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Pooka1
02-11-2011, 05:43 AM
http://my.clevelandclinic.org/multimedia/transcripts/pediatric_scoliosis.aspx


porto2: For a person who has had surgery as a young adult, what problems will she experience as she gets older, particularly in her senior years when she also has to contend with arthritis, osteoporosis, back problems, etc.?

Speaker_-_Dr__Thomas_Kuivila: She may have no problems whatsoever related to the scoliosis. Fusions which leave half of the lumbar spine in tact are no more likely to cause back pain than in any other person.

This is what our surgeon said also. The issue might be that since almost all adults will get back pain bad enough to see a doctor at some point, it is impossible to attribute any back pain in fused folks to the fusion per se.

JulieBW
02-11-2011, 07:46 AM
This sounds like the presenter's opinion. I would love to see some data on this issue.

mariaf
02-11-2011, 08:24 AM
[url]The issue might be that since almost all adults will get back pain bad enough to see a doctor at some point, it is impossible to attribute any back pain in fused folks to the fusion per se.

This is purely anecdotal of course and in no way scientific, but it does seem that once you reach a certain age, most folks develop back pain.

My mom, who does not have scoliosis, had a MRI a few years ago and it revealed a number of things responsible for her back pain. My husband has dealt with back pain, herniated/bulging discs, disc degeneration, arthritis, etc. for a number of years. He's seen several doctors for this. A good friend of mine also in the same situation. Neither of them has scoliosis.

I, myself, have 'thrown my back out' a few times - and have experienced spells of pretty bad lower back pain. Seems if you ask anyone in their 40's or 50's, most would say they've seen a doctor for back pain.

Again, just my VERY unscientific survey :-)

Pooka1
02-11-2011, 12:28 PM
This sounds like the presenter's opinion. I would love to see some data on this issue.

I am told the data on the general population are in and can probably be found easily but I don't know that. The data on post op folks is sparser of course.

Pooka1
02-11-2011, 12:50 PM
If you google back pain in adults there seems to be a lot there.


http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5947a6.htm?s_cid=mm5947a6_w

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Here is a comment from wiki...


In the United States lower back painís economic impact reveals that it is the number one reason for individuals under the age of 45 to limit their activity, second highest complaint seen in physicianís offices, fifth most common requirement for hospitalization, and the third leading cause for surgery.

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http://www.uptodate.com/contents/patient-information-low-back-pain-in-adults


Low back pain is one of the most common disorders in the United States. About 80 percent of people have at least one episode of low back pain during their lifetime.

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http://www.patient.co.uk/health/Back-Pain.htm


About 8 in 10 people have one or more bouts of low back pain.

hdugger
02-11-2011, 02:16 PM
There's clearly some percentage of people who go into the surgery without pain and come out with chronic pain. So, even barring long-term degeneration related to having a fused spine, the surgery itself adds back pain patients into the population.

Here's a recent paper from China with an estimate of 10% of mostly young patients (so, not people who went in to the surgery with pain) coming out of surgery with chronic back pain - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078302/. I have no idea how that relates to the rate in the US.

Beyond that, it is hard to imagine that completely changing the way a major part of your skeletal structure works is not going to put additional wear and tear on the system. That's likely difficult to prove, given the endemic rate of back pain, but I'm assuming that my son will always be at increased risk of back problems as a scoliosis patient whether he gets the surgery or not.

I do think that fusing the spine down to the pelvis probably decreases the chance of future back pain, just because you're gotten rid of all of the moving parts. Not that I think that's a good option for someone with a thoracic curve, for lots of other reasons (including the stress it might place on other parts of the skeletal system). But I do suspect that it decreases risk for back pain.

Pooka1
02-11-2011, 05:14 PM
Some more refs for a huge percentage of the general public having back pain...

http://jama.ama-assn.org/content/302/14/1586.full?ijkey=lio49UgERaHPI&keytype=ref&siteid=amajnls

http://www.vhct.org/case1699/preval_costs.htm

http://www.ncbi.nlm.nih.gov/pubmed/19204216?dopt=Abstract

I didn't research this to death but I think many of these claims trace back to one paper by a guy named Rudin. I could be wrong and probably am in the thought that that is the only or main reference for this 80% figure.

jrnyc
02-11-2011, 05:20 PM
i have heard pain doctors say that if someone lives long enough, odds are high that they well herniate a disc...
of course, there are those with herniated discs as their only problem, and arthroscopic type surgery does exist for such patients...

jess

Pooka1
02-11-2011, 05:20 PM
Oh and the other thing is that it is apparently a fact that DDD is inevitable if you live long enough. Like death and taxes.

To the extent that DDD is often if not always symptomatic, then 100% of people will have back pain if they live long enough FULL STOP.

Pooka1
02-11-2011, 05:21 PM
i have heard pain doctors say that if someone lives long enough, odds are high that they well herniate a disc...
of course, there are those with herniated discs as their only problem, and arthroscopic type surgery does exist for such patients...

jess

Oh hey we posted at the exact same time.

I didn't know that. I do know I herniated a disc in my early 30s.

jrnyc
02-11-2011, 05:26 PM
yes, we posted at the same time...
because great minds think alike!!

jess

mariaf
02-11-2011, 08:54 PM
I remember one doctor telling my husband that if you sent 100 people over a certain age for an MRI, the majority would have some sort of disc related problem.

JulieBW
02-12-2011, 07:43 AM
I'm thinking what is different is the age at which back problems develop. I had low back muscle spasms at age 20, severe osteoarthritis in lumbar vertebrae at age 40, stenosis in my early 50's. This is not the norm. I am very active with gardening, biking, swimming etc., have been all my life, so it is not lack of conditioning. I think it is very difficult to collect data on others like me with aging fusions. No one has kept track of us. It would be pretty difficult to collect data on those who don't have problems warranting surgical intervention.

Pooka1
02-12-2011, 09:46 AM
I'm thinking what is different is the age at which back problems develop. I had low back muscle spasms at age 20, severe osteoarthritis in lumbar vertebrae at age 40, stenosis in my early 50's. This is not the norm. I am very active with gardening, biking, swimming etc., have been all my life, so it is not lack of conditioning. I think it is very difficult to collect data on others like me with aging fusions. No one has kept track of us. It would be pretty difficult to collect data on those who don't have problems warranting surgical intervention.

I think you might be right in general and also in the big picture over large numbers.

As for specifics, I think patients might group in terms of T versus L versus double major and also Harrington rod versus pedicle screws.

There are those with Harrington rods for lumbar fusions who have a high chance of getting flatback syndrome. And there are a few kids with double majors who only have the T part fused and they have severe damage to the lumbar within a short time. Or some folks with an L curve that is fused past L3 and not to pelvis.

Those three groups are going to differ from kids/adults who have T fusions with pedicle screws who achieve a solid fusion.

As I understand it, absent a pseudoarthrosis, nothing can go wrong and therefore there can be no pain in a solidly fused section of spine. Thus people like Ti Ed can only now have pathology north of T2. Counting the neck, that is only 8 vertebra compared to like 26 for the general population. That's a huge difference in terms of possible pathological areas and what we know about things like DDD. People with long fusions are the ONLY people who escape DDD.

I completely expect my daughters to have ZERO issues in the fused parts of their spines if they are fused.

JulieBW
02-12-2011, 03:02 PM
I believe that most typical back problems are in the lumbar area, so maybe a person could be better off than the norm if they have that region fused. But for those of us with thoracic fusions, I believe our vulnerability is enhanced by the fusion, both above and below the fusion. I don't believe the general population experiences difficulty in most of the 26 vertebrae, so thinking that you reduce the chances of back problems by fusing vertebrae could be misleading. These are just my thoughts based on my own experience and reading the many posts here from people with aging fusions. I would love to see data from people with aging scoliosis fusions but I'm not holding my breath. It always makes me uncomfortable to see statements from physicians without data, holding out false reassurance.

Pooka1
02-12-2011, 05:32 PM
I agree that the straight dope is likely not known. In the mean time, here's what I found for long term on fusion... emphasis added. N.B. these might be false.
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Here's a 20-30 years follow up

http://www.ejbjs.org/cgi/reprint/62/3/364.pdf


ABSTRACT: One hundred and ten scoliotic patients
underwent correction and spine fusion by one of us
(J. H. M.) at Gillette Children's Hospital between
1947 and 1957. Sixty-one of these patients were evaluated
in 1977 for this follow-up study. The evaluation
consisted of physical and roentgenographic examination,
photographs, and a detailed psychosocial
analysis. The aims of the study were to evaluate: (1) the
long-term stability of the fusion; (2) the incidence and
severity of low-back pain; and (3) the degree of integration
of the patient into society.

The results showed that a solid fusion had no significant
loss of correction with time. Eighty-four per
cent of the patients lost only zero to 5 degrees of correction
during an average follow-up of twenty-six
years. Low-back pain was found to be no more frequent
than in the normal population in this age group,
and there was less low-back pain than in a comparable
series of scoliotic patients without fusion.
There was no correlation between the occurrence
of low-back pain and the length or magnitude of the
fused curve or the lowest extent of the fusion. An unexpected
finding was the high incidence of neck pain, the
cause of which is unknown. Psychosocial analysis revealed
that the patients were productive, active, stable
persons who were working and contributing members
of society.

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Here's a review of long term H-rod studies

http://www.coa-aco.org/coa-bulletin/issue-85/themes-long-term-outcomes-following-fusion-for-scoliosis-deformity.html

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Here's some long-term L fusion data from relatively early in the surgical period I think that may be one of the studies to establish the relationship between fusing past L3 and later problems...

http://journals.lww.com/spinejournal/Abstract/1987/03000/Long_term_Follow_up_of_Lower_Lumbar_Fusion.4.aspx


Although patients after lower lumbar fusion report more pain than the general population and have more radiographic evidence of instability and stenosis than expected for the general population, they are generally doing well and are satisfied with the results of their surgery.

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Long term on untreated scoliosis...

http://www.ejbjs.org/cgi/reprint/63/5/702


ABSTRACT: Two hundred and nineteen patients
with untreated adolescent idiopathic scoliosis who were
seen at the University of Iowa between 1932 and 1948
were studied, and recent information was available on
194 of the patients. The mortality rate was 15 per cent.
Backache was somewhat more common in these patients
than in the general population, although it was
never disabling. The backache was unrelated to the
presence of osteoarthritic changes on roentgenograms.
Many curves continued to progress slightly in adult
life, particularly thoracic curves that had reached between
50 and 80 degrees at skeletal maturity. The lumbar
components of combined curves between 50 and 74
degrees also tended to progress. Pulmonary function
was affected only in patients with thoracic curves.

JulieBW
02-13-2011, 07:39 AM
These quotes are from the Harrington rod study you posted, the group I am in:

In Danielson and Nachemson's series of patients followed after Harrington instrumentation, they determined that the curves did not increase over time, but that disc degeneration was more common than in a non-operated control group.

Cochrane7 et al, Hayes et al13 found a high incidence of retrolisthesis in the unfused spine especially when the fusion level was more distal; along with this retrolisthesis, came a higher incidence of back pain.

Thank you for these references.