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What's the big deal with 50 degrees?

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  • What's the big deal with 50 degrees?

    This may sound like a silly question, but why do most docs protocol call for a curve to be 50 degrees to be surgically significant? I understand that lung/heart impairment would likely play a part in this decision, but have also read that these functions aren't usually impaired until around 90+ degrees. I hear of people with 50+ degree curves having surgery when they have no pain. I also see people with smaller curves that have a lot of pain that the docs won't touch. It doesn't make sense to me. I have a 46 degree curve that my doctor will correct when my pain pattern gets more predictable. So confused. Is there something physiologically that happens to the nerves and spinal chord when the curve reaches 50 degrees? Thanks for any responses as I am still learning about this disease.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  • #2
    I *think* the issue is that, at about 50 degrees gravity starts working on the curve. So, a curve under that may stay stable, while one larger then that is likely to progress.

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    • #3
      Linda or others will know this better but I'll tell you what I think I know about this.

      Originally posted by rohrer01 View Post
      This may sound like a silly question, but why do most docs protocol call for a curve to be 50 degrees to be surgically significant? I understand that lung/heart impairment would likely play a part in this decision, but have also read that these functions aren't usually impaired until around 90+ degrees. I hear of people with 50+ degree curves having surgery when they have no pain. I also see people with smaller curves that have a lot of pain that the docs won't touch. It doesn't make sense to me. I have a 46 degree curve that my doctor will correct when my pain pattern gets more predictable. So confused. Is there something physiologically that happens to the nerves and spinal chord when the curve reaches 50 degrees? Thanks for any responses as I am still learning about this disease.
      I think 50* is a statistical threshold wherein many/most curves at or above that degree can be expected to increase at least 1* per year and likely more.

      Now I think there is a large variation and that there are people who reach that and higher who don't advance (we have 2-3 people in that category on this forum) and there are some who have a smaller curve whose curves advance more than 1* per year.

      The reason I think they don't operate on smaller curves with pain is that PT might be as or more effective at pain relief than surgery. Nothing else is better than surgery for stopping progression and correcting extant curves with the exception of watching and waiting in some cases.

      Good luck.
      Sharon, mother of identical twin girls with scoliosis

      No island of sanity.

      Question: What do you call alternative medicine that works?
      Answer: Medicine


      "We are all African."

      Comment


      • #4
        Thanks, hdugger.
        My curve has been stable for about 25 years and is now progressing. It's just a waiting game for me as I have always has pain with mine....sigh
        Be happy!
        We don't know what tomorrow brings,
        but we are alive today!

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        • #5
          Yeah, mine is progressing at about 1* per year now (just started over the last 5 years). I feel like it's a waiting game and it's driving me nuts. I don't think there is a surgery out there that scares me more than this one, but some how I am feeling at peace with it. I just want to get it over with. You are all such a help and and inspiration to me.
          Be happy!
          We don't know what tomorrow brings,
          but we are alive today!

          Comment


          • #6
            I have no idea. I suspect, it's many things and our doctors are looking down the road. I was once told that the spine with scoliosis "can" continue to progress a minimum of 2 degrees per year - as the human body ages, this "could" lead to serious complications: respiratory failure and congenital heart failure (thoracic curves), loss of bladder/bowl function and mobility (lumbar, thoracolumbar curves). So, if someone is at 50 degrees at a very young age, the possibility exists that continued progression could cause some serious complications along with all the other fun stuff in aging like arthritis and degenerative disc disease. Of course, that isn't going to happen to everyone - but there is no accurate predicting of who will and who will not have to suffer such things. So maybe a 50 degree cut off is precautionary in nature in some cases - and preventive medicine in others with a very aggressive progression. I don't know. I believe age as well as pain is a factor in this cut off number? Certainly chronic pain contributes to high blood pressure - so, another factor.

            Good question yours, hopefully we'll get some better answers than my ponderings.

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            • #7
              Originally posted by rohrer01 View Post
              Yeah, mine is progressing at about 1* per year now (just started over the last 5 years). I feel like it's a waiting game and it's driving me nuts. I don't think there is a surgery out there that scares me more than this one, but some how I am feeling at peace with it. I just want to get it over with. ...
              Rohrer,

              This is exactly why 50° is significant ... it typically does hint at a 1-2° per year progression.

              There are always exceptions - like mine.

              That said, I had surgery anyway ... and if I'd had equal amounts of faith in the technology and pain, I would have done it sooner. Pain was there ... faith in the technology wasn't. I waited until I hurt so badly I had no other choices (and I'd exhausted them ALL).

              In retrospect, my ankle reconstruction (softball thing ... snapped the outer ligaments) was actually worse than fusion. I was IN bed for 5 weeks (and I mean IN bed) following that, and felt far more limited for a year afterwards. I guess we all form our perspective based on our past.

              Regards,
              Pam
              Fusion is NOT the end of the world.
              AIDS Walk Houston 2008 5K @ 33 days post op!


              41, dx'd JIS & Boston braced @ 10
              Pre-op ±53°, Post-op < 20°
              Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


              VIEW MY X-RAYS
              EMAIL ME

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              • #8
                Do not try to understand it!!!! I went to four different surgeons and got four different opinions. One said, surgery right away,one said my 52 was not enough and would wait until 60 degrees and a lot more pain. One said surgery at 57 degrees and above and the last surgeon said wait for two years with pain management. Pain and the fact that I wanted to have it done while I am still kind of young. good luck,


                rich

                Comment


                • #9
                  Originally posted by rich1752 View Post
                  Do not try to understand it!!!!
                  Sorry, but I think that's somewhat over-simplified.
                  Fusion is NOT the end of the world.
                  AIDS Walk Houston 2008 5K @ 33 days post op!


                  41, dx'd JIS & Boston braced @ 10
                  Pre-op ±53°, Post-op < 20°
                  Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


                  VIEW MY X-RAYS
                  EMAIL ME

                  Comment


                  • #10
                    Its up to the individual surgeon........

                    Some will operate in the 40s and some will want to wait.

                    The one thing all surgeons have in common is that they don’t like making mistakes. They also have to be comfortable with the projected outcome.

                    55MPH was what Nixon liked. Now its 65MPH. In Nevada, we like it at 75MPH.

                    Who knows, maybe in the future, the cobb angle "reference surgical angle" will be reduced as methods improve some more. Its funny, that cobbs do not show the whole picture. It’s a standard in the coronal plane. Its only one parameter of the decision.

                    I waited 34 years.
                    Good luck
                    Ed
                    49 yr old male, now 63, the new 64...
                    Pre surgery curves T70,L70
                    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
                    Dr Brett Menmuir St Marys Hospital Reno,Nevada

                    Bending and twisting pics after full fusion
                    http://www.scoliosis.org/forum/showt...on.&highlight=

                    My x-rays
                    http://www.scoliosis.org/forum/attac...2&d=1228779214

                    http://www.scoliosis.org/forum/attac...3&d=1228779258

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                    • #11
                      besides pain, i think another consideration may be loss of function and the impact of the curve on one's life....and work...

                      i think you said your curves come with pain...but you didnt say to what degree, or how much it is impacting your ability to function...

                      where do you live, if i may ask...and how many scoli surgeons have you consulted with for opinions...?

                      i wish you luck in your quest for answers & solutions...
                      also...have you tried pain management doctors to see if they have help to offfer you? even if only while you wait for answers?

                      jess
                      Last edited by jrnyc; 03-17-2010, 06:57 AM.

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                      • #12
                        My own curve progressed rather slowly until around the 50-degree mark; then the progression really took off until it hit 70 degrees at the time of my surgery. Both surgeons I consulted with told me that usually gravity does indeed take over once the spine hits the "point of no return" -- around 50 degrees. It was my understanding that this isn't a hard-and-fast scientific fact, but an observation that USUALLY holds true.
                        Chris
                        A/P fusion on June 19, 2007 at age 52; T10-L5
                        Pre-op thoracolumbar curve: 70 degrees
                        Post-op curve: 12 degrees
                        Dr. Boachie-adjei, HSS, New York

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                        • #13
                          I also believe that is a matter of gravity force and that this angle is determined only in a statistically way, but if in fact no other force exists increasing the curve, why not edf http://www.tesisenxarxa.net/TESIS_UB...TESISILVIA.pdf is being used in adults? As surgeon, could reduce the curve about a half or more, so gravity could not do a great force. Of course nobody could want to live with a rigid brace for a long time, but with someone else more comfortable as Spinecor? (Or Spincor could not be so strong an only a rigid brace could be used?) If the wedge is not so terrific as it seems supposed to be, ligaments could be restored, neuromuscular and biomechanical system could adapt to the new structure (as I believe it occurs at least in so many cases after surgery) and we can be sure (could it be?) that none not idiopathic cause exists, which could be the great force instead gravity, pulling again, or which could be the factors increasing it in such scale?
                          I believe that probably is a matter of shorts muscles in convex side too, tending to be more shorten over time.

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                          • #14
                            I did not know I had scoliosis, until August of 2009. I was pretty even, body wise. I did notice that I lost 2 1/2 inches in height, but doctors would not do an x-ray. I would go in to my doctor for the last five years, but he would just give me anti-inflamatory pills and say it's just sore muscles. The last surgeon I saw, said that 2 1/2 inches in 3 years, is way too much and didn't believe it. He made me feel like I was lying to him.

                            rich

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                            • #15
                              Thanks so much for all you replies!! I had a really detailed reply but it got lost somehow. So to make a long story short, I had a very, very bad night at the ER last night. I'm alrealdy on fentanyl, percocet, and klonopin daily to control the pain ( my doctor thinks my lower pain is due to spondilolysis -aka- a fracture of L5). I got some sort of nasty bacterial infection and "snorted" to get the mucous out of the back of my throat and that's all she wrote. I ended up in the ER with the WORST neck and upper back pain ever. Definitely a 10. It took a shot of valium, and 4 shots of fentalyl through the IV to get the pain down to about a 4 so I could go home. They also added soma to my pain meds. I made a new appt with my doctor here and am going to beg him for the surgery. I tend to "underestimate" my pain levels. But I'm a 41 year old woman and was crying uncontrollably. I felt like I couldn't breathe. It was just aweful. I had so much more to say. But my typing skills are getting the better of me and I thought I would just give you the highlights. I see Dr. Clifford Tribus in Madison, Wisconsin. He is the ONLY spine doctor that has ever believed me that I have pain with my scoliosis. His bedside manner is great, too. I just hope he can help me. I LOVE you all so much, you have been a great help to me! Anyone else see Dr. Tribus? Again, I'm functioning on about zero sleep topped with narcotics, so I'll say good night to everyone. You all hang in there!
                              Be happy!
                              We don't know what tomorrow brings,
                              but we are alive today!

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