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kimk
04-09-2004, 01:18 PM
My daughter is in a professional ballet training program at the International School of Ballet. She studies 4-5 hours per day, 6-7 days per week. She is 14 almost 15, tall (5-9"), and has a 41 degree curve in her lower spine. Surgery was recommeded to us at her last doctor appointment. She cannot stop her training now and have surgery without giving up the dream of ever dancing professionally in a ballet company. She has no pain, but her back is unusually flexible and strong due to her dance training. We are in shock and seeking more opinions, but she told me she would rather be crippled in later years than to stop her training now. Is that our choice?
Should we risk the curve increasing...it went from 35 degrees to 41 in six months, during which time she grew 1 inch. Should we consider a brace, and if so how can she wear it enough, with all her dancing, to make a difference? Is there an older professional ballet dancer out there with that degree of curve(or more) in her lower spine who continued her training and dancing through her 20:s? If so, what do you advise?

DaveWolpert
04-09-2004, 01:48 PM
A few thoughts on this...

First, I don't mean to second-guess your doctor, but your daughter's curves are not quite yet in the range at which most orthopedic surgeons would advocate surgery. 50 degrees is the usual minimum threshold. Many adults have curves in the 40-50 degree range and live perfectly normal lives.

With that said, it is clear that her curves are progresssing at a fairly fast pace, and if she has significant growth left a brace or surgery may ultimately be the only options to consider. Either option has pros and cons.

To be effective, a brace must be worn 23 hours a day until she finishes growing. This would, unfortunately, put your daughter's dancing activities on hold. However, if bracing works, her curves will not progress and she may be able to resume her dancing career once she finishes growing, and may never have scolioisis-related back pain. But, bracing is usually only indicated (recommended) for patients with curves below 40 degrees. Between 40 and 50 degrees, the probability of success with bracing is less predictable. Even so, I would rather try bracing than jump to the surgical option.

Surgery can be done at any time--it's not urgent that it be done anytime soon. Your daughter could choose to have surgery when she's much older, allowing her to finish her studies and be a dancer for a few years. The caveat to this is that recovery from surgery is much faster, and the level of correction achievable better, when one is younger. But I, for example, had surgery when I was 30 and still had a fairly quick recovery with a great result.

More importantly, surgery does not necessarily mean the end of a ballet career. It would surely be more difficult to dance, but I doubt it's impossible. Brooke Lyons, author of the book "Scoliosis: Ascending the Curve" (see link below) was an avid ballet dancer and had surgery around the age of 15 or 16, and she went on to dance while in college.

If you haven't done so already, I would recommend you have your daughter's skeletal maturity evaluated. A simple x-ray of the pelvic bone reveals something called the Risser Sign, which measures how much bone growth is left. You may find, for example, that your daughter only has a year of growing left to do. If that were the case, I might consider a year of bracing but would certainly wait until at least then to consider surgery. Again, she may never need it.

I hope this helps. Here's a link to Brooke Lyons' book on Amazon:

http://www.amazon.com/exec/obidos/ASIN/0871318830/wwwcurvedspic-20?creative=125581&camp=2321&link_code=as1

Dave Wolpert

kimk
04-09-2004, 04:36 PM
Dave,
This is the first time I have ever tried using a forum. I was hopeful I would get a response. Thank you so much for yours, good information and suggestions, and I will definately get my hands on that book.!

paulasue2
04-09-2004, 09:55 PM
My daughter is also a dancer, not professional - just the love of her life. She was diagnosed just after she turned 14 with 63/50 degree curves, and surgery was recommended. However, the doctor also said that she was at little risk for rapid curve progression because she was skeletally mature and that waiting to have the surgery was an option. We decided to wait to have the surgery until this year (when she was nearly 17) , but have continued to monitor her curves, which have not increased even one degree during that time. Her dancing contributed to her being very healthy and flexible, and she had a great surgical outcome (63/50 to 27/15 - a 50% correction is considered a good outcome). What will become of her dancing only time will tell, but she did not intend to pursue it professionally, so our situation is certainly different from yours. The point I am trying to make is that you probably do not need to rush into anything here. There is no certainty that her curve will get worse, and a 5-6 degree change is within the margin of error that can occur for a variety of reasons in measuring. Although often a horribly shocking and difficult thing to deal with, her condition is not life threatening -take your time, research and get another opinion or two.

racin2win
04-09-2004, 10:29 PM
Hi KimK,
I agree with Dave. Obviously your daughter's curves have progressed to the point of (in my opinion, ALMOST) considering surgery, but I've heard this same thing: usually most doctors wait until at least the 50 degree mark. MAYBE you can discuss with the doctor the possibility of seeing if a brace could help prevent the curves any? (Even though the curves might start to be getting too bad for the brace, and sometimes the brace doesn't even work). I am not sure what to call on this one. I do know though what it's like to have to give up something that is your life for this surgery because I went through fusion back in November. I completely understand why your daughter would not want to give up her dancing right now but truthfully she would not want to be crippled the rest of her life, either! Letting curves progress and not doing anything about them will not only lead to crippling early on in her life, but there's a big chance she would have major respiratory problems too...and if she waits too long, does she realize there's a chance it could stop her dancing in the future? I highly suggest if your doctor wants the fusion done on her, and if there aren't any other options, to go through with it, because she'll only be out of dancing for at least 6 months, and believe me, the time seems to fly. If surgery is needed, it is worth getting it done now while one is young, that way they can look forward to the rest of their life ahead of them! Spinal fusion, if gone well, will only temporarily put a hold on things, I know personally...just my opinions however, so good luck :)

LindaRacine
04-09-2004, 11:35 PM
I suspect it varies by doctor, but I think most say that curves > 40 degrees in a skeletally immature teen will almost always require surgery. Bracing is not considered effective for anyone with curves > 40 degrees. Here's a quote from the SRS Bracing Manual:

"Arthrodesis with spinal instrumentation is the treatment of choice for curves of more than 40 degrees in growing children, or curves of more than 60 degrees in patients who have reached maturity."

With all that said, I definitely think that Dave's recommendation of getting a second opinion is a good idea.

--Linda

Celia
04-11-2004, 11:39 AM
If you should decide to go the bracing route there are some braces out there which may be of help. I recently read an interesting case of one girl who had a 58 degree curvature of the spine and wore the Cheneau brace for a number of years and her spine stabalized at 38 degrees. The story under BZebra (with x-ray pictures) is available on:


http://www.scoliosislife.net/





Celia

dapsbounce8
04-12-2004, 12:21 AM
There are several reasons for pursuing spinal fusion: to relieve back pain, because the curve is above 50 degrees or in the upper 40s, for cosmetic purposes, or because the curve has caused health problems (lungs, heart). It seems that your daughter doesn't identify with any of these reasons, so there is no need to rush into surgery at the moment.

However, just because she is flexible and strong does not mean that her back will not get worse. I also had an ususually strong and flexible back because of previous dance training and horseback riding, but it did not stabilize my back, at least not for long.

Surgery seems to be a very real issue looming in the future, especially if your daughter has not had a major growth spurt yet, so keep spinal fusion in mind. For the moment, fight the curve growth as well as you can and research alternatives.

Good luck - I hope you can find strength in your difficult situation.

Celia
04-12-2004, 11:27 AM
Sorry, I should have mentioned this in the previous post but another brace which has had very good results is the Spinecor brace. Their website is at:



http://www.spinecorporation.com/





Good luck,



Celia

Mary Lou
04-12-2004, 02:12 PM
Kimk....

I agree with what everyone else has said on this forum, and the only advice I could add is for you to get a second opinion. If you need to, get a third or even fourth opinion.

Mary Lou

kimk
04-14-2004, 11:54 AM
Thank you all for your sincere concerns, interest and suggestions. I am reading many of the other threads and learning so much. One thing you gain reading about struggles others are having, is perspective. I feel less devastated now, facing this with my daughter, because there are so many who have fought through pain, surgery, recovery and bigger (or multiple) curves. I almost feel my daughter is lucky at this point, because of what I see others have had to deal with.