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LindaRacine
10-27-2014, 11:40 AM
Hi...

I was trying to find some information about the natural history of Degenerative Scoliosis, and found a good PowerPoint presentation about if/when to do surgery. I believe it's meant for medical professionals, but it should be fairly easy to understand for many of you.

When to Operate and When to Say No (http://www.google.com/url?url=http://www.orthospine.com/powerpoint/SRS_When_to_operate.ppt&rct=j&frm=1&q=&esrc=s&sa=U&ei=3nJOVJurO8S1oQT3k4HwBA&ved=0CCoQFjAB&sig2=H0uYqCcOXZabD-VX0Uycwg&usg=AFQjCNH6cyQICrYK1flm0VM-ojwCBJEAfw)

--Linda

Mojo's Mom
10-27-2014, 10:32 PM
Thanks, Linda, this was very interesting, even though some of it is over my head. But overall, it is pretty clear what conclusions are drawn.

titaniumed
10-27-2014, 10:34 PM
Linda

They sure stress the sagittal plane..... “Not coronal cobb angle” (page 15)

They mention the lordosis component a few times, and they don’t like these curves too large..... (grim face)

On Pg 40, I’m in the winners column! Major pain and disability(Yes), male (yes), subluxation>6mm (Don’t know), Lost lumbar lordosis, (I know I was way less than 40 deg)Osteotomy (Wasn’t used) My sagittal views didn’t change much from my surgeries....I had slightly lower kyphosis and lordosis cobb’s from normal.

Thanks for posting, I found this very interesting!

Ed

LindaRacine
10-28-2014, 12:08 AM
Ed...

It's what I've been telling Jess for years. (I think she finally has it. :-) Cobb angle becomes useless after skeletal maturity. Things like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.

--Linda

burdle
10-28-2014, 06:37 AM
Am a bit confused re. the lordosis component. It says lordosis >40 as the consideration - it doesn't mention loss of lordosis ( flatback). I have 27* in lumbar spine. Normal lordosis is considered as being between 40-60*. Why is the consideration here >40*?

LindaRacine
10-28-2014, 02:24 PM
Am a bit confused re. the lordosis component. It says lordosis >40 as the consideration - it doesn't mention loss of lordosis ( flatback). I have 27* in lumbar spine. Normal lordosis is considered as being between 40-60*. Why is the consideration here >40*?
I couldn't find anywhere that had anything negative about lordosis >40. The author is showing that lordosis >40 is a good thing, and that patients with good lordosis had worse surgical outcomes than patients with less lordosis. (That's another thing I've been saying for awhile. People who are worse off prior to surgery do much better than people who have little to gain.)

Make sense?

--Linda

jrnyc
10-28-2014, 03:54 PM
hmmmm.....WHAT?

i cannot walk anymore....i am guessing that counts...?
i have flatback tho i never knew...thought everybody had similar
spine...never looked, really....
i have stenosis, arthritis, listhesis, DDD and herniated disc....
bursitis in hip (caused by "uneven loading of spine")
and oh yeah.....the PAIN

so ASIDE from ANGLES....i got reasons...

is that what you guys are referring to....???
but my legs are OK...guess that would rule me out for certain
surgeons. and that, to me, is absolutely ludicrous.

now...i am sorry if that sounds a wee bit like "attitude"
but i am quite well aware that curve alone does not surgery need...
it is function....i know people with curves same size as mine who function
fine....SO FAR....but....they are also younger than i am...sooooo....
am not a betting woman....if i were, i would lay odds the curves will
catch up with their function in another 5 or 10 years, give or take a year....
and the pain will creep up on them, too.

jess...and Sparky, the bravest sweetest dog in the world

j.

Mojo's Mom
10-28-2014, 04:44 PM
Ed...

It's what I've been telling Jess for years. (I think she finally has it. :-) Cobb angle becomes useless after skeletal maturity. Thinks like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.

--Linda

Ah, so this is why Dr. O'Brien never talks about or seems interested in my Cobb angles, but talks about my curve balance, pain level and level of function.

LindaRacine
10-28-2014, 05:15 PM
hmmmm.....WHAT?

i cannot walk anymore....i am guessing that counts...?
i have flatback tho i never knew...thought everybody had similar
spine...never looked, really....
i have stenosis, arthritis, listhesis, DDD and herniated disc....
bursitis in hip (caused by "uneven loading of spine")
and oh yeah.....the PAIN

so ASIDE from ANGLES....i got reasons...

is that what you guys are referring to....???
but my legs are OK...guess that would rule me out for certain
surgeons. and that, to me, is absolutely ludicrous.

now...i am sorry if that sounds a wee bit like "attitude"
but i am quite well aware that curve alone does not surgery need...
it is function....i know people with curves same size as mine who function
fine....SO FAR....but....they are also younger than i am...sooooo....
am not a betting woman....if i were, i would lay odds the curves will
catch up with their function in another 5 or 10 years, give or take a year....
and the pain will creep up on them, too.

jess...and Sparky, the bravest sweetest dog in the world

j.

Jess... think you probably missed this:



Things like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.


The only reason I mentioned you is that you always seemed to question whenever someone with a small curve was considering surgery. :-)

jrnyc
10-28-2014, 11:10 PM
no...i did not miss that sentence.

i do not think anyone can make a blanket statement...
however, i was told that my bursitis in hip is from uneven
loading of spine...so am i to believe that smaller curves have
as much uneven loading of spine as larger curves do...?????

i realize there are alot of things that are looked at when a
fusion surgery is being considered.....and that not all large
curves need surgery, and not all small ones do not...

however....i do believe that larger curves make the spine
weaker....and lead to more risks of other problems occurring.
.
jess...and Sparky

LindaRacine
10-29-2014, 11:55 AM
no...i did not miss that sentence.

i do not think anyone can make a blanket statement...
however, i was told that my bursitis in hip is from uneven
loading of spine...so am i to believe that smaller curves have
as much uneven loading of spine as larger curves do...?????

i realize there are alot of things that are looked at when a
fusion surgery is being considered.....and that not all large
curves need surgery, and not all small ones do not...

however....i do believe that larger curves make the spine
weaker....and lead to more risks of other problems occurring.
.
jess...and Sparky

Hi Jess...

As far as I know, no one has studied that. My tronchanteric bursitis didn't get back until after my spine had been straightened. I think we can agree that curve size is a consideration, it's minor compared to pain and function. And, we can also probably agree while that most people with big curves end up in surgery and maybe most people with small curves do not have surgery, there are plenty of exceptions to both rules. Curve size does not correlate directly to pain or loss of function.

--Linda

susancook
10-31-2014, 02:33 AM
Thanks forms ting, Linda!

Comments about presentation about "my people":

First of all, this surgeon needs a new person to do his Power Point! How embarrassing and unprofessional to show such a poorly done layout for his presentation. (If the surgeon did his/her own presentation....unsure what to think of his surgical skill).

Interesting, his balance of "reasonable to operate" that he had at the R side of the curve "sure success"....nobody ever has SURE success.

Can't remember that he separated out the 2 groups: of de novo and previous adolescent curve. While both certainly can have lots of degenerative changes, they may be very different. The former group would definitely be older.

How do factors like severe osteoporosis, preoperatively high score of on measure for catastrophizing, and pre-operative long term use of narcotics affect outcomes?

Susan

flerc
10-31-2014, 12:20 PM
They sure stress the sagittal plane..... “Not coronal cobb angle” (page 15)


Surgeons in USA doesn’t recommends always surgery (when is possible to do it) for every curve >50° regardless any other condition ??