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Thread: surgery

  1. #1
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    Nov 2004
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    California
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    Unhappy surgery

    Hi I am a 46 y.o. woman who has recently been dealing with the aspect of surgery. For years, I have avoided surgery through alternative measures and have been very successful. I was braced from 7 y.o. to 16y. o Through the 60's/70's. I was one of the earliest cases they discovered back then and was involved in a research project at the Spine Institue of Houston. Well, back then the belief was once your bones "capped" you never had to worry. I have had no pain or limits most of my life. I discovered yoga in the 70's when I was in college and it was like discovering my body for the first time. Since then I have included tai chi, chi gong and daily meditation. Then in 1998 when I moved to Colorado I began having severe respiratory problems which led to the discovery that my curve was 45 thoracic 24 lumbar. The MD at National Jewish reported after CTs that the scoliosis was pinching off 2 airways but he wanted to consider stints. Two years and minimal progress I went back to alternative medicine and was able to get off oxygen and I moved to CA. Now, my respiratory problems are getting the best of me and I was referred to an orthopedic. Many XRays and CT scan later I am told that the scoliosis as hyperextended inward and pressing the lungs and heart. Surgery I am told has to take place. I am scared and angry. So I am glad there is a forum. I hear horror stories of permanent pain and limitations which I can't even comprehend living with. My pain has been manageable most of the time through the exercises and meditation that I do. So sorry I wrote so much just struggling with this. I am living alone and don't have anyone to lean on. Too independent to burden friends.

    Thanks,
    Christine
    57/32 degrees.

  2. #2
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    Hi Christine...

    I think you may want to find another doctor to get another opinion. While most people with thoracic curves have a small loss of lung function, it usually doesn't get severe until the thoracic curve reaches 90-100 degrees.

    With a 57 degree curve, you're definitely a surgical candidate if you're having pain, or just want to stop the curve from progressing more, but I can't imagine that it would really be the cause of your respiratory problems. I think that a good specialist can give you the real scoop. You can find a list of specialists at:

    http://www.srs.org/directory/directory.asp

    Regards,
    Linda

  3. #3
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    Nov 2004
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    California
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    Wink

    Hi Linda,
    Thank you for your reply. I am doing ongoing research about the surgery. The breathing problem is quite significant and has reduce my stamina and recreational lifestyle very much. The pain is moderate and I do my exercises daily. I am do for a second opinion in Jan. The pulmonologists agree on the surgery as recent CT scans have seen changes in lung capacity. So, I would like any references you have. Have you been able to avoid surgery? Please let me know what practices you have found helpful.
    Thank you,
    Christine

  4. #4
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    Christine:

    http://www.vh.org/pediatric/provider...alHistory.html
    "Scoliosis affects pulmonary function only in patients with thoracic curves and does not cause significant limitations in vital capacity or forced expiratory volumes in one second until the curve approaches 100-120"
    and
    "The mortality rate for adolescent idiopathic scoliosis is comparable to that of the general population. Only in high angled thoracic curves (>100) is there an increased risk of morbidity and mortality secondary to pulmonary hypertension and right heart failure."

    http://www.wheelessonline.com/o11/63.htm
    "although some effect on pulmonary function can be seen at 60 deg, significant compromise is not seen until the curve is > 90 deg"

    http://www.srs.org/patients/review/default.asp?page=6
    "Pulmonary and cardiac function are not impeded with lumbar curves and significant changes of pulmonary function are not seen in patients with thoracic curves until the curve reaches a level greater than 70"

    I can certainly find more if that's not enough. :-)

    Regards,
    Linda

  5. #5
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    Sep 2003
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    NJ
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    1,294

    breathing

    1: Bull Acad Natl Med. 1999;183(4):721-30. Related Articles, Links


    [Respiratory problems in severe scoliosis]

    [Article in French]

    Barois A.

    Service Pediatrie, Hopital Raymond Poincare, Garches.

    In kyphoscoliosis restrictive ventilatory defect occurs. In idiopathic scoliosis vital capacity failure is significantly correlated with Cobb angle, vertebral rotation, and thoracic lordosis. Maximum voluntary ventilation is the most affected measurement. Forced expiratory volume in 1 second is reduced. Residual volume remains longtime normal. Hypoxemia due to decrease of diffusing capacity occurs, with initially reflex hyperventilation hypocapnia, and secondary hypercapnia. Pulmonary hypertension and cor pulmonale is related to hypoventilation and hypoxia. The lung situated on the concave side of the scoliosis curve shows a more functional derangement. Ventilatory pattern consists of low tidal volume and high respiratory rate with increase of ventilatory work. Scoliosis that appears in the earlier stage of the life has the worst respiratory prognosis (before 5 years of age) with impairement of lung and thoracic growth. To stimulate pulmonary and thoracic growth, intermittent ventilatory assistance by pressure preset ventilator should be performed as soon as possible and pursued up to 8 years of age, at least, more if necessity. In over 60 degrees angle idiopathic scoliosis, respiratory failure appears after 40 to 50 years of age. Non invasive ventilatory assistance with preset pressure ventilator by oral way in moderate cases and nocturnal nasal ventilation by volume ventilator or inspiratory assistance ventilator, in the most severe cases are efficient. In very severe and acute respiratory insufficiency (scoliosis over 90 degrees) ventilation by intubation then tractheostomy may be required. Earlier orthopedic management and surgical procedure to correct and stabilize spinal deformities is the best to prevent respiratory insufficiency. For scoliosis below 60 degrees, post operative pulmonary complications are very low, with no requirement of post operative ventilatory support. In very severe respiratory insufficiency treatment of respiratory failure precedes, and follows, orthotic treatment and surgical procedures; it shouldle pursued afterwards.

    Publication Types:
    Review
    Review, Tutorial

    PMID: 10437294 [PubMed - indexed for MEDLINE]

    --------------------------------------------------------------------------------


    I have a strong interest in this problem since I had breathing problems before surgery. Some of the research says it is more of a problem if there is a triple curve(my case) another says the natural aging process causes more problems in adults with thoracic curves. Common sense dictates that the heart and major blood vessels will not be in the normal position.
    Last edited by Karen Ocker; 11-11-2004 at 07:23 AM.

  6. #6
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    Sep 2004
    Location
    Baltimore, MD
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    Hi chrisfrie,

    Regardless of what the "experts" say, I can tell you from our experience, the respiratory impact can be very signifigant. Our 13 year old daughter has a 35 degree thoracic curve T3 to T9 and a 53 degree rotatory thorcolumbar curve from T9 to L4. The doctors say she shouldn't have a respiratory deficit, but we noticed about a year ago that she was getting pale and out of breath when she climbed stairs or a steep hill. We had her respiratory function checked... twice... and both docs said she had a signifigant deficit. So, just because the experts say it shouldn't be so, doesn't mean it's not real for you. Trust your body and your instincts. If you feel it, it's probably a problem.

    Good luck!

    Susanna

  7. #7
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    Sep 2003
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    Northern California
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    Susanna...

    There are many reasons why someone might have respiratory problems.

    --Linda

  8. #8
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    Sep 2004
    Location
    Baltimore, MD
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    Yes, there certainly can be. my daughter, however, never had any problems prior to scoliosis. she doesn't have asthma or allergies or any other problems. The doctors believe it's because she is small (5 ' 1") and has a relatively short torso. The curve and the rotation is compressing her lungs. When I asked them originally, they said it couldn't be the scoliosis, but after ruling everything else out, here we are! i'm just making the point that everyone's body is different, and just because "most" people don't experience respiratory deficit at lower curves doesn't mean it's true for all. lafetr all, doctors tell people scoliosis doesn't cause pain... i see too many examples here that tell me that just isn't true.

  9. #9
    Join Date
    Nov 2004
    Location
    California
    Posts
    52

    surgery/ respiratory

    Thank you all for the feedback. It is good to get different opinions. The doctors have linked the respiratory problems to the scoliosis because along with the thoracic curve my spine has hyperextended inward, like a swayback horse. The area that the lungs have to expand has been reduced significantly, along with the rotation pinching off airways. I have been warned noy to wait to the usual degrees of 60 percent or more because of not knowing if my lungs could withstand the surgery. My scoliosis was identified as far back as 3yrs due to xrays taken for pnuemonia and I was braced at 7yrs old. So the article was very interesting. I am going for other opinions just to make sure. The orthopedics and pulmonologist after reviewing the CT-scans are in agreement. I do want to see one other physician recommended for a third opinion. This forum is so helpful I look forward to hearing more.
    Thank you!
    Christine

  10. #10
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    Nov 2004
    Location
    California
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    Karen,
    Thank you for the article

    Christine

  11. #11
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    Nov 2004
    Location
    California
    Posts
    52

    spinal kyphosis

    Linda,
    Along with scoliosis I have kyphosis which is a curvature of the sagittal plane. This is the condition exacerbating the respiratory problem along with the rotation of the thoracic curve. If you come across information on this condition please share. It is so kind of you to share your research

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