Re: Re: Non Harrington Rod Flatback Syndrome(Iatrogenically (Surgically-Induced Flatback)

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The site no longer exists but I believe has them in the files from the papers that I sent her. If not then send me an e-mail, mad.monk@... , with Mina papers in the subject line and I will send you a copy. Remember that these were written in the early 90's. LlweynSent from my BlackBerry device on the Wireless NetworkFrom: Durand <d.durand56@...>Sender: Date: Sun, 20 Mar 2011 08:03:18 -0700 (PDT)< >Reply Subject: Re: Re: Non Harrington Rod Flatback Syndrome(Iatrogenically (Surgically-Induced Flatback) i cannot find the site that this Mina report is in I would like to know more I had Harrington Rod surgery in 1966 and do not have flatback or any pain whatsoeverFrom: rebeccamaas <rebeccamaas@...> Sent: Sat, March 19, 2011 10:14:21 PMSubject: Re: Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback) I find these terms to be interesting. I don't have Harrington rods. Mine are Luque instrumentation (original fusion in 1989). But my flatback didn't seem to be instantaneous. Yet my flatback revision surgeon described my flatback as iatrogenic flatback.It makes me wonder how universal these terms actually are? Perhaps my flatback WAS created immediately during my surgery (though I specifically remember talks about the need to retain lordosis, and how bad it was earlier because docs didn't originally do this - this was from my original pediatric surgeon in 1989!), but I didn't feel off-balance right away. I think that I developed flatback at a faster rate than many Harrington people do - since most of them seem to be in their 40s, 50s and even 60s when they find these lists, and I was just 31 when I had my revision. But like I said before, these terms to describe Harrington versus iatrogenic flatback are quite interesting.Thanks forsharing the article! Any clue as to when Mina wrote the article?>> > > > > > There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:> > HARRINGTON ROD - INDUCED FLATBACK:> > Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at thebackwaist.> Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.> When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.> > IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:> > Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."> Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.> Since most cases of Iatrogenically-Induced Flatback are caused in scoliosispatients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)> Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is whyscoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.> > My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish RiteHospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me tophysical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP forabout five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats werementioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).> > I was wondering if there are manyothers on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.>