SPEAKER_00: In fact, I remember talking to a surgeon and he said, Well, we have to send someone to general physical therapy, and we do scoliosis-specific physical therapy or exercise.
• 10:15
  SPEAKER_00: And he said, But as long as it's physical therapy, once we rule that out, we can do surgery.
• 10:19
  SPEAKER_00: But what most surgeons do is they just refer for general physical therapy, which is not successful, and that's when surgery becomes warranted because the non-surgical treatment options or conservative treatment have failed.
• 10:31
  SPEAKER_00: But it likely just was not the right type of conservative treatment.
• 10:35
  SPEAKER_00: You see, general chiropractic, general physical therapy, soft braces, there's no real evidence to support or show that they can be effective at treating scoliosis, either in preventing it from getting worse or potentially reducing the size of scoliosis.
• 10:49
  SPEAKER_00: You need scoliosis-specific exercises or scoliosispecific treatments, like 3D custom bracing, like the scoli brace, or scoliosis-specific exercise, like scoli balance, which incorporates shroth and disease in chiropractic biophysics.
• 11:06
  SPEAKER_00: Completely different than traditional physical therapy.
• 11:09
  SPEAKER_00: You see, you can go see a chiropractor or physical therapist for back pain from scoliosis, and you're likely going to get some relief, and there's some benefits.
• 11:16
  SPEAKER_00: Maybe even do spinal decompression, which may give you some relief.
• 11:19
  SPEAKER_00: It's just not effectively changing or influencing your scoliosis or where your scoliosis is going.
• 11:25
  SPEAKER_00: So those can be great adjunctive treatments along with custom bracing and scoliospecific exercises, but they shouldn't be the only thing you're doing for conservative treatment of scoliosis.
• 11:36
  SPEAKER_00: Now, here's what's really interesting.
• 11:38
  SPEAKER_00: The literature clearly says that the outcome goals of non-surgical scoliosis treatment is or should be the same goal of surgical treatment option, which is to stop curved progression, reduce pain, and enhance quality of life.
• 11:51
  SPEAKER_00: And that's the exact same goal of non-surgical treatment option like custom bracing and scoliosis-specific exercises.
• 11:58
  SPEAKER_00: I remember one day when I was visiting with a surgeon, and here's what he told me.
• 12:01
  SPEAKER_00: He said, You see, surgery is a double ring contract, but there's no divorce.
• 12:06
  SPEAKER_00: And once you go down the path, there's no turning back.
• 12:09
  SPEAKER_00: He said, Sometimes people absolutely need surgery.
• 12:11
  SPEAKER_00: But he also told me he only recommends people do surgery when they've exhausted all the appropriate non-surgical treatment options.
• 12:19
  SPEAKER_00: The worst case scenario with a non-surgical treatment option is you just end up having surgery.
• 12:25
  SPEAKER_00: The worst case scenario with surgery is that when you could potentially not wake up or you could have life-altering permanent complications.
• 12:34
  SPEAKER_00: And I'm not anti-surgery because some people do need surgery, but it should only be done when you've exhausted the most appropriate non-surgical treatment options.
• 12:43
  SPEAKER_00: If you remember one thing from this video, before you ever get surgery, make sure you absolutely need surgery and there are no other non-surgical treatment options that you can try.
• 12:53
  SPEAKER_00: And there are no other non-surgical treatment options that have shown effectiveness for your scoliosis that you can try before resorting to surgery.
• 13:01
  SPEAKER_00: Now, the link to our clinic is actually in the description.
• 13:04
  SPEAKER_00: You can learn more about us there.
• 13:05
  SPEAKER_00: If you're looking for specific non surgical treatment options, we're happy to discuss whether you're still a candidate for conservative treatment for scoliosis or if surgery really is your best option.
• 13:16
  SPEAKER_00: And if you're wondering why your scoliosis keeps getting worse and what you can actually do about it, watch the next video.
• 13:22
  SPEAKER_00: I'll see you there.