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Debra JGL
06-07-2010, 06:59 PM
Way to go on my 1st post I started in years. I thought I better send this again with a subject or no one would respond. I'll get this posting down.

Hi All,
I'm having a consult with Dr. Boachie next Thurs. I did see him 2 years ago as well. Thanks to this forum I have a long (growing) list of questions to ask. He said at the time I was a candidate for selective fusion, fusing the top curve T3-T12 and letting the compensatory curve correct itself, with the understanding that an extension may be necesary in the future. Also, I would have less of a correction than if he fused to L3 or L4 (about 5 degrees). I'm really hoping this is still an option for me, but I'll have to wait and see.

I wanted to ask if anyone else has had this type of fusion and what has been their experience; did the lumbar curve correct as hoped, do you expect an extension of the fusion, is there much pain in the lumbar curve area now. The muscles around my lumbar curve cause me the most pain, sometimes I fell like someone just drove a knife into my back, or I wouldn't mind if they did. Sorry sound a ittle extreme, it just hurts now, it's not alway this painful-but is alot. My doc said he thought it was "mechanical" and would subside when the curve was corrected.

Thanks for any of your thoughts,
Debra
__________________
Debra
Age 44
Thoracic curve - 69
Lumbar curve - 54
Milwaukee braced, 11 years old to 15 yo
follow-up with Dr. Boachie in June

titaniumed
06-07-2010, 07:26 PM
Hi Debra

No worries. You can always delete your posts if you make a mistake.

I do remember reading about Dr B doing these shorter fusions on the HSS site. I do not remember anyone posting here that has had this done.... It might not be a bad idea to go through the site again.

Good luck
Ed

cyborg2be
06-07-2010, 07:53 PM
hey guys you bith mention "hss" - what is that? I'm always looking for new places of info...

thanks!

marissa

Pooka1
06-07-2010, 08:02 PM
As far as I know, compensatory curves correct on the table. That happened with both my kids wherein the first radiograph at Day 4 for each kid showed pretty much a straight lumbar when the thorax was straightened.

My understanding is that the ones that don't straighten immediately or very soon after fusing the structural curve were misidentified as functional when they were in fact structural.

As far as I can tell, when the T curve is larger then the L curve is very likely functional as in your case. And according to something Dr. Hey wrote, the straighter and more balanced you get the T curve the more straightening you will drive in the L curve.

There are at least three testimonials I have read of kids who seemingly had double major curves (two structural curves) wherein the surgeon only fused the T curve. Problems seem to follow in terms of trunk shifts in the short term and severe and varied damage in the lumbar within a year or so IIRC in the case of a kid on another forum.

What I don't understand is Boachie telling you he would only go to T12 and not even L1. Both my kids had smaller T curves that you do but the surgeon went to L1 in both cases. Their curve apex was at T9 and maybe yours is higher. Also maybe there is some hypertechnical reason they needed to have L1 included in the fusion and you don't but then I don't understand Boachie's comment about possibly going to L3 or L4 on you. And the reason... to get slightly more correction in the T curve is very novel to my ears... the only way I would let the surgeon fuse into my kids' lumbar is if it was structural, not solely to get a 5* better correction in the T curve. I really hope Linda comments on that one.

To my understanding, they fuse L curves because they are structural and would be unstable absent including that in the fusion. And I conclude there is some extremely good reason for going to L1 on T curves because if there isn't then you wouldn't see anyone with a T curve fused to L1.

Linda will dope-slap me if I have this wrong which I suspect I do.

Pooka1
06-07-2010, 08:03 PM
hey guys you bith mention "hss" - what is that? I'm always looking for new places of info...

thanks!

marissa

Hospital for Special Surgery in Manhattan.

Debra JGL
06-07-2010, 08:22 PM
Thanks Ed for the tip on the delete, I finally figured out how to do it. I'll look over the HSS site again too.

Sharon, I probably should have given more info.. Dr. B had mri'd my lumbar spine to see what kind of condition it was in and if the SF was a reasonable option. He felt L1, & L2 were not in good enough condition to end a fusion there. So T12 was the best option for a SF with the slight less correction and chance of an extension down the road but preserve lumbar motion, or go ahead with the longer fusion to L3 or 4 and lose some mobility in the lumbar. I had bending xrays and my lumbar bent to about 26. Of course this is a couple of years ago, so this may be a mute point. I just want to be ready with any question if this is still an option. I also had another consult with Dr. Lonner of NY that had told me the same thing. It's really wonderful that your kids had such a great response. You must have been relieved. I really appreciate your feedback too

Deb

Pooka1
06-07-2010, 08:37 PM
Ah okay that makes sense. :)

You do have a compensatory L curve and they would want to go to L1 or L2 but can't. So your choice becomes T12 or L3/L4. And you have two identical opinions from two top shelf guys so that is great.

That's a tough break having to decide to fuse into a functional L curve due to those two questionable discs.

Were it me or my kids I think I would try to go to T12 assuming the L curve is without any doubt not structural. And if Dr. Hey is right about driving the L curve straight then I would hope the surgeon did his very best to get that T curve as straight as possible to preserve the upper L discs. I think maybe the final decision would rest on the surgeon's confidence in how straight he could get the T curve.

Something else to consider... if you go to L3/L4 now you are likely to need an extension due to adjacent level disease as far as I know. If you go to T12 you may never need more surgery. I would hit that comment off both surgeons were it me to see what they say.

Good luck with whatever you decide. Tough decision.

txmarinemom
06-08-2010, 01:15 PM
To my understanding, they fuse L curves because they are structural and would be unstable absent including that in the fusion. And I conclude there is some extremely good reason for going to L1 on T curves because if there isn't then you wouldn't see anyone with a T curve fused to L1.

Sharon,

I knew your girls had the same fusion levels as me, but I didn't realize their apices were also identical to mine.

Anyway, regarding T12 vs. L1, I've never heard of any reason to extend to L1 except when L1 is involved. Although she hasn't been on here in a while, vndy had a pre-op curve that was very similar to mine (more severe, I believe, but same geography). She was slated for a T4-L1 fusion, and Dr. Wood ended up only taking her to T12.

Just throwing that out there. It does happen (even in the case of non-compromised vertebrae), although I can't say how often.

Pam

Pooka1
06-08-2010, 07:38 PM
Anyway, regarding T12 vs. L1, I've never heard of any reason to extend to L1 except when L1 is involved.

I think I may have read somewhere that surgeons don't like to stop at T12 for some stability reason and not necessarily because L1 is involved. But I am not sure about that. Maybe Linda knows.

loves to skate
06-09-2010, 04:33 PM
[QUOTE=Pooka1;100787]As far as I know, compensatory curves correct on the table. That happened with both my kids wherein the first radiograph at Day 4 for each kid showed pretty much a straight lumbar when the thorax was straightened. QUOTE

Sharon, This may be true for kids, but I don't think it is true for adults, especially the older ones. It took almost two years for my compensatory thoracic curve to correct itself. Sally

Back-out
06-09-2010, 05:10 PM
I'd like to follow-up lovestoskate's comments on older adults and lumbar curves.

Two of three surgeons consulted to date, want to fuse me T4 - to sacrum with/w-o pelvic fixation, while #3 wanted to start at T10 saying the rest was in good shape and would straighten itself including de-rotating the thoraco-lumbar hump.

Who's right? God knows I'd LOVE to maintain more flexibility (not looking forward to needing devices to wipe my behind! :p)

I intend to see more docs and I'll ask more intelligent questions then, largely thanks to this forum.

Meanwhile, I wonder how much patients are EVER in a position to evaluate their MD's surgical programs. Right now, I'm forging ahead with consults as much to take a vote on what the right thing to do is, as to choose my eventual surgeon. Good thing my present insurance supports that! Medicare, only allows for ONE second opinion. :eek:

One of many reasons to get a move on.

Note, I think my DDD is as or more painful than the scoliosis per se. (The lumbar X-rays really do look like - fuzzy - blocks falling down from a child's tower). That to me, means the lumbar fusion surgery is probably a necessity no matter what, along with creating my proper lordosis (started to write "recreating" then realized it didn't apply as I never had it! :o)

Debra JGL
06-09-2010, 08:10 PM
Thanks all for your comments. You all got me thinking - sometimes dangerous. I did find a study -abstract (yikes, I try to read them and decifer what I can-but I know there's alot of details left out, and some things I'm not going to understand) titled Lumbar Curve Response to Selective Thoracic Fusion in adult AIS from www.thespinejournal.com. The mean age of the 30 patients was 40. The end instumented vertebra in patients was T11 through L2. T12 had 7 patients. The majority were L1 with 14 patients. So hopefully ending at T12 would be ok for me. Lucky me, Boachie is on this study, so I can ask him some questions. In this particular study it said the "mean" spontaneous lumbar curve correction at 39 months was about 50%.

Well I think the main question will be what does he think my chances are of having to have an extension in the future with the SF (if still an option), and what are my chances if the fusion is the L3 or 4. If the same, SF would be a better option for me. I think that's kind of what you said Sharon. I would really love to keep the mobility in my lumbar spine, and I'm very much hoping this is still an option for me. I guess I'll find out next Thursday.

Thanks again,
Debra

txmarinemom
06-09-2010, 10:05 PM
Sharon, This may be true for kids, but I don't think it is true for adults, especially the older ones. It took almost two years for my compensatory thoracic curve to correct itself. Sally

It's not even universally true for the middle aged group. We don't all correct (compensatory) on the table.