When to Have Surgery

[rtremb]

How do you decide when to have surgery?

Cosmetically my daughter's back looks great however the x-rays show curves just over 60 degrees. She is Risser 1 at best and probably still has a lot of growing to come.

Do the doctor's evaluate the need for surgery or just automatically recommend it for large curves?

Is the decision for surgery based on breathing and organs being compromised and are tests done to evaluate this?

Ruth

[rainbow2010]

Most doctors say operate at 45 degrees or larger. Some say 50 degrees. Mine was at 45 degrees and 3 months later when I went in for surgery, it was 50 degrees. My daughter's curve was at 45 and 6 weeks later when she went for her surgery it was 48 degrees. Make sure they xrayed her wrist before deciding on surgery. If the growth plate is closed in the wrist, then she is finished growing and the surgery will be easier.

[Aussiemum]

There is LOTS of discussion on this forum regarding the risser number and to perform surgery when the child has completed growing. Everyone has their opinion on this and for those of you in the states it seems that the surgeons there prefer to wait until the skeleton is matured as Ruth has said. Here in Australia - our surgeons prefer to get in while there is plenty of flexibility and get a good correction. (I don't know why the different perspectives on treatment plans)

For us with a daughter at Risser 0 - possibly 1 by the time surgery was performed - it was a question of do we fix this while she is still very very flexible or wait until she's done with her growing.
I know all about the Crankshaft Phenomenom and will be praying that this doesn't happen for her. But.... her lumbar was showing a compensatory curve at 23 degrees and this was going to get worse as the curve in the Thoracic grew. I wanted to avoid at all costs her having her lumbar area fused. This coupled with the fact that her rotation was quite severe and causing her pain - we decided to risk it and proceed with surgery. Originally we were told T1 - L1 - in the end it was T5 - L1, it would have been more fusion for sure if we had waited years for her growing to be complete.

So you can see - you have to take into account a lot of factors relating to each individual case. All you can do is gather as much information as you can, get your 2nd and 3rd opinions and then go with your gut feeling on what you think is best for your child. It's going to be a tough call on your part believe me, the 18 months prior to my child's surgery was agony for our entire family in trying to come up with the best solution.

Good luck, hope eveything goes well.

Cheers
Del

[rtremb]

Del: I am new to this surgical subject - What is Crankshaft Phenomenon?
Ruth

[Aussiemum]

Ruth in very layman terms......

If the child is Risser 0 or 1 and has the posterior (back) of the spine fused... as the bones continue to grow the front of the spine can twist and curve around the actual fusion and further surgery would then be needed.

At first our surgeon was concerned about this...... but when I brought it up with him later he brushed it off as it's only a small percentage that this happens to. MAYBE why he didn't use Screws in Elysia and only hooks??? Look out for my post after the 31st and I'll let everyone know the outcome of our post-op visit with the Dr or you can read about it on our blog.

cheers
Del

[LindaRacine]

Hi Ruth...

At Risser 1 and 60 degrees, I'm really surprised that your daughter isn't already scheduled for surgery. I'm guessing that the vast majority of surgeons would tell you that her curve will continue to worsen. And, as it worsens, there is an increasing risk of complications. There are new techniques that avoid the risk of crankshaft phenomenon, so I believe that's not something about which you need to worry (unless the surgeon wants to do a single posterior approach).

Good luck.

Regards,
Linda

[rtremb]

Linda:

When I did discuss surgery with one doctor at CHEO he said they only go in from the back - which I understand is posterior?

Esme was 50 degrees as far as we knew until this last week when we found out her curves are now in the 60 degree range. We don't have an appointment to see a doctor at CHEO again for about a month and then we are expecting to get a surgery date. We are going to try to get an earlier appointment though.

Ruth

[flowerpower]

Hi Ruth,

Linda brought up a point I was going to share. When discussing the possibility of surgery for my older son (he was 44T/39L, Risser 0 in Mar. 05), we wanted to give him as much time to grow as possible before surgery. The dr. indicated he didn't want to let the curve go over 60 deg. though because less correction may be achieved, the possibility of complications may increase in higher curves. We thought we could wait until the next summer but by July 05 I noticed increased asymetry in my sons shoulders, rib cage, etc. I insisted on an appt. with dr. and his curves were indeed increasing (49T/44L) and the rotation was rapidly progressing. We scheduled surgery for Dec. 05 and by that time his curves increased to 60T/53L and the rotation had gotten pretty bad. I am so sorry you are in the same boat we were in, kind of a "damned if you do, damned if you don't" feeling.... Anyway, keep a close eye on Esme and watch for any changes. I hate to say, but you probably shouldn't wait too long to schedule surgery. If they have to go through this you want the results to be as optimal as possible. Keep up with stretching to remain flexible, eat healthy, take vitamins, do everything to get her body in the best shape now will go a long way in helping her recover and heal post surgery.

Best wishes to you,
Renee

[scoliboymom]

From a Canadian perspective,
Patricks curves were about 72*/38* the first time the surgeon saw him. His thoracic curve had increased from 58* in 4 months time. Even with this large rate of progression the surgeon wanted to wait another 3 months to re x-ray and re-evaluate. Because Patrick was still a risser 1 at the time there was no urgency to do surgery and the surgeon felt there would be benefit to wait and let him grow as long as possible.(my feelings too for fear of crankshaft) Unfortunately after those three months his curves measured 79/43 and the surgeon felt that we couldn't wait anymore. His concern was not so much the size of the curves but that bending x-rays showed his spine to be very stiff, and he was still progressing rapidly.
As far as long wait times for surgery in Canada goes we could have got into surgery 4 weeks later but opted for a bit more time to get ready and he had the surgery 3 months later.
In the end his spine turned out to be much more flexible then suggested by the bending x-rays and his correction was from above 80* to mid 20's.
So my point is that waiting is not always a bad thing and each case/surgeon is different.
By the way we are at Sick Kids Hospital in Toronto.
Ramona

[JamieR]

I would just listen to what your doctor tells you, maybe even get a couple of opinions to make you feel better about whatever decision you decide. I know it was said earlier, the lower the curve you have when it is time for surgery, the better the correction you can get so you might not want to wait too long. I would think since her curve is so large and she still has some growing to do, I would think they would go ahead and do surgery.