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View Full Version : Can you curve more after metal work is removed??



jo1979
06-30-2005, 11:13 AM
Hi
I am 26 years old and from the UK. In 1994 i had a spinal fusion for idiopathic scoliosis. Pre op i was 74 degrees curved, post op 54 degrees. I also had an anteria release ( rib reduction forthe hump on my back) the fusion was high sorry cant give exact levels as don't know.
In 1996 i bagan to get a lot of pain and the harrington rod was removed as it was "taught" they never gave a proper reason that was all they said. Since then i led a normal ish life, unableto work full time as my backwas so unpredictable. Three years ago i had a little boy by c section and all has beengoing ok, up untill the last few months. I have been getting bad pains again that are not really in "a" specific area. I have also noticed that my tops keeps shifting to one side and i have never really noticed that before. I was told that once your spine is fused is cannot curve any more as it is solid bone. I have a lost some weight and have been walking and it has not improved the pain at all.
If anyone is out there in the same boat i would really like to talk as i really don't know whats goign on? Is this it for the rest of my life? I have been to my Gp and all he has done is prescibed me with painkillers, anti inflamaty and muscle relaxants, surley i can't keep popping pills can i?
I look forward to hearing from anyone as i don't know anyone else with my condition and could really do with a talk.
thanks for reading this
jo

kates mom
06-30-2005, 11:52 AM
Hi Jo!
I'm sorry I don't have an answer for you but I would like to add to your post. My daughter is having her hardware removed 7/15/05 and we were told by her Ortho. surgeon that her spine is fused now and won't "recurve" after the hardware is removed. I have my reservations about that as well.
After numerous x-rays (I'm surprised she doesn't glow in the dark now! :eek: ) her doc is still undecided about whether or not one of the fusions is fully solid. He said he will check it when he removes the hardware. If it is not fully fused he will actually fracture :( it so that her body fixes it like a broken bone. Like you, I wonder if she can "recurve" after removal, especially seeing as her fusion might already be weak and she still has a 35 degree curve in her upper back that was supposed to adjust after the 1st surgery. It has a little but you can still see quite a curve and her shoulder blades are still very uneven.
In my daughters case I guess time will tell. In your case I guess I would go see a spine doctor to get your curves remeasured. I am fairly new at this so that is just my opinion, nothing based in fact.
I hope everything goes well for you! :)
Kathy (kate's mom)

LindaRacine
06-30-2005, 12:02 PM
Hi Jo...

It's next to impossible to tell if a fusion is solid. If it isn't solid, and the implants are removed, you can indeed re-curve. You should try to get referred back to a surgeon.

Regards,
Linda

kates mom
06-30-2005, 01:03 PM
Hi Jo...

It's next to impossible to tell if a fusion is solid. If it isn't solid, and the implants are removed, you can indeed re-curve. You should try to get referred back to a surgeon.

Regards,
Linda

Hi Linda,
When you say it is almost impossible to tell, did you mean with the tests or when they are actually looking at the fusion during surgery? Kate's surgeon is the one who told us about fracturing the fusion during surgery if it is not solid.
Thanks,
Kathy

LindaRacine
06-30-2005, 01:07 PM
Hi Kathy...

I think areas of non fusion (pseudarthroses) are USUALLY obvious during surgery. I have, however, known of a few people whose fractures weren't seen during surgery, but who later had rods break because of a non-fusion.

Regards,
Linda

kates mom
06-30-2005, 01:21 PM
Hi Kathy...

I think areas of non fusion (pseudarthroses) are USUALLY obvious during surgery. I have, however, known of a few people whose fractures weren't seen during surgery, but who later had rods break because of a non-fusion.

Regards,
Linda

Hi Linda.
I'm not a doctor by any means, but it just seems to me that if he factures the fusion, making it weaker and then removes the hardware supporting her spine, doesn't she run the risk of breaking her back? Am I way off the mark here?
Thanks again,
Kathy

LindaRacine
06-30-2005, 01:34 PM
Hi Kathy...

I would hope that your daughter's surgeon is talking about breaking up the old fusion to correct a problem and then re-fusing and reinstrumenting.

Regards,
Linda

jo1979
06-30-2005, 02:37 PM
i had an xray in 2000 and the surgon said everything was ok, Do you think that it can just start to curve for no reason? i know you are not a medical advisor, its just nice to here an opinion!

LindaRacine
06-30-2005, 02:58 PM
Hi Jo...

You can curve above and below the fusion, but I think that if your curve increases within the fusion area (beyond a small amount of settling that occurs in the early post-operative stage), there's something wrong with the implants and/or the fusion.

Regards,
Linda

rachael
06-30-2005, 07:59 PM
Just wanted to share my personal experience. I recently had x-rays and compared them to my '91 x-rays with a spine surgeon. He pointed out that my curve had progressed after surgery probably due to a growth spurt. I guess it is possible that it happened before I was completely fused, but I don't know if that is true. (btw I still have my hardware in)
Does most people's curves progress only during puberty or does it continue after one stops growing? or is it just at a slower rate?
Also, is the only reason for having hardware removed because of complications, or do some people just have them taken out just becuase?
Just curious...

jo1979
07-01-2005, 07:09 AM
hello,
i had my rod out in 1996 (no real reasons were given for this, only i was in real pain and removing the rod was their soloution)and have had xrays since then and the surgon never said that it had moved. I am now 26 and just wonderd if at that age it would curve again as i should be fully grown by now!

kates mom
07-01-2005, 07:09 AM
Hi Kathy...

I would hope that your daughter's surgeon is talking about breaking up the old fusion to correct a problem and then re-fusing and reinstrumenting.

Regards,
Linda

Hi Linda,
According to Kate's surgeon, he has to fracture the fusion that isn't solid (if there is one) so that her body treats it like a broken bone and fixes it. He is taking all her hardware out, except for the cages where the fusions are. That is what has me worried. If he weakens her spine and takes her hardware out, can't she recurve again?
We are going for her pre-op visit on the 11th and I have a page full of questions to ask him. Right now, Kate is basking in the Florida sun while I slave away in Buffalo :( , but she needs to get away from all of this anyway! She is a basket case - rightfully so, I guess!
Kathy

LindaRacine
07-01-2005, 11:00 AM
Hi Kathy...

I'd certainly trust the surgeon, unless of course, you've got reason to think he might not know what he's doing. I'll be curious to hear how it all goes.

Regards,
Linda

Karen Ocker
07-01-2005, 05:10 PM
I am living proof that a fused spine(never had hardware with the original fusion) will recurve.

In 1956 I had a 2 stage posterior fusion T-4 to L-2. I was 14 at the time. Bone from the bone bank was used. I spent a year in bed, with a series of 3 plaster casts to enable the fusion to heal. I was told that the fusion would maintain the correction.

Gradually my spine re-curved over 40+ years. At age 35 a cousin said I looked more crooked than before. I insisted it was impossible. At age 52 I visited Dr. Keim who measured my curve at 64 degrees. I was waking up at night with pain at the end of my fusion. He said I wouldn't get worse because my fusion was "solid". At age 59 I went to Dr. Boachie who measured me at 80 deg. I had an old lumbar X-ray from 20 years before. That compensatory curve measured 40 deg; it had doubled in 20 years.

I want to add that I never smoked and do not have osteoporosis which would have contributed to the weakening.

I had a successful revision in 2002 with a 50% correction.

Karen

LindaRacine
07-01-2005, 10:59 PM
Hi Karen...

I think most of the patients who had long fusions prior to Harrington rods have had their curves increase significantly. I know at least half a dozen of "your kind." :-)

Regards,
Linda

sonia
07-04-2005, 10:29 PM
Hi Kathy...

I would hope that your daughter's surgeon is talking about breaking up the old fusion to correct a problem and then re-fusing and reinstrumenting.

Regards,
Linda

Hi Linda,

I agree with you about breaking up the old fusion where its fractured, then reinstrumenting to make the union solid. I have pseudoarthrosis at T-10 and T11 which clearly showed up in the x-ray. In 1985 I had a Harrington rod removed from my upper back to L-4. The rod was broke because the fusion never took at this site. The rest of the fusion was fine. The doctor (Hospital of Joint Disease), felt that cleaning up that area and adding more bone gragh w/o implants would fix it. I wore a brace for six months. I felt fine for a few years. Having pain on my upper back in 1994, I went to see an othro, took x-rays and tommography and discovered that i had a fracture again at the same site, over the years the pain has gotton worse, since my kids were born. I struggle not to lean forward, but by the end of the day i cannot stand straight and i hurt. In Sept. I am having posterior/anterior fusion with implants to correct my pseudoarthrosis and i think that this procedure will prevent this from happening again. I HOPE.

I've learned a lot on this forum. Thank you all! Best of luck to everyone.

Sonia

kates mom
07-05-2005, 05:22 AM
WOW, I'm dumb-founded! I guess I was grasping for straws with this removal surgery. Kate is in so much pain I was willing to take any avenue to help her. After reading all your posts and emailing a few of you I realize that this might not be the magic bullet we were looking for. Unfortunately, Kate's surgery is July 15th and I seriously doubt that we'll be able to get a second opinion before that. Which leaves me with the question, do I put off surgery indefinitely in hopes of finding something else or do I go forward with it and hope it works?
What now?
Kathy

LindaRacine
07-05-2005, 11:34 AM
Hi Kathy...

I responded to your email, but thought I should also post here. I really think you should consider postponing the surgery until you know for sure what is going on. Once you have a copy of Kate's current x-rays, I can probably find someone to give you a tentative diagnosis. If possible, you should get a copy of both the A/P (or P/A) and lateral films.

Regards,
Linda

gscarpato
07-05-2005, 12:18 PM
Dear Linda: I spoke with you last year about my daughter Cara. In 2000 she had spinal fusion correcting a 48 degree curve. In 2004 she had a revision surgery to cut one rod which was a little too long, per the doctor. Since she was having a lot of unexplained paid we chose to cut the rod and solve the problem. Unfortunately she got an infection (staff) and her incision opened and she had it closed by a plastic surgeon. It obviously was not the problem. She still has pain. Now, she has a new problem! A kidney infection which urologists cannot explain! I cannot held feel everything is related. What do you think. Have you ever heard of the hardware causing kidney infections or possible the staff infection is still in her system?? am I totally off base with this thought. I am truly going crazy by all this and my daughter is mentally and physically depressed. It has been 5 year today since her first surgery at 14 years old and she thought and was told it would be behind her after a year. Do you have any suggestions? Thanks for any reply. Grace

kates mom
07-05-2005, 12:28 PM
Linda,
I spoke to a couple of people about your email - both the local scoli support group and the national and they both agreed with you. A second opinion is required in Kate's case. They gave me the name of a local Dr. who is "certified" by the Spine Foundation (?). I called him and I'm waiting for his reply. He does work in the same hospital as Kate's current Ortho. My hope is that I can get Kate in to see him before her surgery for a second opinion. I don't think she can take too much more of the pain she's in. It's effecting her mentally and emotionally as well as the obvious physical problems.
As for the x-rays, she had the PA and lat about a month and a half ago. I will try to get them to email them to me - or I'll just go pick them up.
Keep your fingers crossed for me!
I can't thank you enough for all your help.
Kathy

LindaRacine
07-05-2005, 01:04 PM
Dear Linda: I spoke with you last year about my daughter Cara. In 2000 she had spinal fusion correcting a 48 degree curve. In 2004 she had a revision surgery to cut one rod which was a little too long, per the doctor. Since she was having a lot of unexplained paid we chose to cut the rod and solve the problem. Unfortunately she got an infection (staff) and her incision opened and she had it closed by a plastic surgeon. It obviously was not the problem. She still has pain. Now, she has a new problem! A kidney infection which urologists cannot explain! I cannot held feel everything is related. What do you think. Have you ever heard of the hardware causing kidney infections or possible the staff infection is still in her system?? am I totally off base with this thought. I am truly going crazy by all this and my daughter is mentally and physically depressed. It has been 5 year today since her first surgery at 14 years old and she thought and was told it would be behind her after a year. Do you have any suggestions? Thanks for any reply. Grace

Hi Grace...

I'm so sorry to hear about (OOPS, not Grace) Cara.

I honestly know very little about infections. I can tell you that I had a liver abscess (which is an infection) several years ago. There was some thought that it might be related to my implants, but in the end, they decided it probably wasn't.

I hope you get the infection under control quickly, and then find some way to deal with the spinal pain. Can you remind me of who Cara's surgeon was?

Regards,
Linda

LindaRacine
07-05-2005, 01:06 PM
Hi Kathy....

I know that this is probably really a stressful time for you, and I'm really glad that you're willing to find out what's going on instead of just forging ahead with the surgery. I'll be very anxious to see the more current x-rays, and hear about what the second opinion has to say.

Regards,
Linda

kates mom
07-05-2005, 01:33 PM
Hi Kathy....

I know that this is probably really a stressful time for you, and I'm really glad that you're willing to find out what's going on instead of just forging ahead with the surgery. I'll be very anxious to see the more current x-rays, and hear about what the second opinion has to say.

Regards,
Linda

It's me again!
Well, I did make some phone calls and got some recommendations and this is what I found out. The Scoliosis Research Foundation doctor that comes recommended will not do a second opinion unless I switch Kate entirely to his care , sight unseen before he will even look at her. Is that legal and/or ethical? What happens if we meet him and one or both of us doesn't like him?
I feel like our backs (literally) are against a wall.
Kathy

LindaRacine
07-05-2005, 01:59 PM
Hi Kathy...

I'm sure it's legal, but I'm not at all sure it's ethical. Obviously, the guy doesn't like being a second opinion. Here are the names of specialists in your area:

Christopher Hamill
Cameron Huckell
Robert Lifeso

I think it might be wise to see if any of them would see Kate for a second opinion. If not, you can purchase a second opinion from Dr. Robert Pashman for $75:

http://www.espine.com/purchase.html

I think you should make getting the most recent x-rays a priority, as anyone you see is going to need them. Please don't be shy about asking for them. If the surgeon isn't hiding anything, he should be fine with you getting another opinion. You have a right to the x-rays and records. If you don't trust the doctor, you might want to just drop in, unannounced, during normal business hours. Tell the receptionist that you need the x-rays NOW for a second opinion. Be strong. Don't walk away without them. If you get the actual x-rays instead of a digital copy, you can place a white sheet over a sunny window and then tape the x-rays to the sheet to take a photograph.

Regards,
Linda

kates mom
07-06-2005, 10:47 AM
Hi Linda,
I called around and got 2 of the same names you did (the ones on top of your list). I am calling Dr. Hamill today, hopefully I can get Kate in to see him soon. I talked to her current surgeon who has encouraged me to get a second opinion himself. He has offered his support and any documentation we'll need (x-rays included).
I think I am going to go with that and hope Dr. Hamill can set up an appointment very soon. I am also going to try the internet link you sent. Have you heard any feedback from anyone who has used his service?
Thanks again for all your help.
Kathy

LindaRacine
07-06-2005, 11:51 AM
Hi Kathy...

I can only remember hearing back from one person who did the internet second opinion thing and she felt it was worthwhile.

Is the surgeon sending the latest x-rays to you?

--Linda

d_ann
07-06-2005, 12:02 PM
Kathy,

It sounds like you have spent plenty of time weighing the pros and cons. Have you talked it over with Kate as to why you are considering canceling her surgery? I am sure she will agree with you that she'd rather be confident that surgery will help rather than just hope it will work.

Also, I am wondering if a pain management doctor might be able to provide her with some temporary relief until you are able to get the second opinion and schedule whatever seems to be the best option. Perhaps even your current doctor or one of the others you've called could recommend someone.

Just a little more food for thought...

kates mom
07-06-2005, 12:51 PM
Linda,
Kate's surgeon said he would be happy to help me in any way possible including giving her x-rays to me, all I have to do is ask. He was very supportive!

d_ann,
I haven't spoken to Kate about any of this because #1: she is on vacation in Florida and #2: I want her to have absolute confidence in her surgeon. I feel it's an integral part of her recovery.
She is so nervous now she is having trouble keeping food down (partly because of her pain meds - partly because of nerves) and she wants to talk to a counselor, which I whole-heartedly support. We originally had her scheduled for a pain management specialist, but she decided to cancel when we found out about her surgery date. If it turns out that we have to delay her surgery I will definitely reschedule that.
Thanks again,
Kathy

LindaRacine
07-06-2005, 01:01 PM
Kathy...

When you get the current x-rays, please send them along, as I think I can get Dr. Hu to comment on them.

--Linda

sweetness514
07-06-2005, 01:51 PM
Kates mom, I have a few questions I woul like to ask you...

Is Kate's pain all along her rods and hardware or specifically at one place? I remember discussing with you that I had a portion of my harware removed after a year an a half of my first surgery, as it helped tremendously without compromising the bone graft at the time.

Also, when was Kate operated on? It took me at least two years to not feel all the screws and hardware, as my ortho told me I should wait instead of taking it out like I wanted to.

I also think it is a good idea to wait for surgery and get a second opinion for her.

jo1979
07-12-2005, 04:18 PM
Hi,
just to let you all now Regarding original thread of mine ( re curving after metal work removed) that i went for an x ray today. Unfortuanlty over in the uk it takes up to three weeks to get a report on them. I will keep you all posted, the pain hasn't got any better and i am getting real bad pains in my left should blade ( normally it is my right) anyway watch this space and will get back to you,
joanne xx