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cathydownunder
11-10-2013, 07:22 AM
Just wondering what the smallest size curve was that anyone's has fused.

Mine is thoracolumbar and is steady at roughly 35 degrees but is quite rotated and painful. Ive had L3/4 fused, a disc replacement at L4/5 and fusion at L5/S1 in 2 previous surgeries for DDD but now my L2/3 has a large central bulge and my sacroiliac joints are playing up as well.

My surgeon thinks it's time to consider the long fusion that we'd been trying to avoid, probably T6/8 to sacrum which may seem a bit strange considering I;m on the lower end end of the curve scale.

So has anyone here had a long fusion for a similar size curve and what were the results?

Cathy

LindaRacine
11-10-2013, 11:22 AM
Hi Cathy...

I've actually seen very small curves corrected. In these cases the curves are not being fused for the same reason a large curve is fused. Curve size makes a difference in kids, but is not necessarily a big factor in adults.

With that said, I'd like to encourage you to get a second opinion. Starting a fusion at T6-T8 would be incredibly unusual, at least among the best surgeons here in the U.S, as the risk factor of needing an even higher fusion is fairly high. (There are probably reasons to start a fusion there in some unique cases, but it would be nice to confirm that you're one of those patients.)

Regards,
Linda

titaniumed
11-10-2013, 11:40 AM
Cathy

Here are some examples from Dr Pashman. Click review case for specifics. Each case is so different.
http://espine.com/scoliosis/adult-scoliosis-cases/

I donít believe we have seen a full fusion over a Maverick artificial disc before...You might address this with your surgeon and get a 2nd opinion.
http://www.methodisthealthsystem.org/discreplacementlumbarmaverick

Hang in there
Ed

susancook
11-10-2013, 01:19 PM
Cathy: As you can see from my curve #s, my curve is about 25/36. People w/ adult onset scoliosis have smaller curves in general, as the curves are caused by degeneration of discs that is asymmetric. Generally the lumbar area is the main problem, so the curve is larger there and the thoracic curve is just a compensation curve, or it could be the other way around, but generally the lumbar discs are the start of the degeneration in the aging spine.

Curves in Adult Degenerative Scoliosis can be and are smaller, certainly than mine. It is not the size of the curve, BUT the symptoms that are the reason that the surgery is done. There are not any rule of # in the curve for adult onset scoliosis. The reason for the curves in adult degenerative scoliosis is the collapse of discs and the pain that it causes, as well as stenotic outlets from discs. Most adult degen do not have any history of scoliosis, but certainly could have scoliosis which was mild earlier, but without films, you don't know.

The rules for the scoliosis in the younger set are generally a much higher number [I have heard 60] as the cause and future for those curves is different.

Is that helpful?
Susan

jrnyc
11-10-2013, 02:27 PM
confusing...all the surgeons i saw...including Boachie, Lonner, Neuwirth,
and a few others...all debated starting fusion at T4 to sacrum and then
agreed IF my upper curve did not bother me, they could start from T10....

i do not know that they would say that now, as my upper spine has been
bothering me more lately...
but i have heard of people being fused from lower spots on spine, and not
all starting fusion higher...
wondering what complication rates are like for those patients...
not 20 years later, but sooner...like a year or two later...

jess

Irina
11-10-2013, 03:53 PM
Hi Cathy...

I've actually seen very small curves corrected. In these cases the curves are not being fused for the same reason a large curve is fused. Curve size makes a difference in kids, but is not necessarily a big factor in adults.

With that said, I'd like to encourage you to get a second opinion. Starting a fusion at T6-T8 would be incredibly unusual, at least among the best surgeons here in the U.S, as the risk factor of needing an even higher fusion is fairly high. (There are probably reasons to start a fusion there in some unique cases, but it would be nice to confirm that you're one of those patients.)

Regards,
Linda

Oh-oh, I am fused T6 to S1 and after reading this hope I won't need to extend the fusion higher. One doctor said he'll fuse T2 to sacrum because he is fusing EVERYBODY from either T2 to S1 or T10 to S1 and it sounded really odd to me. Why not T3 or T4 I was thinking and this cookie-cutter approach was a turn-off for me. The second opinion said either T4 or T5 to S1 and Dr. Hu said either T5 or T6 to L5 or S1 and fused me T6 to S1. I had a thoracolumbar curve and my upper back and shoulders were pretty straight, I believe that the appex was at T10, may be this is why she fused me from T6? Some doctors said that my curve was unusual for juvenile idiopathic onset scoliosis.

jackieg412
11-10-2013, 04:51 PM
I think this comment will add to the different approches to scoiliosis surgery. Part of my surgical team wanted to fuse me t-9--pelvis. The scoli doctor said no way as starting the fusion at t-9 could create a top off problem later. The dr's then did t10-pelvis. Six days after surgery{when you are barely moving} I fractured through t-9. Not that we can go back, but makes me wonder if we started at t-9 maybe I would not have fractured???
Two years later --I was fused t2-t10. So now it is t2-pelvis.
I think there is another member started at t-9. Maybe they will sent an post about it.
But I do agree --second opinions or third opinions are called for--no one wants to have problems with this surgery .

leahdragonfly
11-10-2013, 05:45 PM
Hi,

I am fused T8-sacrum. My collapsing lumbar curve was the problem (went from ~30-35 to 47 degrees in 2 years after being apparently stable prior to that), but I also had a thoracic curve that measured around 25 or so. My surgeon felt that my lumbar curve would be well-stabilized by starting the fusion at T8. He did a CT and MRI of my thoracic to ensure the discs there were healthy enough to leave unfused. He told me I would have some risk of needing an extension up to around T4 later in life, but after the surgery he told me my bones were plenty strong, and that it would be a long time before I would have to consider an extension. I truly hope that day never comes!!! At this point (3 years since original fusion) I have no real issues or pain with my upper back other than occasional muscular fatigue.

If given the choice I would have absolutely chosen to start my fusion at T8 as opposed to T4 due to the additional loss of mobility from a longer fusion. I am one of those who does not love having restricted mobility due to fusion.

I have read some interesting articles on Pubmed about choosing fusion levels for scoliosis surgery. The "standard" upper levels seem to be either T2-4 or T10, and there is some scientific basis for these choices. Dr. Pashman's site as mentioned above seems to support this.

LindaRacine
11-10-2013, 09:02 PM
As I said, there are reasons to start a fusion at T6-8, but I would want to get a second opinion to be sure it's the right thing. It's totally dependent on where the apex of the coronal and sagittal curves are.

--Linda