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lray
03-24-2010, 01:12 PM
I met with Dr Gupta yesterday and had new x-rays done and asked him a lot of questions. Overwhelming to say the least!

First of all, the measurement of my thoracic curve is making me a little nuts! March of last year my first surgeon said it was about 56*. Dr Gupta read those same x-rays 4 months later and disagreed and said they were 53*. I had new x-rays done at that July visit that were read as 61*. Yesterday, my new x-rays were 58* and the x-rays from last July were re-measured at 57*! This is crazy! I know that it's very subjective & I should not obsess over this number but it seems to be pretty important in determining progression, right? I noticed that Dr Gupta had a Fellow do the measurements, a different 1 at each visit, thus the discrepencies I guess. I wasn't expecting progression anyway, my point in meeting yesterday was to discuss surgery.

He will do it as I am a candidate, but he said I could wait 5 years and see how much it is progressing. I am 50 now and in his words, young (ha!) but I feel the time is right since I am so healthy, well-insured, and desiring to change careers soon. What's hard is that I have no proof of progression since I haven't been x-rayed since I was about 12 & who knows where those x-rays are, & I certainly don't remember anything (I blocked it out). So he's basing progression on my comments and my husband's belief that my back hump is worse. But I'm already seeing my measurements all over the place so when will there be absolute proof of progression?

Cosmetic is one of my main reasons for having this too. My clothes do not fit right, my posture is bad when I sit, my torso is so off balance, and I have 1 leg longer. I bet many of you have these same issues!

I do not have constant pain - I have pain only when sitting or standing or walking for an hour or so. (Hmmmm, so I guess that unless I want to lay on a couch all day everyday, I'll be fine!) I do have every day muscle discomfort. So if it's the weekend and I'm active, I'm pretty OK. But at work I have to get up a lot & walk around. I'm also studying right now to be a medical transcriptionist and I sit for HOURS and I have to get up every hour or I'm getting out the trusty heating pad and eventually I have to quit typing for the day. But since I plan on becoming a transcriptionist, I will HAVE to sit for hours, & that is not possible now and it will get worse. Aside from my thoracic-area pain, I also have lumbar pain after exertion, which he said based on my x-rays is likely due to arthritis and has nothing to do with my curve. That was a shock. So even with surgery, my lumbar pain will not get better? I was hoping that it was my curve that was putting undue pressure on my lumbar vertebra.

He is quite confident that he can get about 75% correction with my curve, maybe down to the teens. The fusion will be from T2 to L2 or L3. I have a significant hump that he feels will be almost gone with a thoracoplasty and he does quite a few of those. I am very confident with him doing my surgery, I just want to be sure that I'm fully educated about this. My plan is to have it this September or October, it's up to me. They were ready to schedule me yesterday but I was so overwhelmed that I decided to think about it. I just can't imagine waiting for years until I am in constant pain, especially when I've learned that it is not guaranteed that the pain will go away after surgery! It could remain the same or even get worse.

Wow! For those of you who went forward with the surgery or are about to, I applaud you! You are/were very brave as this is probably the hardest decision we will ever make.

joyfull
03-24-2010, 04:25 PM
I suggest you do some research about the thoracoplasty. Dr. Boachie who is the head of scoliosis surgery at the Hospital for Special Surgery in New York, the number one rated orthopedic hospital in the county, doesn't seem to like them. Otherwise, it seems likely that you will experience some relief after the surgery, based on the reports of others here. Best, Joy

jrnyc
03-24-2010, 05:29 PM
you didnt mention whether you have had several opinions on your surgery...especially considering what Joy has said that Dr Boachie feels about thoracoplasties!

i cant imagine doing this surgery for cosmetic reasons at the age of 50, but that is just my opinion...
at the ripe old age of 61, i really dont care what my back looks like..only what it feels like...and mine hurts a great deal!! all the time!! which is why i am considering surgery...but waiting to see if doctors in nyc pick up the newer less invasive method for lumbar surgery...

good luck whenever you go through with it...

jess

lray
03-24-2010, 08:22 PM
The severity of my hump cannot be corrected fully with just the fusion. I want to have the best correction that I can without having a 2nd surgery later.

Oh my, I'm 50 not 90! Cosmetic is just one of the reasons I want to have this surgery.

JenniferG
03-24-2010, 09:55 PM
My curve did not seem to move from age 13 - about 49-50 then it progressed rapidly. I thought I'd got away with doing nothing about it but obviously I didn't. As the curve progressed, so did the discomfort. I only really noticed the hump at about age 55. I did not have a thoracoplasty but my hump has gone. Perhaps one more opinion could be warranted?

michael1960
03-24-2010, 11:00 PM
Iray

Just one comment on the x-ray measures. It is hard to get consistency in the numbers. There have been a lot of studies on reading x-rays. Here are some details on how much the measurement can be off:

1. Positioning of the patient when getting the x-ray - measurement can be off by 17 degrees

2. One doctor, reading the x-rays and taking a measurement multiple times, of the same x-ray - measurement can be off by 5-6 degrees (by the same doctor)

3. Two doctors - the measurement can be off by 10-12 degrees. Looking at the same x-ray, one doctor can measure 50 and the next 60-62.

4. The curve can be off by up to 5 degrees between morning and afternoon, based on how tired you are

5. The curve can be off by 2-3 degrees on whether it was taken facing forward or backward

These are just some examples. I know how you feel about these measurements. It always frustrates me. I get my x-rays now at a hospital that puts them on dvd and it has a tool for measuring the angle, so I always do some of the measurements myself when I get an x-ray (actually x-ray for my daughter).

Good Luck
Michael

titaniumed
03-24-2010, 11:58 PM
Iray

Having multiple x-rays (dated) for comparison is of value. Probably of more value than the cobb angle figures. There are methods (shadow) that scoli orthos use for measuring rotation of vertebrae in the coronal plane only, which has a lot to do with size of rib humps. Cts are great in that respect.

Dated digitals are best, that goes for cts also. I have posted my cts, and you can see the rotation after my surgeries. Its on my one of my threads, titled rotational ct scans. The view is from feet to head. My rib hump is gone, but my vertebrae are about 30 degrees off.

Once again, Cobb angles are only one factor involved with scoliosis.
I wouldn’t worry about Cobb angles too much, since you "are" a candidate for surgery. The chances of a 1 degree per year progression from now on, are of concern at 50 years of age.

I was a Luque candidate back in 1974. All these years I have always known, I would have my day..... With having multiple major pain events, that acted as a catalyst. It made a very tough decision much easier.

Have you been to any of the scoli meetings with Diane Gums?
Ed

dailystrength
04-04-2010, 09:34 PM
which is why i am considering surgery...but waiting to see if doctors in nyc pick up the newer less invasive method for lumbar surgery...

jess

Jess, looking forward to what you find out. Thanks. Christina

doodie
04-05-2010, 12:42 PM
Hi Iray -

I see the word 'thoracoplasty' and I just cringe.... I had a noticeable rib hump on the right side and one lower down on the left hip area as I was cork-screwing...

I mentioned having to do a thoracoplasty to my surgeon and he made a frowning face indicating he is not a fan, then proceeded to tell me he was nearly certain he could get good enough correction as to not need to do the thoracoplasty. AND I'm happy to report that I have no right rib hump or rib protrusion on the left front, nor do I have that hip hump thing anymore either. :D

Just throwing in my two cents worth!

Doodles
04-05-2010, 01:50 PM
The thoracoplasty is apparently not something Dr. Lenke prefers either. I e-mailed my concerns that my rib hump seems to be increasing since surgery and I mentioned that perhaps I might need that. The answer was no. I also had more prominence on lower left. That seems to be better. The right rib hump was never gone from surgery but swelling masked it for quite a while. Part of it is that might right shoulder blade juts out so much. I'll be interested to see what he says in April for my year plus one month appt. Janet

Karen Ocker
04-06-2010, 02:10 PM
I had significant reduction of my rib hump with thoracoplasty but it still shows. Dr. Boachie didn't flinch when I asked him but my ribs were pointed from my teen curve of ~100deg. With the 50% reduction of my curves the hump moved more to the middle.
The bone from the thoracoplasty was used for my fusion.

Doodles
04-06-2010, 07:11 PM
Karen--
Perhaps you can explain. Exactly how do they do the thoracoplasty. Parts of ribs are removed? I'm not seeing how that would reshape or make hump less prominent. Thanks for your help. Janet

lray
04-07-2010, 10:54 AM
I have seen 2 spine specialists and both recommended surgery within next few years including the thoracoplasty. From what I've read, some surgeons perform them with good results, others feel that it's unnecessary. I don't have to have it done, it is recommended, so I'm thinking about it at this point. I'm still researching as I'm a research nut! My surgery has been scheduled for Oct. 1.

tonibunny
04-07-2010, 11:07 AM
During the thorocoplasty, sections of rib bone are removed at the apex of the rib hump. Then the remaining cut ends of the ribs are drawn together so they appear flatter, and the "sleeve" of muscle that surrounds each one is sewn back. Eventually the ribs heal back together and are as strong as they were before.

I've had two thorocoplasties. This is unusual and is to do with the fact that I had Infantile Scoliosis, and also because my thoracic spine was fused with a Harrington Rod which could not derotate the vertebrae. I had one done at 18, at the same time as my lumbar fusion, and the second one done as a standalone procedure when I was 25.

If your spine still rotates out into the hump it's not possible to completely flatten it, but even so the cosmetic results for me were dramatic.

Doodles
04-07-2010, 01:48 PM
Tonibunny--
Thank you so much for that great explanation. I've never really gotten that before. Janet

elizabeth1st
06-09-2010, 01:05 PM
to all
I have found the discussion related to rib humps and the treatment to be validating. For years, I have been encouraged (family and friends) not to dwell on the cosmetic effects of scoliosis but to "embrace" the fact that I am healthy etc. Quite frankly, living in a world obsessed with beauty, youth and sexually, I have have struggled at times in my life to keep the self esteem positive.

The rib hump is of a size where it is very prominent from the right side, distorts my shirts(they twist) and necessitates a larger size to not only accomomdate the hump but to lessen the visiability of it.

The older I get, I find I am less focussed on my appearance. However, when I compare myself generally, my appearance is no so bad. Still there are times when I wish I could have benefited from the more modern interventions available for scoliosis and not have to consider another revision in the future etc. Better yet - not to have had the anomaly in the first place. As someone commented - a genetic train wreck!!

There is comfort on this web site in understanding that I am not alone with these issues
Thank you

cyborg2be
06-09-2010, 02:47 PM
I met with Dr Gupta yesterday and had new x-rays done and asked him a lot of questions. Overwhelming to say the least!

First of all, the measurement of my thoracic curve is making me a little nuts! March of last year my first surgeon said it was about 56*. Dr Gupta read those same x-rays 4 months later and disagreed and said they were 53*. I had new x-rays done at that July visit that were read as 61*. Yesterday, my new x-rays were 58* and the x-rays from last July were re-measured at 57*! This is crazy! I know that it's very subjective & I should not obsess over this number but it seems to be pretty important in determining progression, right? I noticed that Dr Gupta had a Fellow do the measurements, a different 1 at each visit, thus the discrepencies I guess. I wasn't expecting progression anyway, my point in meeting yesterday was to discuss surgery. Hi there -
I've seen 5 different specialists and one explained to me that from day to day and person to person there can be up to 5* in difference of measurements. Don't let that frustrate you too much.
He will do it as I am a candidate, but he said I could wait 5 years and see how much it is progressing. I am 50 now and in his words, young (ha!) but I feel the time is right since I am so healthy, well-insured, and desiring to change careers soon. What's hard is that I have no proof of progression since I haven't been x-rayed since I was about 12 & who knows where those x-rays are, & I certainly don't remember anything (I blocked it out). So he's basing progression on my comments and my husband's belief that my back hump is worse. But I'm already seeing my measurements all over the place so when will there be absolute proof of progression?

Proof of progression can take several years to show. I, too, have lost all my records & xrays prior to 2005(thanks to a really unprofessional chiropractor). Drs have told me is that after 45* you can reasonably expect to progress at a rate of 1-2* each year. That is due to gravity. The only proof I have of progression for myself is the fact that I remember being 28* when I was 11, and I know I had no lumber curve when I got married @ 21. I also remember a chiro in 2005 saying my thoracic was past 50*

[QUOTE]Cosmetic is one of my main reasons for having this too. My clothes do not fit right, my posture is bad when I sit, my torso is so off balance, and I have 1 leg longer. I bet many of you have these same issues! I'm right there with you - so many times my dh tells me to sit up straight, and I say "I am..." And no clothes with stripes - they give away my back
...I do not have constant pain - I have pain only when sitting or standing or walking for an hour or so. (Hmmmm, so I guess that unless I want to lay on a couch all day everyday, I'll be fine!) I do have every day muscle discomfort. So if it's the weekend and I'm active, I'm pretty OK. But at work I have to get up a lot & walk around. I'm also studying right now to be a medical transcriptionist and I sit for HOURS and I have to get up every hour or I'm getting out the trusty heating pad and eventually I have to quit typing for the day. But since I plan on becoming a transcriptionist, I will HAVE to sit for hours, & that is not possible now and it will get worse. Aside from my thoracic-area pain, I also have lumbar pain after exertion, which he said based on my x-rays is likely due to arthritis and has nothing to do with my curve. That was a shock. So even with surgery, my lumbar pain will not get better? I was hoping that it was my curve that was putting undue pressure on my lumbar vertebra. I also usually have "no pain" but then again it will often be a pain that is temporary or can be easily masked with ibuprofen and my one chiropractor pointed out to me that I probably have a higher tolerance for pain due to the last twenty years of a crazy spine. She said that if a person w/o scoliosis experienced even a bit of what we go through, they would be freaking out.



He is quite confident that he can get about 75% correction with my curve, maybe down to the teens. The fusion will be from T2 to L2 or L3. I have a significant hump that he feels will be almost gone with a thoracoplasty and he does quite a few of those. I am very confident with him doing my surgery, I just want to be sure that I'm fully educated about this. My plan is to have it this September or October, it's up to me. They were ready to schedule me yesterday but I was so overwhelmed that I decided to think about it. I just can't imagine waiting for years until I am in constant pain, especially when I've learned that it is not guaranteed that the pain will go away after surgery! It could remain the same or even get worse.
Yes, I had one dr tell me that as well. It was something like I need to decide whether or not the pain I have no may be bad enough to have the surgery which may or may not leave me in more pain than I am in now. :rolleyes: That was NOT helpful. What did help me to decide is the frequency of pain and the increase in my need for chiropractic visits. At best they "fix" the pain for a week. And the location of my curve is at my right shoulder blade and when it gets worked up, there are days when I can't move my right arm - just to get the curve and its muscles to chill out a little. BTW I'm right-handed...

Anyway, I know I've said a lot! Hopefully I've helped. It is such a BIG decision. Good luck.

Marissa

cyborg2be
06-09-2010, 02:49 PM
SORRY EVERYONE

I'm new to the posting and quoting business - my reply doesn't set apart the quotes and I don't know why, so it is hard to see a diff between what I wrote and what she originally wrote.

??

Marissa

Back-out
06-09-2010, 04:59 PM
Drs have told me is that after 45* you can reasonably expect to progress at a rate of 1-2* each year. That is due to gravity.

That must be about when I reached what one of my knee docs called the "tipping point" (nb. there are NO spinal physicians in my town!). DAMN just realized what I should have chosen as my net-name: "LeaningTower" (or maybe even "Leaning Tower of Pizza :D"). I keep fearing the one I picked will be a self-fulfillng prophecy!

Of course, one member congratulated me on the name, saying it showed I was getting back out in the fray to work on the problem. I wish I saw it so positively.

One highly reputed surgeon I saw, commented, looking grave, that "cosmesis" was NO reason to have this surgery. I think he was referring to the enormous risks involved as well as sequaelae. Thoughts?

I'd love to know what various members of the medical community consider legitimate reasons for surgery. Clearly, many have Cobb cut offs (wondering how this varies by spinal level) and others use rapidity of curve progression. Most seem satisfied by self-reporting on pain and disability, probably with a mimimally "severe" curve and/or progression.

Back-out
06-09-2010, 05:29 PM
What about the hump self correcting when the scoliosis is corrected? I was told mine would be derotated once the major curve was fixed.

Is this a difference of "faith" , anatomy or surgical approach? (re last, meaning some take the chance on derotation and others like to do the whole shebang and not "hope for the best")

I'm confused? Aren't rib humps generally secondary to the primary curve and abnormal vebtrebral rotation? Why so much difference in approach to the point where some would do a whole separate operation (ie thoracoplasty)?

And still wondering if they ARE separated, how insurance companies tend to regard a thoracoplasty especially one separate from the other corrections. God knows they tend to frown on paying for "mere" cosmetic improvement for anything but breast reconstruction. Moreoever in this case, pulmonary compromise will result, which some could argue was an insufficient trade off .

rohrer01
06-09-2010, 07:15 PM
I'm hoping my rib humps will go away when I have surgery. The one on the left in the front sticks out pretty far, but isn't noticeable unless I'm laying on my back. The two that I have on my back are staggered and make sitting against anything solid uncomfortable. Even so, I don't think I would opt for thoracoplasty. It scares me. I'm to the point that I don't really care what I "look" like as long as I can get rid of the pain.;)

cyborg2be
06-09-2010, 07:46 PM
Hi, again.

The way my curve affects my ribs also leaves a hump (left in front, whole shift to right in back) but worse than that, when I sit my rib cage rests on my pelvis. This can lead to such squishing pain and spasms in my ribs.

My desire to have the thoracoplasty was never cosmetic (I'd be going for lipo if it was a cosmetic thing - and the specialists don't even laight when I ask if they'll pull out a vaccuum once they're in the neighborhood). However, the specialist I revere the most - Dr. Bridwell said that he no longer does the thoracoplasty b/c it isn't necessary (or at least for me). He expects that fusing me from t1 to L1 will provide enough relief on my ribs. When I think about it now, in theory he would be right. I never had problems with my ribs until the last 5 years or so(when I passed the 50* mark)...which is when most of the progression has occurred for me - so if the surgery gets my thoracic curve down to 40*, maybe the rib discomfort would stop??

Marissa