Trying to understand structural and non structural curves.....

[susancook]

I am 66 and have adult onset degen scoliosis. I have my next surgeon follow up in a week. I have noticed that when I stand in front of the mirror, I lean ALOT to the right....right shoulder is much lower then it was 6 months ago. I look pretty pitiful.

When I sit, my shoulders are straight and when I was in the pool with water up to my neck, and feet on the bottom, my shoulders were straight. So, gravity is not my friend.....but my question is, how does the flexibility affect surgery? My physical therapist says that I am flexible and that i will do well the surgery, but I am uncertain what that means.

Read King14 entries, but still don't understand.

I have not had bending X-rays. Susan

[Pooka1]

...but my question is, how does the flexibility affect surgery? My physical therapist says that I am flexible and that i will do well the surgery, but I am uncertain what that means.

As far as I know, the amount of flexibility affects how much correction can be safely achieved without osteotomies and such. I suppose adult degenerative cases are about stopping the damage and associated pain which may only require some correction as opposed to hypercorrection. Your curve(s) may not even be structural but that is probably irrelevant to adult degenerative scoliosis where the problem is the damage/pain that results in the collapse and development of the curve I think. I don't know but your surgeon will know.

Read King14 entries, but still don't understand.

There is little to be learned generally or globally from King14 in my opinion. Her case of two large non-structural curves seems to be beyond rare.

I have not had bending X-rays. Susan

That is the only rigorous way to my knowledge to determine structural versus non-structural and to determine degree of flexibility. Your surgeon will have the straight dope on this.

[susancook]

As far as I know, the amount of flexibility affects how much correction can be safely achieved without osteotomies and such. I suppose adult degenerative cases are about stopping the damage and associated pain which may only require some correction as opposed to hypercorrection. Your curve(s) may not even be structural but that is probably irrelevant to adult degenerative scoliosis where the problem is the damage/pain that results in the collapse and development of the curve I think. I don't know but your surgeon will know.



There is little to be learned generally or globally from King14 in my opinion. Her case of two large non-structural curves seems to be beyond rare.



That is the only rigorous way to my knowledge to determine structural versus non-structural and to determine degree of flexibility. Your surgeon will have the straight dope on this.

Thanks so much for the info. I am trying to be as prepared as possible for my next appointment. Honestly, I am really scared on the progression of things in such a short time. This is not what I planned on for retirement . Sometimes, I think that I can just ignore all of the changes and pains....and then I get my head out of the sand and have a self talk and try to get real. The forum is so helpful. Thanks again.
Susan

[Pooka1]

Just to add... the point of trying to identify structural and non-structural curves is to know what to fuse and what NOT to fuse. In your case, I imagine they are going to fuse the area with the damage in a straighter position and perhaps free the nerves in that area to alleviate the pain. That's why I suspect it is irrelevant if your curve(s) are structural or compensatory.

[Pooka1]

Thanks so much for the info.

This is info but from a lay person. Only a surgeon can give you the actual facts. I am just making some logical guesses from what I do know. It could be wrong.

[golfnut]

I think with a flexible spine, it is easier for your surgeon to put the spine back in the proper position. My spine was inflexible, so I had to have osteotomies to get a good correction.

[Pooka1]

I think with a flexible spine, it is easier for your surgeon to put the spine back in the proper position. My spine was inflexible, so I had to have osteotomies to get a good correction.

I think this goes to the big difference between idiopathic scoliosis (IS) and adult degenerative (AD). With IS, there is an anterior overgrowth that causes the rotation and curving and subsequent further wedging over the years. There is always rotation with IS because of this. With AD, I think the spine curves because it is collapsing from the damage to the other tissues, NOT because he vertebra have an anterior overgrowth or are otherwise wedged. I suspect there is no rotation with AD and that these curves aren't even structural. They have to be fused to stem the curving from the damage. I'd like to hear what the surgeon says.

[LindaRacine]

I think the amount of rotation varies greatly in both idiopathic scoliosis and adult degenerative scoliosis. I've seen vertebra rotated 90 degrees in some degen curves.

[titaniumed]

I suspect there is no rotation with AD and that these curves aren't even structural. They have to be fused to stem the curving from the damage. I'd like to hear what the surgeon says.

This is a good question, and of course CT’s would tell the story.

Susan, if you shoot any CT’s, request a disc to be burned for your records. and you can look for yourself. I have posted mine in the past here and you can clearly see what rotation is all about. Let me know if you want to see them, I will throw them up again.

I found it amazing that you posted from the jungles of New Guinea..... with Wi-Fi coverage in the outback.... but there are no malaria nets??? Do these people have cell phones? In todays world, priorities are pretty important. (smiley face)

Ed

[Pooka1]

I think the amount of rotation varies greatly in both idiopathic scoliosis and adult degenerative scoliosis. I've seen vertebra rotated 90 degrees in some degen curves.

Oh wow. That's some serious damage. But again, that rotation with AD is not due to any anterior overgrowth or it would be IS. I think it's like the situation with Type I and II diabetes... same effect (high blood sugar) but entirely different cause (no insulin production versus resistance to insulin). The curves in AD and IS having different causes.

[titaniumed]

Its hard to believe that this happens.....Sigh. It’s a serious matter.

Take an idiopathic scoliosis and then live with it for several decades, add a little degeneration and more rotation, and all I have to say is my nervous system was completely shot.....Scoliosis would have killed me, I have no doubts about this. Dr Menmuir and team saved my life. I would NOT have made it to age 50.

If we only had some sort of pain meter to judge where a person is at......it would be a valuable tool especially for those adults that have waited like I did. Why wait till it kills you? If I only knew I would have had surgery many years sooner. I’m talking about pain tolerance levels that rise where your at a high level, but don’t realize it. I broke my shoulder and that pain was masked by my spine pain and didn’t matter. On pain levels at my Chiro, I was writing down 3’s till the last few months, then it all went downhill quite fast. The pain levels in my whole spine, every level went through the roof.

The nervous system can only handle so much....the problems of my scoliosis resulted in a major nervous system meltdown. I don’t know if it became an electrical problem and was short circuiting? This is a neuroscience question. I often wonder what was happening? It wasn’t good at all.

I was way beyond structural....way beyond expectations of correction, and ANY improvement was welcome. Greed does not play a part at this stage. I hope others don’t have this happen to them.

On a lighter note, after all these years, I have finally registered on SOS as “Rod Stewart”. Hey, I think it’s a fantastic scoliosis username...and having that good sense of humor is what we all need.....I wonder if they like Benny Hill? lol

Ed

[susancook]

This is a good question, and of course CT’s would tell the story.

Susan, if you shoot any CT’s, request a disc to be burned for your records. and you can look for yourself. I have posted mine in the past here and you can clearly see what rotation is all about. Let me know if you want to see them, I will throw them up again.

I found it amazing that you posted from the jungles of New Guinea..... with Wi-Fi coverage in the outback.... but there are no malaria nets??? Do these people have cell phones? In todays world, priorities are pretty important. (smiley face)

Ed

WiFi is rare, but everyone in the world has a cell phone, I've decided. Nets? Some people have them, but the mosquitoes are still winning. I have a new respect for mosquitoes and I probably have brain damage from all of the DEET that I put on.
Great idea about the CD, I will ask.

I have had some leg weakness and an inability to walk upon standing about once a year for 10 years. Of course I told my surgeon, but he seemed unimpressed. Well, the other day when I returned to Fiji, I sat down and when I tried to get up, my legs were so weak. I sat down and then laid down and stretched and tried to get up...same thing. I was in my hotel room alone, it lasted for a while, then after lying down again and stretching something must have popped into place. Scary. Also, on the international trip back, I was left standing in line for a long time since there was a "food"delay on loading the plane. I was in such pain, that I layed down in line and moaned. I am so lucky that I was mostly painfree for most of my trip. My stenotic L4 had apparently used up all the steroids that I had before I left, and I am wondering how many more inj I can have before the disc collapses.

So, I sent the surgeon a note and his PA writes back, "Make an appt". I write back that I have one on Tuesday, and then she writes back that she emailed the surgeon and he said not to twist or bend my spine and if I can't walk again to call an ambulance. I read that message after I returned from a swim workout at the Y. I think that decision time has come. Susan

[leahdragonfly]

Hi Susan,

Sorry to hear of your recent troubles and increased pain. Severe stenosis is frequently more of a mechanical narrowing (rather than strictly inflammatory) that doesn't respond well to steroid injections. I tried two rounds for my severe stenosis/spondylolisthesis at L4 and it did nothing to help. Standing was the absolute worst position for me before my surgery.

I saw Dr Keenen in Tualatin for a second opinion prior to surgery. He agreed I probably needed surgery, although he commented that most of the stenosis patients he sees can only crawl. I thought that was a really asinine comment.

I'm not surpised to hear Dr H's advice--there's really nothing else they can advise when you are so far away. Best of luck at your appt Tuesday. Are you having new imaging done? Take your list of questions in priority order. I would recommend you bring your husband to listen, also. It does sound like you are out of non0-surgical options.

Safe travels home, and please let us know how things go Tuesday.

[titaniumed]

Everyone (including people in New Guinea) with a cell phone is hard to believe but I guess its true. Time is flying.... I did work on the electronics for Motorola and L3 communications 15 years ago, it was for repeater sites in eastern Europe.....When you pay your phone bill, you are paying for this electrical hardware that’s in all repeater stations on mountain peaks. Its all silver plated copper hardware and very expensive....”Can you hear me now?” Of course not. What’s with these marketing people anyway? LOL

I will not use DEET. I’m not fond of applying chemicals on my body. I’ve been exposed to lovely things in the past, and will not do it anymore. I am aware now and will not work around toxic areas or superfund sites. The OSHA people don’t even visit anymore because they know how funky I am about this sort of thing. We are destroying our planet...period. Everyone needs to be an environmentalist. Start teaching the kids at age 5, turn them green. DEET has caused seizures in the past.....so do cell phones, the warnings are on the first page of your phone manual. Go easy with the phone, and video games.

Mosquitoes are dangerous!!! I don’t think that it would be a good idea to go back if your immune system is compromised “during” your recovery.....It will be working full time, getting bit by a nasty mosquito would be something I would avoid. You don’t need this in your recovery.

Radiculopathy is a condition that many of us experience. It’s a tough situation. If you are laying down in public places, it’s a sign. I’ve been there. I have battled weakness through exercise......some times its so hard, we have to accept the reality of the situation. Sigh...
http://en.wikipedia.org/wiki/Neuropathy
http://en.wikipedia.org/wiki/Radiculopathy
http://en.wikipedia.org/wiki/Compression_neuropathy
http://en.wikipedia.org/wiki/Sciatica

I agree with Gail, it sounds like you are running out of non-surgical options....Everything I was doing at the end, massages, manipulation, etc, these methods that DID work through the years, suddenly didn’t work anymore.....my nerves were on FIRE. Compression, lack of blood, decreased nerve function, degeneration....its almost like a stack of cards falling down. A very upsetting situation, but we need to be brave when this happens.

Ed