Re: Making the surgery decision

January 12, 2008

Hi,

I'm not in a postion to be able to offer any advice but wanted to

reply to your message as I am in a similar situation to you...

I'm also in the postition of looking toward the surgical route (so my

consultant says)

Yes it hurts (all the time!) and getting through the day is hard but

my issue is that I know how I'll feel tommorow... I'll feel like

poo!... What I don't know is how can expect to feel post surgery??...

I know the first 9 months will be hard but, after that?????????...

feels like stepping into the abyss!

I'm interested to read the replies you get and, if you feel like

you're standing on the edge of an abyss too, we could stand there

together )

Take care

>

> I'm 33 with a 33 (what a coincidence!) degree upper lumbar curve

and a 22 degree thoracic curve and am contemplating posterior fusion

with instrumentation surgery. Basically they will be fusing T4

through L2.

> I'm thinking of the surgery for 2 reasons. First is the pain. I

am hoping to reduce my amount of pain I have had for many years. I'm

tired of limiting my activities because I'm afraid to hurt my back.

Second, is for the deformity. I am frankly tired of living with

myself looking the way that I do. Scoliosis runs my life and pretty

much every decision that I make (even to what side of the bed I sleep

on) is due to my curved back. I am still in the learning phase of

the surgery and I haven't made the decision yet. I am trying to weigh

all my options and learn the most that I can about the pros/cons to

this surgery. I've read so many case studies but thought I would

jump on this forum to get advice/input. I am meeting with my surgeon

again next week to have him clearly outline the potential risks and

their probabilities as well as the success potential that I might

have.

>

> If anyone has any insight into their experience...it would be

greatly appreciated!

>

> Thanks in advance~

>

January 13, 2008

,

Were those angles 33 lumbar & 22 thoracic? So your

bottom curve is greater than your top curve? Have they

always been in this proportion to each other? ~Moonbeam

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January 13, 2008

>

> ,

> Were those angles 33 lumbar & 22 thoracic? So your

> bottom curve is greater than your top curve? Have they

> always been in this proportion to each other? ~Moonbeam

>

Yes...they have been like this since I was 12 years old. Not much has

changed. My doc said the curves offset each other but I still have a

shoulder that is higher than the other and my hips aren't identical by

any means.

>

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January 14, 2008

Regardless of the measurements of the curves, pain can be a result because there

are other factors. You probably also rotate front/back which also causes strain

on the muscles. My surgeon won't even do the measurements. And after my surgery,

when I commented on the curve tha still existed in my lumbar, he said that

wasn't what to look at. It's the front/back curve of the spine that matters. It

also depends on how flexible you are, whether you're a high strung person who

tends to hold your body tight. You can have back pain with a straight spine. So

33 and 22 is nothing to ignore.

I had minor back pain for years, and my curves were minimal. Then suddenly in a

few months they increased over 10 degress, each curve. The pain increased as

well.

Re: Making the surgery decision

>

> ,

> Were those angles 33 lumbar & 22 thoracic? So your

> bottom curve is greater than your top curve? Have they

> always been in this proportion to each other? ~Moonbeam

>

Yes...they have been like this since I was 12 years old. Not much has

changed. My doc said the curves offset each other but I still have a

shoulder that is higher than the other and my hips aren't identical by

any means.

>

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> Find them fast with Search.

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>

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January 15, 2008

,

Thanks for confirming that. I've found it atypical for

the lumbar curve to be greater than the thoracic is

all. But when dealing with individuals, what is

typical anyway? ~Moonbeam

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January 15, 2008

Hi A;;,

I had a postterior fusion done one 9-10-07. I was fused from T10 to

L5 for 53 degree curve. The surgery took 6 hours and four pts of

blood. It was done on Monday and I left the hospital on Friday

evening. I was too stubborn to go to rehab so my husband took care

of me. I had pain for maybe 3 weeks. By the end of the first month

the pain had lessened but I was still fatigued.

I still have some fatigue and I am still wearing my backbrace but I

am basically pain free.

Beverly from Aurora, OH

> >

> > I'm 33 with a 33 (what a coincidence!) degree upper lumbar curve

> and a 22 degree thoracic curve and am contemplating posterior

fusion

> with instrumentation surgery. Basically they will be fusing T4

> through L2.

> > I'm thinking of the surgery for 2 reasons. First is the pain.

I

> am hoping to reduce my amount of pain I have had for many years.

I'm

> tired of limiting my activities because I'm afraid to hurt my

back.

> Second, is for the deformity. I am frankly tired of living with

> myself looking the way that I do. Scoliosis runs my life and

pretty

> much every decision that I make (even to what side of the bed I

sleep

> on) is due to my curved back. I am still in the learning phase of

> the surgery and I haven't made the decision yet. I am trying to

weigh

> all my options and learn the most that I can about the pros/cons

to

> this surgery. I've read so many case studies but thought I would

> jump on this forum to get advice/input. I am meeting with my

surgeon

> again next week to have him clearly outline the potential risks

and

> their probabilities as well as the success potential that I might

> have.

> >

> > If anyone has any insight into their experience...it would be

> greatly appreciated!

> >

> > Thanks in advance~

> >

>

January 16, 2008

hmmm...unrelenting pain can be a cause for surgery...

But before you cross the bridge, consider something.

One of the reason for your surgery is the deformity and acitivity

limiting factor.

Would surgery be that much helpful? Remember, when you fuse your

spinal segments you'll have no ranges of montion on those segments.

Other risks are that the segments immediately above and below fused

vertebras will degenrate faster and will require you to have another

surgery within several years due to pain caused by it...

Considering your age, you have a very long active years to live.

Which means you'll be more likely to have surgeries due to secondary

conditions resulting from the first surgery. Most likely several

surgeries..

Another is that you are replacing one deformity with another. Often

after the surgery, patients will develop flat back syndrome which can

be another source of excruciating pain.

Have you tried every conservative methods out there? I'd think spine

surgery due to pain should be only considered after every conservative

options have failed. The reason is that patients will likely have

pain from surgery for another year and need to go through long rehab.

Then, you'll never reach 100% of presurgical state. Many patients

with less complicated spinal conditions than yours end up with no

change in status after surgery or get worse pain. Surgery due to back

pain is basically a crap shoot. You'll improve on pain somewhat if

you are lucky but decreased function and added risk for another

surgery within 5 years. If you are unlucky, you are worse than before

surgery...so think very carefully...once you cross the bridge, there's

no going back..

Have you tried PT? Chiro? Braces? (Spinecor works great for

symptomatic relief) Yoga? Pilates? Regardless of your opinion on

those therapies, they do have merits on symptomatic relief from pain

caused by scoliosis.

On Jan 11, 2008 4:01 PM, julie.bixby <julie.bixby@...> wrote:

>

> I'm 33 with a 33 (what a coincidence!) degree upper lumbar curve and a

> 22 degree thoracic curve and am contemplating posterior fusion with

> instrumentation surgery. Basically they will be fusing T4 through L2.

> I'm thinking of the surgery for 2 reasons. First is the pain. I am

> hoping to reduce my amount of pain I have had for many years. I'm

> tired of limiting my activities because I'm afraid to hurt my back.

> Second, is for the deformity. I am frankly tired of living with

> myself looking the way that I do. Scoliosis runs my life and pretty

> much every decision that I make (even to what side of the bed I sleep

> on) is due to my curved back. I am still in the learning phase of the

> surgery and I haven't made the decision yet. I am trying to weigh all

> my options and learn the most that I can about the pros/cons to this

> surgery. I've read so many case studies but thought I would jump on

> this forum to get advice/input. I am meeting with my surgeon again

> next week to have him clearly outline the potential risks and their

> probabilities as well as the success potential that I might have.

>

> If anyone has any insight into their experience...it would be greatly

> appreciated!

>

> Thanks in advance~

>

--

An important scientific innovation rarely makes its way by gradually

winning over and converting its opponents: it rarely happens that Saul

becomes . What does happen is that its opponents gradually die

out, and that the growing generation is familiarised with the ideas

from the beginning.

Max Planck (the founder of Quantum Physics)

January 16, 2008

Sports DC <accdoc@...> wrote:

>hmmm...unrelenting pain can be a cause for surgery...

I'll assume from your screen name you're a Chiro vs. a scoli EXPERT?

I'm 39, highly athletic, dx with JIS/AIS (I was 10 which puts me

borderline juvenile/adolescent) and Boston braced. My curve is

stable, " only " ±53° - and not progressing - but the pain qualifies me

as a good candidate.

Personally, I have exhausted all less invasive methods for pain

relief - and didn't enter the decision lightly. I did, however, at

least get ACCURATE information from an SRS specialist who devotes

most of his practice to Spinal Deformities, attends SRS yearly

conferences to stay abreast of new and emerging techniques, and to

achieve SRS status did a full year of fellowship under one of THE

best scoliosis surgeons (and researcher) in the U.S., Dr. Lawrence

Lenke.

I ultimately chose Dr. Darrell Hanson at Baylor in Houston, and am

set for posterior approach fusion and instrumentation (T5-L1) with

6mm Vitallium rods and pedicle screws. Estimated chance of

significant pain relief? 70%.

I have to wonder about YOUR qualifications and level of training when

you're warning someone considering surgery in the day and age about

*flatback* (mostly a Harrington and early 2nd generation rod issue).

>One of the reason for your surgery is the deformity and acitivity

>limiting factor. Would surgery be that much helpful? Remember, when

>you fuse your spinal segments you'll have no ranges of montion on

>those segments.

Mobility is highly dependent on levels fused (you lose VERY little

mobility when the thoracic spine is fused), and your activity level

PRE-op plays a large part in your activity POST-op. The use of BMP

also speeds fusion, and my surgeon has said he'll release me back to

slow and fastpitch softball at 4 months post-op (I play about 10

games a week, mostly year round). And I play highly competitive

ball ... we aren't talking church league here.

>Other risks are that the segments immediately above and below fused

>vertebras will degenrate faster and will require you to have another

>surgery within several years due to pain caused by it...

>Considering your age, you have a very long active years to live.

>Which means you'll be more likely to have surgeries due to secondary

>conditions resulting from the first surgery. Most likely several

>surgeries..

Decompensation (if the right levels aren't fused - i.e., find a

QUALIFIED surgeon for YOUR case) and stress on discs above and below

are certainly a possibility, but NOT a guarantee of osteotomies down

the road.

And, again, flatback is FAR less common these days with 3rd

generation rods.

>... patients will likely have pain from surgery for another year

>and need to go through long rehab.

Again, for younger patients, this is not a certainty! I will have NO

rehab afterwards.

While I agree completely with investigating every conservative method

FIRST, what value do you find in return to " 100% presurgical state "

when that state is constant pain? I don't *want* " 100% presurgical

state " if that qualifies.

Quality of life should be a deciding factor, as well.

>Have you tried PT? Chiro? Braces? (Spinecor works great for

>symptomatic relief) Yoga? Pilates? Regardless of your opinion on

>those therapies, they do have merits on symptomatic relief from pain

>caused by scoliosis.

Reputable surgeons will NOT brace an adult - it weakens core muscles,

often causes MORE pain, and serves no purpose to a mature spine.

Your info is not entirely accurate, although PT, Yoga and Pilates can

help manage symptoms and spasms. Chiropractic is temporary, and its

benefits are debatable.

A fusion to L2 will limit mobility *somewhat*, but I would still

encourage the original poster to see an SRS surgeon - or several -

and get current data.

Regards,

Pam

___________________________________________________________________

~ Proud daughter of a Marine Recruiter (MCRD SD 1954)

~ Proud sister of a Marine (MCRD SD 1976)

~ and VERY proud Mom of L. Cpl. Jett (VMGR-152 Headed to Okinawa

4/24/07)!

January 16, 2008

Well..I wasn't speaking about your case..but you want to make this your case..

Why are you taking this so personally? Your case is your case. I was

generalizing..

I'm glad you had successes..that doesn't mean every person who has

scoliosis pain should go out and get cut up..

The bottom line is, surgery works for some..it doesn't work for others...

Yours is probably the base case scenario..let's not decide things

based on your anecdotal case..

someone's life depends on her choice..

We don't know what kind of insurance coverage she has, we don't know

what type of curve she has, we don't know many things...that 3rd

generation rods are not an option for many people..there are handful

of specialists doing the procedure using it and less insurance

companies covering it.

The BMP is so expensive that a lot of hospitals don't use it..ie..the

university hospital in my local region do not..

You painted a rosy picture of most ideal situation and think people

are going to decide based on that?

Come back to reality...there are people who don't get best of the

world in everything...

As far as brace goes, look up Spinecor. It does not weaken spine.

It's not a traditional rigid brace...

As for PT's and chiros...I'm sorry it didn't work for you...but it

does work for many...

we are talking about symptomatic relief..not correction..I don't think

there's many debate about benefits of nonsurgical alternatives for

symptomatic relief.

Let's not kill entire field of study and profession just because it

didn't work for you...Whether it's main stream or alternative, there's

no procedure that's 100% effective..

Please get out of Pam's world and try to be REAListic~

You are asking me for qualifications for reconsidering surgery while

you think you qualify to recommend surgery to someone? You don't feel

you are accountable where other's are?

Read my post again...I didn't tell her to not have surgery...I merely

recommended that she weigh the situation carefully and exhaust all

possibility...that's what i'd call responsible recommendation...

You are actually telling people to do a surgery...

Hello??? This is not a Pam's world...at least try to use the same

standard when judging or responding to other's post..

What the heck is the problem with telling someone to becareful? You

love surgery that much? Why don't you have another one yourself??

ly, I don't have much respect for SRS. The direction they are

moving to is scary...their agenda is to eliminate and contain all

conservative treatment and make the surgery the only option of

treatment..

It may be great for you since you just love having surgery...but there

are those who'd like to actually weigh the risk vs benefit with real

world facts...not just Pam's wonderful world of best instrumentations

and procedures...

On Jan 16, 2008 12:17 PM, Pam s <pamelicious2k4@...> wrote:

>

> Sports DC <accdoc@...> wrote: hmmm...unrelenting pain can be a cause

> for surgery...

> Personally, I have exhausted all less invasive methods for pain relief . I'm

> 39, highly athletic, dx with JIS/AIS (I was 10 which puts me borderline

> juvenile/adolescent) and Boston braced. My curve is stable, " only " ±53° -

> and not progressing - but the pain qualifies me as a good candidate.

> I choose a wonderful SRS surgeon at Baylor in Houston, and am set for

> posterior approach fusion and instrumentation (T5-L1) with 6mm Vitallium

> rods and pedicle screws. Estimated chance of significant pain relief? 70%.

>

> One of the reason for your surgery is the deformity and acitivity

> limiting factor. Would surgery be that much helpful? Remember, when you fuse

> your spinal segments you'll have no ranges of montion on those segments.

> Activity is highly dependent of levels fused (you lose VERY little mobility

> when the thoracic spine is fused). The use of BMP also speeds fusion, and my

> surgeon has said he'll release me back to slow and fastpitch softball at 4

> months post-op (I play about 10 games a week, mostly year round).

>

> Other risks are that the segments immediately above and below fused

> vertebras will degenrate faster and will require you to have another

> surgery within several years due to pain caused by it...

> Considering your age, you have a very long active years to live.

> Which means you'll be more likely to have surgeries due to secondary

> conditions resulting from the first surgery. Most likely several

> surgeries..

> Decompensation (if the right levels aren't fused) and stress on discs above

> and below are certainly a possibility, but not a guarantee of osteotomies

> down the road.

> And flatback is FAR less common these days with 3rd generation rods.

>

> ... patients will likely have pain from surgery for another year and need to

> go through long rehab.

> Again, for younger patients, this is not a certainty! I will have NO rehab

> afterwards.

> While I agree completely with investigating every conservative method FIRST,

> what exactly do you consider " 100% presurgical state " when that state is

> constant pain? I don't *want* " 100% presurgical state " if that qualifies.

> Quality of life should be a deciding factor, as well.

>

> Have you tried PT? Chiro? Braces? (Spinecor works great for

> symptomatic relief) Yoga? Pilates? Regardless of your opinion on

> those therapies, they do have merits on symptomatic relief from pain

> caused by scoliosis.

> Reputable surgeons will NOT brace an adult - it weakens core muscles, often

> causes MORE pain, and serves no purpose to a mature spine.

> Your info is not entirely accurate, although PT, Yoga and Pilates can help

> manage symptoms and spasms. Chiropractic is temporary, and its benefits are

> debatable.

> A fusion to L2 will limit mobility *somewhat*, but I would still encourage

> the original poster to see an SRS surgeon - or several - and get current

> data.

> Regards,

> Pam

>

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> ~ Proud sister of a Marine (MCRD SD 1976)

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>

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January 16, 2008

pain can be a cause for surgery...

>

> I'll assume from your screen name you're a Chiro vs. a scoli EXPERT?

>

your point??

> achieve SRS status did a full year of fellowship under one of THE

> best scoliosis surgeons (and researcher) in the U.S., Dr. Lawrence

> Lenke.

Wow..hooray for Lenke brace that isn't covered by most insurance due

to experimental status and not performed by most surgeons due to

prohibitive cost...

>

> Again, for younger patients, this is not a certainty! I will have NO

> rehab afterwards.

you will?? you are that certain? you know gurantee of outcome is

ethical violation for healthcare professionals...if your surgeon told

you that you won't have rehab for sure, then he surely is not a nice

guy is he??

>

> While I agree completely with investigating every conservative method

> FIRST, what value do you find in return to " 100% presurgical state "

>

> when that state is constant pain? I don't *want* " 100% presurgical

> state " if that qualifies.

yes..100% presurgical state would be constant pain for the person we

are discussing..but less than that would mean more pain and less

function isn't it? you need to think about 100% of what?

>

> Quality of life should be a deciding factor, as well.

That's precisely why patient needs to weigh things carefully..the

precise reason why surgery is always the last resort..

notice I didn't say no surgery...

> Reputable surgeons will NOT brace an adult - it weakens core muscles,

> often causes MORE pain, and serves no purpose to a mature spine.

I thinking this statement was made out of your ignorance of Spinecor.

Spinecor causing muscle atrophy is news to me. Their design was

precisely to not cause atrophy and rather help with the rehab..I

believe I specifically used the word Spinecor in original post...

> Your info is not entirely accurate, although PT, Yoga and Pilates can

> help manage symptoms and spasms. Chiropractic is temporary, and its

> benefits are debatable.

I can see from your initial sentence that you have strong emotions

regarding chiros...let's see...Pt's do pt at their office..chiros do

PT and spinal manipulation..hmm...PT works but chiro does not? Do you

think there's a little bias there? In most instances, the debate

regarding chiropractic care is whether the correction achieved through

their care is permanent or temporary...there's no debate about

symptomatic relief...

>

> A fusion to L2 will limit mobility *somewhat*, but I would still

> encourage the original poster to see an SRS surgeon - or several -

> and get current data.

Seeing surgeons is fine...in fact I always recommend that people see

at least 3 surgeons...there are surgeons out there who'd like to

perform surgery to every warm body that walks in their door...so

yes..seeing surgeon is fine..noone has every said that was a bad

idea...so your point is? Do you always take people's point out of

context or create and insinuate a point that never was there? Helluva

way to discuss things..

--

An important scientific innovation rarely makes its way by gradually

winning over and converting its opponents: it rarely happens that Saul

becomes . What does happen is that its opponents gradually die

out, and that the growing generation is familiarised with the ideas

from the beginning.

Max Planck (the founder of Quantum Physics)

January 17, 2008

As I just wrote to Bea, I think most ALL of us have tried just about everything

out there. If you are in constant pain, that is a GOOD reason for surgery. How

about quality of life? I think yours is a very negative way of looking at this

problem. And I bet you don't have scoliosis or live in pain!

Sports DC <accdoc@...> wrote: hmmm...unrelenting pain can be a

cause for surgery...