Age Effect on Surgical Outcomes

[LindaRacine]

so does that mean that older patients are ....trusting that they will come out with less pain after they have healed...?

i can see those two reasons...less pain and wishing to restore lost functioning...as reasons for older people to turn to surgery...especially if they have tried most other treatments without much success...

but....there is no guarantee that the pain will be reduced...

jess

Hi Jess...

While there is never a guarantee, it's very rare for patients (especially the group we're discussing) to not get some improvement.

I would guess that there are about as many patients who get 100% improvement as their are patients who feel like they're worse after surgery. So, you could look at all this as a gamble. The vast majority of patients are going to have some significant improvement. But, maybe 1% are going to be very unhappy, and 1% are going to be over-the-top happy. What I hear surgeons tell their patients is that there is no guarantee, but it's almost certain that their pain level will be reduced significantly.

Regards,
Linda

[jrnyc]

thanks, Linda...that is what most of the surgeons basically told me...i guess i have "fear of 1% syndrome"

great quote on your signature...i will remember that before i write back to certain folks on forum! or refrain from writing!

jess

[mamamax]

Spine (Phila Pa 1976). 2010 Jul 30. [Epub ahead of print]
Risk-Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age.

Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH; the Spinal Deformity Study Group.

From the Departments of *Neurosurgery and daggerOrthopedic Surgery, University of Virginia, Charlottesville, VA; double daggerNorton Leatherman Spine Center, Louisville, KY; section signSpinal Disorders Service, University of California, San Francisco, CA; paragraph signNYU Hospital for Joint Diseases, New York City; parallelState University of New York, Buffalo, NY; **Emory Orthopedics and Spine Center, Atlanta, GA; daggerdaggerDepartment of Neurosurgery, Northwestern University, Chicago, IL; double daggerdouble daggerDepartment of Neurosurgery, University of Maryland Medical Center, Baltimore, MD; and section sign section signSpinal Deformity Service, WA University, St Louis, MO.
Abstract

METHODS.: This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0-10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb >/=30 degrees ), plan for scoliosis surgery, and 2-year follow-up.

PMID: 20683385 [PubMed - as supplied by publisher]

I have to say I am glad to see a multicenter spinal deformity data base in place. Some of the terms in the explanation of methods are new to me. When they say: prospective multicenter spinal deformity database ... does this mean that it is newly formed and is a prototype for a national or international data base? I was also wondering if the results are based on back and leg pain only and if that assessment is based solely on the questionnaire? Was also wondering if the reporting was voluntary or mandatory. Sorry for all the questions ... new stuff to me.

[LindaRacine]

I have to say I am glad to see a multicenter spinal deformity data base in place. Some of the terms in the explanation of methods are new to me. When they say: prospective multicenter spinal deformity database ... does this mean that it is newly formed and is a prototype for a national or international data base? I was also wondering if the results are based on back and leg pain only and if that assessment is based solely on the questionnaire? Was also wondering if the reporting was voluntary or mandatory. Sorry for all the questions ... new stuff to me.

The SDSG has been around for awhile (at least 6-7 years). It consists of about 15 centers in the U.S. and an equal number of centers from the rest of the world. The Adult Deformity Outcomes study is optional for patients of participating surgeons. Patients answer the ADO questionnaire plus the SF12, Oswestry, and SRS30 instruments at pre-op, 6 months, 12 months, 2 years, 3, years, 5 years, 10 years, and every 5 years to a max of 20 years. Studies are based strictly on outcomes data.

[LisaB]

I'm participating in the Adult Spinal Deformity Outcomes Analysis Research Study for Dr. Bridwell. I filled out the presurgery questionnaire at my last visit and then will fill them out at various intervals post surgery.

[Shari]

Linda R.,

That is a very interesting article. I only read it because you posted it. My mind shot into many different directions. I was very happy to see this, so why don't ALL of the Medical Professionals that deal with the spine, whether it be orthopedic or neurological, know that this surgery is helping many adults.

I will never understand why they don't know that we can be helped!!!

Shari

[LindaRacine]

Linda R.,

That is a very interesting article. I only read it because you posted it. My mind shot into many different directions. I was very happy to see this, so why don't ALL of the Medical Professionals that deal with the spine, whether it be orthopedic or neurological, know that this surgery is helping many adults.

I will never understand why they don't know that we can be helped!!!

Shari

Hi Shari...

Just conjecture, but I suspect that many facilities are not prepared to deal with the complications that arise from surgeries on this category of patient.

Regards,
Linda

[Shari]

Linda, I understand that part of the puzzle. I just think they should know that we can be helped, and know where to direct us. There is a woman that lives near by me, I always see her walk to the mail box, and I could tell she has scoliosis. I knew she had to be in pain.

I didn't know how to approach her. We all try to hide it, she's got the long hair camoflauge. We eventually had a conversation where I felt comfortable bringing it up. I brought her into the house, showed her my before and after pictures and showed her my scars. She has a Doctor that still thinks adults can't be helped. I get sad and mad about this. I didn't find out about adult surgery until I was 40. And I saw the surgery on the Discovery Health Channel.

Sorry for rambling,
Shari

[loves to skate]

I'm with Shari on this one, only I would extend it to all medical professionals. My PCP looked at me with a blank stare when I told him about finding an adult scoliosis specialist. He didn't have a clue. I had emailed Joe O'Brien over a year ago and suggested that there must be some way to educate primary Docs about the fact that older adults can be helped.

Sally

[debbei]

I'm with Shari on this one, only I would extend it to all medical professionals. My PCP looked at me with a blank stare when I told him about finding an adult scoliosis specialist. He didn't have a clue. I had emailed Joe O'Brien over a year ago and suggested that there must be some way to educate primary Docs about the fact that older adults can be helped.

Sally

Hi Sally,

PCP's are not the only docs to need education--the first ortho I went to (the 'back specialist' of the practice) had no clue I could be helped. I don't know if you remember but I referred him to 'Dr. Dumbell.'

[Back-out]

MY PCP - an intelligent, otherwise well-informed internist of forty, tops - has not only urged me not to have the surgery, he has made such remarks as "I didn't know they were still doing those operations...I thought everyone knew the outcomes were too negative." In other words, he is discouraging about it not just for older patients, but for everyone.

It has made me doubt the information I get. What are they teaching doctors in medical school, anyhow? Or does he know something I don't?

[Karen Ocker]

Ignorant medical professionals

Medicine is specialized-so most specialist non-ortho docs have "tunnel vision" and may remember something they heard 20 years ago in Medical school. I once had an emergency room doc tell me scoliosis surgery is never done over age 19-he was trained abroad. I told him to throw away his old books!

I had my revision 8 years ago at age 60--still no pain but residual lung issues persist because my scoliosis was so advanced. I am capable of living a perfectly active, satisfying life. Without the surgery---disabled and a burden on my family--not to mention my own suffering.

[Back-out]

Medicine is specialized-so most specialist non-ortho docs have "tunnel vision" and may remember something they heard 20 years ago in Medical school. I once had an emergency room doc tell me scoliosis surgery is never done over age 19-he was trained abroad. I told him to throw away his old books!

I had my revision 8 years ago at age 60--still no pain but residual lung issues persist because my scoliosis was so advanced. I am capable of living a perfectly active, satisfying life. Without the surgery---disabled and a burden on my family--not to mention my own suffering.

Karen you are always an inspiration. And your reply cuts to the quick.

I know I'm not the only one on site who's been discouraged from surgery by care-givers. It IS hard to know what to think, though, when it comes from a good physician whom one trusts and with whom one has a great relationship. Otherwise, how could I work with him for all my health issues?

I guess the best approach is to realize no one has a complete education. If I have surgery and emerge stronger and healthier, I will be able to re-educate such professionals as no book learning could. He said "I have no patient who has had such scoliosis surgery".

Fair enough. Hopefully, someday he will and I will prove to him that he was taught wrong. (And not only him!). Undoubtedly, my rural location is part of the problem in what he has been exposed to during his professional life.

[LindaRacine]

I'm with Shari on this one, only I would extend it to all medical professionals. My PCP looked at me with a blank stare when I told him about finding an adult scoliosis specialist. He didn't have a clue. I had emailed Joe O'Brien over a year ago and suggested that there must be some way to educate primary Docs about the fact that older adults can be helped.

Sally

This should help some. If you get past the stuff about kids, you'll find some interesting stuff quoting one of my bosses, Sigurd Berven.

http://www.nytimes.com/2010/08/10/health/10brod.html

[Confusedmom]

No, it looked pretty good for the younger people (and better yet, I'd guess, for the under-25 crowd). It's the 71% complication rate in the older group that caught my attention.

My main take-away from this would be that it's better to get the surgery sooner rather then later.

Actually, I was wondering if the implication of this study was just the opposite, i.e. you might as well wait until you are older and more disabled because older people are likely to get a disproportionate improvement in pain & disability and be happier with the results.

Also, I thought it was interesting that the authors said:
"Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis..."

I added the emphasis. Are we still at the point where they can't say definitively on a scientific (non-anecdotal) basis that there are benefits from this surgery?