Curious would you not have surgery if your not having back pain?

[Bigbluefrog]

I often wondered if you would avoid surgery if your scoliosis is not causing back pain?

If your living pain free and can function well, no issues with internal organs...would you continue living and avoid surgery and its complications.

I read that scoliosis pt can have a long healthy life.

If your having pain....surgery makes sense.

Did your child have pain?

What was the deciding factor for surgery? Is it just degrees of a curve or is there more involved.

[Snoopy]

My daughter has both Scoliosis and Kyphosis and never had pain from either. The reason we decided to do surgery was because although she was skeletally mature, her curves continued to progress.

Mary Lou

[LindaRacine]

Pain rarely becomes part of the equation in making the decision about whether an adolescent or teen should have surgery. At that age, it's really all about progression.

[livingtwisted]

This is a great question and something I'm struggling with right now as I'm (luckily) not in a lot pain.

Linda or May Lou -- could either of you explain why progression without pain is a reason for surgery? From what I understand the severity of the curve is not necessarily relative to the severity of the pain, so isn't it possible for a curve to progress and yet you never need surgery?

[LindaRacine]

This is a great question and something I'm struggling with right now as I'm (luckily) not in a lot pain.

Linda or May Lou -- could either of you explain why progression without pain is a reason for surgery? From what I understand the severity of the curve is not necessarily relative to the severity of the pain, so isn't it possible for a curve to progress and yet you never need surgery?

Yes, it's entirely possible to have a large curve and no pain. I know several people with curves over 100 degrees who describe no pain. The reason for an adolescent/teen to have surgery when there is progression, with or without pain, is to keep the curve(s) from becoming very severe. Large lumbar curves don't usually cause medical problems, but can result in pain and deformity. Large thoracic curves can cause heart and lung issues in addition to pain and deformity.

--Linda

[Sherie]

My daughter was 15 and having a lot of pain/discomfort in her lumbar curve which was 60'sh at the time of surgery. It became progressively more painful after 40 deg. It was a necessity for quality of life in her case.

If she hadn't had any pain, I still think it would have been necessary to go ahead with surgery because of the degree of her curves, there was almost 100% chance it would progress into adulthood. I think you need to consider the risk of progression, the chances they would need surgery sooner rather than later and how if would impact their life as an adult to wait. The other major factor to consider is length of fusion. It seems to me that kids who have thoracic fusions do very well, recover quickly and don't have the limitations that a lumbar fusion impose. My dd is fused down to L4 and now has the one disc working for her below the fusion, Dr. Lenke said it's very likely she'll need additional surgery down the road.

On the other hand, there's a good chance there will be surgical advances and waiting 10 or more years would allow you to benefit from them. You only need to look back to see how things have improved.

[Elisa]

Wow, I just looked at the pics of your daughter in PB and what an incredible difference in the before and after pics.

[Elisa]

My head feels as though it's going to explode; so much information here. I really don't think it's possible to retain all this information that I've collected in two days and I need to give it all some time to sink in.

Like I said before, the degree of the curve(s) isn't something I remember the doc telling me but honestly I'm somewhat recalling a number around 38* and the doc shaking his head as though he was telling me he's sorry and that there's no one on this island that is qualified to look at him and Vancouver it is.

At the time I was annoyed that there was no one on this island that would/could look at him and we had to travel to the mainland, but now I'm just hopeful that we get to actually see Dr. Riley any time soon.

I need to look more into the Shriners I think.

[Bigbluefrog]

Thanks for your input, so surgery was decided not based on pain factor but of curve progression. Imagine it was after a certain degree as the critical time to consider surgery. Is there a standard curve degree that surgery is needed? After 60 degrees? After 40 degrees? And imagine type of curve, age, progression, and degrees of curve are all factors. Interesting that pain is not a major factor.

This condition, is very dynamic...and a mystery.

[Pooka1]

Thanks for your input, so surgery was decided not based on pain factor but of curve progression. Imagine it was after a certain degree as the critical time to consider surgery. Is there a standard curve degree that surgery is needed? After 60 degrees? After 40 degrees? And imagine type of curve, age, progression, and degrees of curve are all factors. Interesting that pain is not a major factor.

This condition, is very dynamic...and a mystery.

As far as I can tell, 50* is a widely held surgery trigger for kids though the decision to fuse can be made at <50* with proven progression. My one daughter was below the surgical trigger when we made the call and was well over the trigger point about 2 months later. Of course her curve moved at ~5*/month for all observation periods until fusion It never moved less between radiographs than 5*/month so the call was obvious.

I saw one testimonial where a kid was recommended to be fused just to save lumbar levels in a TL curve per the report from the parent on what the surgeon recommended. I am saying I don't think there was necessarily progression also as I recall. If so, that is another reason to fuse earlier than 50* or <50* plus progression... to try to save levels in the lumbar.

[kennedy]

Well my spine surgeon (Dr Gupta) at uc davis said that most doctors say scoliosis is painless but he said that he don't think like that scoliosis is painful