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richardis
06-15-2016, 08:18 PM
Hey,
I am a male with 30 years old. I have been submitted to scoliosis surgery and I will hit my 4th month threshold very soon. I am fused from T3 to T10.

My surgery went very well or so they told me.
I do have a little bit of shoulder imbalance. I did have my 1 month follow-up with my surgeon and he told me to look myself in the mirror and to try to correct my posture. He says the inner ear and the vestibular system has to adapt to my new body shape and sense of perception. Although it might be the case, I think it is a side effect of surgery like this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230354/
My movements kind of remain similar to the pre-op times, That is, some muscle memory still lingers and the muscles are having a hard time at settling down into new position.

But I am writing in the forum to hear your answers to this questions:

1) Did you feel crooked just after surgery? I did, my scoliosis was well hidden in the thoracic spine but right after surgery I thought surgery could not achieve a good correction. When I looked at the post op x- ray I was both surprised and happy. The correction of the bones was instantaneous but the muscular imbalances take time to subside. That might have been the cause to the crooked feeling.

2) On my post-op x ray I had a little neck tilt. This was just a confirmation because when I stand up the first time and I saw myself on the mirror I was able to check this. Do you remember the sensation of your body standing up the first time? Did your posture changed 1 year after surgery for the better?

3) On the last weeks my shoulder imbalance has improved but I still think something just not rest as it should. I still have to think how to put my clavicles, and my shoulder blades into a normal resting position (mainly the right one). But it does not come naturally. Did you struggle with this?

4) what was you schedule of recovery? when did your doctor lift the restrictions to have the normal range of movements and flexibility so you could just forget to have precautions with your back? Like have a normal life and pick up things from the floor and stuff? Do you still log-roll? I mean, when did you start to have confidence to live a normal life without being aware of the major surgery you went through, like stop obsessing over your movements so you don't break the hardware/instrumentation?

5) when was the month or week in the recovery that you started to feel really better?
I numbered my questions to make it easier for you to answer.

thanks in advance

jackieg412
06-16-2016, 06:47 AM
Hi and I will comment on some of the issues. You are young but healing takes time. Don't be discouraged but at least a year. You get better slowly.
I will encourage you to pay close attention to your shoulder problem. Work with your PT to encourage proper movement of the scapula. You can look up my posts and read in my signature the problems that may be there. In a few words my ribs were deformed right where the scapula needed to move. It has been a big challenge. It took years to find the problems and it wasn't until my shoulder got trapped down that any doctor I saw took the problems seriously.
If yours continues I encourage you to see an upper extremity specialist in a major teaching hospital. I had two unusual surgeries. I am open to questions. Jackie

titaniumed
06-16-2016, 11:29 PM
Welcome to the forum

I didn’t feel crooked, it was the opposite, I felt straight and tall.....My shoulders were or seemed overcorrected, instead of my left shoulder hanging down, it was slightly higher probably for around a year. I would say they are quite even now. Your shoulder imbalance and your thoughts of surgery will eventually diminish in time.....it takes a year or so to heal physically and mentally. Its quite a distressing, disturbing thing that we go through, amazing actually that we can endure such a procedure. Healing happens!

I was never actually released per say, but ordered to go skiing at 15 months. I guess that counts as a release. (smiley face) The bending over process was something that I took seriously, so didn’t do it till around the 8 month mark. At that point, I started LIGHT hanging stretches with one leg up on a stool. That went on for around 6 months till I limbered up some more. That was done so I could finally reach my feet to tie my shoes. Since many books will state that it takes 12 months for fusion to occur, that stood out in my mind.

Log rolling is the easiest way to get out of bed. After a year or so, I realized that I didn’t need to do this and can sit up if need be, but it takes more effort.

Some surgeons will order PT for scoliosis surgery and some will not. I didn’t do a scoliosis therapy program but my arm and shoulder were broken when I did do my spine surgeries. When I did my “shoulder therapy” I discovered that the arm bike was beneficial for the paraspinal’s and soft tissue that run over the screw heads in the thoracic. Pedaling with my arms helped with toughening up the 4 inch wide surgical zone in the thoracic area. I used no resistance doing this, and I was around 9 months post. You can emulate this arm pedaling motion without any machinery. I would pedal forward and backward in 12 inch circles. Much of this was done standing up straight staring straight ahead.

Walking is our therapy.....its actually amazing how valuable this is. Outdoors is much better....

Do try to eat well.....I have found that when I break dietary rules, it has an affect on things...

Hang in there

Ed

richardis
06-28-2016, 06:24 AM
I think I may have found the cause for my shoulder imbalance post-op.

My left shoulder was higher on the pre-op xray.
I was fused from T3 to T10.

According to what I have looked up online, the surgeon should have planned the surgery as this for the upper instrumented vertebrae:
"T2 for preoperative left shoulder elevation, T3 for preoperative level shoulders, T4 for pre- operative left shoulder depression" according to http://upload.orthobullets.com/journalclub/free_pdf/23996983_23996983.pdf

I should have been fused from T2, instead of T3, because I had not preoperative level shoulders. I had preoperative left shoulder elevation.
I will rule out another possible cause for this with a shoulder specialist. If he tells me everything is fine, the cause should be the one I mentioned above.


This applies to almost everyone(read the article to match the pre-op curve of your case to the ones standardized), so those who have shoulder imbalance post-op may find this info useful.

In my case the shoulder imbalance was aggravated on the post-op x ray when compared to pre-op x ray.

The take-way message from this seems to be: surgery planning is crucial for a successful outcome.

Pooka1
06-28-2016, 06:28 AM
I may be wrong but I think the degree of correction is also related to the shoulder leveling. I asked the surgeon why he didn't hyper-correct my second daughter like he did the first. He said her T curve was different than the first kid's T curve and couldn't be hyper-corrected without leaving her with a high left shoulder.

Both their fusions start at T4.

richardis
06-28-2016, 09:58 AM
I am not sure. Some very severe scoliosis have shoulders leveled.

Anyway, in my case the correction is very good so that is not the cause.

Pooka1
06-28-2016, 12:10 PM
I am not sure. Some very severe scoliosis have shoulders leveled.

Anyway, in my case the correction is very good so so that is not the cause.

I don't think I was clear. I am saying over correction can cause high left shoulder. Sometimes the surgeon does not correct the curve as much as possible so the shoulders will be level.

It is a trade off... more correction producing uneven shoulders versus less correction and even shoulders.

You say your correction is very good. I am saying that may be linked to the uneven shoulders. My one daughter could have been corrected more but the surgeon didn't do it and left some curve because if he corrected it more she would have a high left shoulder.

richardis
06-28-2016, 04:35 PM
I don't think I was clear. I am saying over correction can cause high left shoulder. Sometimes the surgeon does not correct the curve as much as possible so the shoulders will be level.

It is a trade off... more correction producing uneven shoulders versus less correction and even shoulders.

You say your correction is very good. I am saying that may be linked to the uneven shoulders. My one daughter could have been corrected more but the surgeon didn't do it and left some curve because if he corrected it more she would have a high left shoulder.

good point. It has crossed my mind too.



So, what of the following is correct:

"overcorrection " = correction so good that the curve now leans to the other side

or

overcorrection = corrects a thing at a greater cost for other imbalances

?

Pooka1
06-28-2016, 06:13 PM
good point. It has crossed my mind too.



So, what of the following is correct:

"overcorrection " = correction so good that the curve now leans to the other side

or

overcorrection = corrects a thing at a greater cost for other imbalances

?

The second one. I am not sure anyone is ever corrected past zero.

Can you post your x-rays?

richardis
06-28-2016, 06:49 PM
I will send you my x rays via PM.

Is there any difference between overcorrection vs hyper-correction?


I think I have seen a picture of pre and post x ray somewhere on a scientific article, where they measured the curves like 45º (pre) and -15º (post-op).

Thanks for your collaboration.

Pooka1
06-28-2016, 08:28 PM
I will send you my x rays via PM.

Is there any difference between overcorrection vs hyper-correction?


I think I have seen a picture of pre and post x ray somewhere on a scientific article, where they measured the curves like 45º (pre) and -15º (post-op).

Thanks for your collaboration.

I don't know any official definitions but I think hyper-correction is when you take a large curve and bring it very close to straight.

Over-correction can happen in a growing child when you staple or tether the spine. Also, curves can be over-corrected temporarily in braces I think.

I have never heard of over-correction in an adult. Maybe Linda can comment.

Pooka1
06-28-2016, 08:43 PM
Here is my before and after of my twin girls.

http://www.scoliosis.org/forum/showthread.php?13180-Before-and-After-Pictures-Xrays&p=135792#post135792

I would say Thing 1 was hyper-corrected because she went from 58* down to no residual scoliosis. Her shoulders are even now but were uneven before surgery. She fretted a lot for several months until they came even.

Thing 2 was not hyper-corrected and the surgeon left a residual curve. It is 20* there but increased a bit to abut 25* on her last x-ray. I think she had a false double curve which looks like two curves but the lower one bent out and so is only compensatory. I have read that you can't hyper-correct this type of T curve or else you will have a high left shoulder. Her shoulders are even because she was not hyper-corrected as far as I know. She would have had a high left shoulder had she been hyper-corrected as far as I know.

richardis
06-29-2016, 06:01 AM
@Pooka1 please get some space out of your PM inbox. Cannot send you a message because it is full.

richardis
06-29-2016, 06:14 AM
Here is my before and after of my twin girls.

http://www.scoliosis.org/forum/showthread.php?13180-Before-and-After-Pictures-Xrays&p=135792#post135792

I would say Thing 1 was hyper-corrected because she went from 58* down to no residual scoliosis. Her shoulders are even now but were uneven before surgery. She fretted a lot for several months until they came even.

Thing 2 was not hyper-corrected and the surgeon left a residual curve. It is 20* there but increased a bit to abut 25* on her last x-ray. I think she had a false double curve which looks like two curves but the lower one bent out and so is only compensatory. I have read that you can't hyper-correct this type of T curve or else you will have a high left shoulder. Her shoulders are even because she was not hyper-corrected as far as I know. She would have had a high left shoulder had she been hyper-corrected as far as I know.

your Pm inbox is full. get your box cleared of some space so that I can send you my 20 yrs x -ray again.

Pooka1
06-29-2016, 06:47 AM
Hi. I just cleared it. So sorry.

richardis
06-29-2016, 08:44 AM
Here is my before and after of my twin girls.

http://www.scoliosis.org/forum/showthread.php?13180-Before-and-After-Pictures-Xrays&p=135792#post135792

I would say Thing 1 was hyper-corrected because she went from 58* down to no residual scoliosis. Her shoulders are even now but were uneven before surgery. She fretted a lot for several months until they came even.

Thing 2 was not hyper-corrected and the surgeon left a residual curve. It is 20* there but increased a bit to abut 25* on her last x-ray. I think she had a false double curve which looks like two curves but the lower one bent out and so is only compensatory. I have read that you can't hyper-correct this type of T curve or else you will have a high left shoulder. Her shoulders are even because she was not hyper-corrected as far as I know. She would have had a high left shoulder had she been hyper-corrected as far as I know.

You have taken good care of your children. congrats.

richardis
10-10-2016, 02:52 PM
"
So, what of the following is correct:

"overcorrection " = correction so good that the curve now leans to the other side

or

overcorrection = corrects a thing at a greater cost for other imbalances

?



The second one. I am not sure anyone is ever corrected past zero.

1898
open the image above

By the way it is a screenshot taken from here:
https://www.amazon.com/Scoliosis-Sourcebook-Michael-M-D-Neuwirth/dp/1435295765

It is a book that I intend to buy. If someone has a a .pdf please send it to me. I open a thread today called "book requests". post it there.

Thanks in advance.

Pooka1
10-10-2016, 06:51 PM
That definition in that screenshot is obviously correct. I was using the term incorrectly.

I was thinking that no surgeon is going to fuse a person at minus degrees with respect to the original curve. Even hyper-corrected people probably all have a slight residual curve in the original direction.

But overcorrection refers not to making the spine curve in the opposite direction but rather correcting too much such that the balance is off or the shoulder is high or whatever.



"
So, what of the following is correct:

"overcorrection " = correction so good that the curve now leans to the other side

or

overcorrection = corrects a thing at a greater cost for other imbalances

?


1898
open the image above

By the way it is a screenshot taken from here:
https://www.amazon.com/Scoliosis-Sourcebook-Michael-M-D-Neuwirth/dp/1435295765

It is a book that I intend to buy. If someone has a a .pdf please send it to me. I open a thread today called "book requests". post it there.

Thanks in advance.

richardis
11-15-2016, 08:27 PM
I can mark this thread as "solved". The cause of my post surgery shoulder imbalance was discovered.

This very recent and interesting scientific article ( august,2016) has solved it:
http://dl.umsu.ac.ir/bitstream/Hannan/124056/1/2016%20SPINE%20Volume%2041%20Issue%2016%20August%2 0(12).pdf

It is a must read. Read it carefully and do take some time to analyse it.

spread this message to improve the outcome of your surgery.
Unfortunately, I may have to deal with shoulder imbalance for life.

Pooka1
11-18-2016, 07:08 AM
Well that seemed like some nice work in that article. I think it explains why the same surgeon hyper-corrected my one kid and did not hyper-correct the other. He specifically told us that he had to leave some curve in the one kid or else she would have a high left shoulder.

I looked at both sets of radiographs for my kids. Their necks came vertical fairly quickly. Both were fused starting at T4 and both UIV look horizontal as far as I can tell.

I can't find your radiographs. Is your UIV horizontal?

richardis
12-05-2016, 06:24 PM
Yes, my UIV is horizontal. but I assume my T2 has a residual degree of proximal scoliosis.

I asked the hard questions to my surgeon and he kindly replied. I told him I knew he did the best he could and probably it was not possible to have a better outcome. Despite this, I went on and asked him the technical stuff.

To summarize his response: he basically said that surgery is not like geometry or maths. He surely thinks I am the type of guy that believes that maths explains everything. In fact, I do :p. Unfortunately, it all boils down to math, proportions, shapes, and sizes. And I struggle a lot to understand advanced math and physics. It is beyond my comprehension but ultimately therein lies the answer.

He also said:- You are not perfect.
To which I replied: - No one is.
The point being that no one who undergoes scoliosis surgery should expect a perfect shoulder balance. It is a 3D deformity, only a correction on the 3 planes will provide you a near-perfect symmetry. An don't forget the ribs. Any deformed rib will trigger shoulder asymmetry. At least when you are standing with your back against a chair.

Also, in my opinion the degree and rotation of the curve should have a pain score - a quasi-scientific pain score . Scoliosis does indeed cause pain. It is about time to stop lying to patients. Scoliosis causes pain. Bridges with asymmetrical piers will deteriorate faster or need higher maintenance. A bird with asymmetrical wings will struggle to fly.

Bodies with scoliosis are incredible feats of engineering. Defying the laws of physics comes at great cost to us all - pain- all those muscles work to counterbalance asymmetrical loads.

But I started this to ask this:
Does someone has more info on this?
http://ada-posturologie.fr/Normalite-a.htm

Pooka1
12-05-2016, 06:59 PM
Yes, my UIV is horizontal. but I assume my T2 has a residual degree of proximal scoliosis.

If your UIV is horizontal, unless your proximal scoliosis is structural which I doubt, it will come vertical eventually just like my kid's lumbar came straight. What is preventing the proximal portion from coming vertical if the UIV is horizontal and the proximal curve is not structural? It may take some time... my daughter's shoulders came level only after several months.

LindaRacine
12-05-2016, 09:29 PM
If you insist that scoliosis causes pain, how do you explain that a relatively large percentage of scoliosis patients don't have pain. Even those with large curves.

richardis
12-06-2016, 05:45 AM
If you insist that scoliosis causes pain, how do you explain that a relatively large percentage of scoliosis patients don't have pain. Even those with large curves.
My answer to that: have they ever known a life without scoliosis? they assume that pain is normal.
Plus, being straight is certainly more comfortable than the opposite.

Now look at this pic https://static.spineuniverse.com/sites/default/files/images/2011/03/21/fig1-roh-mis-scoliosis-pre-op-clinicals-0.jpg
Do you even feel the need to ask her if she struggles to do the activities of her daily life? Do you believe her if she says she is pain-free? She is being kind to you as someone who tells his/her child everything is OK just to calm them.

And it is common practice to teach doctors that certain things they will do to you won't cause any pain.
For example, after my surgery several things were done. I asked: - Will this hurt?
his or her answer: This won't hurt a bit.

It turned out painful :rolleyes:


But I want to me the conversation to this:
Does someone has more info on this?
http://ada-posturologie.fr/Normalite-a.htm

richardis
12-06-2016, 06:28 AM
https://static01.nyt.com/images/2013/10/21/health/21brody/21brody-tmagArticle.jpg look at this pic. your back is always working harder than non-scoliotic backs

Pooka1
12-06-2016, 06:49 AM
My answer to that: have they ever known a life without scoliosis? they assume that pain is normal.

This is clearly wrong with respect to my kids. The reason their backs got so bad before being diagnosed was because they didn't have any pain between when their back was straight and when a large curve developed. Only my one daughter whose curve moved at 5 degrees a month complained of some pain at the end. I suspect her muscles couldn't adjust to that rate of change in the curve. That is the fastest rate I have ever seen posted by anyone on this forum so I assume it is very atypical. Her sister whose curve moved more slowly didn't have pain even right before surgery if I recall correctly. Her curve was high 50s.

There are many adults who never realize they have scoliosis because they don't have pain. There are people ON THIS FORUM with very large curves who have no pain but are fused to stop progression.

Also, the vast majority of people will have back pain bad enough in their life that it drives them to a doctor. So the percentage of people with scoliosis who have pain seems similar to that for the general population.

This issue of pain with back issues was discussed on doctor radio yesterday. They had a surgeon who used to do these small fusions for back pain so not scoliosis. He stopped dong them because most patients didn't improve. He concluded the pain must be coming from soft tissue for those patients and not the disc/nerve. Herniated discs clearly have pain from a compressed nerve so that is different. I have had two of those and the pain down the buttock is instantaneous and is nothing like a muscle pull.

So anyway, this surgeon says cognitive behavior therapy (CBT) is better than surgery because that can interrupt the pain sensation at the brain if I understand him correctly. He also said that chronic pain is different than acute pain. Chronic pain is a learned response in the brain that won't go away by any physical treatment but must be addressed by CBT.

LindaRacine
12-06-2016, 10:12 PM
The correct way to say it is that there are things about scoliosis that can cause back pain, but back pain is definitely not normal in kids. Pain is relatively common in adults with scoliosis, but it's also relatively common in adults without scoliosis.