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Thread: Lenke classification

  1. #1
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    Lenke classification

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    Last edited by hdugger; 05-19-2013 at 03:41 AM.

  2. #2
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    If you are limiting it to the Lenke classification there seems to be only one choice... 2A-.

    I am guessing the curve right below the main high curve is just assumed to be structural as it would be physically impossible to even try bend that out to see if it bends out as it is entirely within the the rib cage area.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  3. #3
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    I'm changing my answer... 2C+
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    It's hard to classify with the child in a brace. I think there's a thoracolumbar curve w/apex at L3, so I'm not sure Sharon is correct.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
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    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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  5. #5
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    Quote Originally Posted by LindaRacine View Post
    It's hard to classify with the child in a brace. I think there's a thoracolumbar curve w/apex at L3, so I'm not sure Sharon is correct.
    Hey! I'm very doubtful that I'm correct.

    There are actually 4 curves there, the major one high in the thorax and three below it. Only the large one seems structural but it would impossible to try to bend out the one below it so I guess that is why the only choice in Lenke's table is double structural Thoracic.

    The curve directly below the large one is >25* to my eye.

    The C is because the L spine does not come straight up normal to pelvis but curves immediately (though slightly). Look at the other chart on Lenke's page. I could possibly go with a "B" also.

    I would really like to hear what three surgeons independently classify that as. That would be pretty good.
    Last edited by Pooka1; 12-30-2010 at 08:21 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Hi hdugger,

    I sent you a PM (regarding asking Dr Hart your question).
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  7. #7
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    Quote Originally Posted by hdugger View Post
    ??? He's not in (has never been in) a brace
    I don't know why, but the lumbar curve looks unusual to me. (What I think is, though not positive,) the L3-L4 angle looks more sharp than it should be for the size of the curve. Has anyone mentioned a listhesis or some other issue?

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  8. #8
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    Quote Originally Posted by hdugger View Post
    No, not at all, His doctor told us last time that he didn't have any lumbar involvement, or any risk of he curve going down into his lumbar spine.

    We're seeing him again soon, and I'll discuss it with him. Thanks so much for pointing this out.

    Leah, for some reason I didn't get your PM.
    I agree with Gayle if she said ask Hart. Please report back.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    Hi hdugger,

    Not sure where the PM went but anyway I wanted to tell you that I am sure Dr Hart would answer your question if you e-mail it to him. I have e-mailed questions to him via his wonderful assistant, Robin, who is very responsive about getting questions answered. If you don't have her e-mail let me know and I will get it to you.

    Gayle
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  10. #10
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    seeing Dr Hart Tuesday

    Hi hdugger,

    Funny, I am seeing Dr Hart on Tuesday also for my 12 week post-op appt. I think I will be there around 11:30. Would love to say hi if you're there around the same time.

    In regards to your question about taking your son to see a "big name"--I understand where you are coming from and it has sometimes crossed my mind when I read about people seeing some of the big names. However, I think if it were my son, and he were doing fine, stable and not in pain, and you're not pushing for surgery, I would feel comfortable with the opinions you have gotten in Portland and let some time go by, see how things unfold in the future. I am sure you could go and see one of the prominent surgeons, some of whom may offer surgery if you were interested or because they thought you were interested. But to me, bottom line is if his curve is stable and he's doing ok, why go out looking for someone else to make you question your decision. I hope you understand what I mean. I guess what I'm trying to say is, your son sounds like he's stable and doing fine now, the future is open and the gift of youth is on his side, if surgery becomes necessary you will know it and there will be a way to fit it into his life. Just my two cents. Plus I really think Dr Hart would steer you towards surgery if he felt it was the thing to do at this point.

    Just my two cents worth and I hope this helps. Good luck Tuesday.
    Last edited by leahdragonfly; 12-31-2010 at 10:50 AM.
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  11. #11
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    Would someone mind looking at my daughter's x-ray and telling me what her Lenke classification might be? I've tried to do it but I don't know that I'm getting it right.

    Thanks!
    Attached Images Attached Images
    Mom to 11 year old DD who was:
    diagnosed 5/09: 8*L, 8*T
    braced 7/10: 17* L, 25*T, 20*C
    x-ray 11/10: 7*L, 17*T, 20*C (x-ray immediately OOB)
    most recent x-ray 06/11: 17*L, 24*T, 22* C (x-ray 24 hours OOB)

  12. #12
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    Wow that is one of the clearest radiographs I have seen.

    Here are my LAY guesses...

    I see they measured three curves though I'm guessing only the middle one is structural but I have no idea. Did they tell you how many structural curves she has? So I think it's a Type 1 (main thoracic). I'm guessing.

    I think the reason they measured the top curve and what makes it a curve is that the top vertebrae is not level and in the opposite sense as the lower end of that curve. As I understand this game, a curve is defined between level (or at the first non-level) vertebrae. That seems to be the case but I don't know if that is what a surgeon would say. I would love to see a bunch of radiographs that are labeled as to what curve type they are. I was able to tell my one daughter had a Type 1C (false double) which the surgeon confirmed but that was a fairly easy case to figure out.

    The lumbar is off center but the plumb line still intersects the vertebra which is apparently what they are using as the criteria for the lumbar modifier.

    My guess is it is a 1B and the + or - will denote the kyphosis situation if any.

    If the top curve is structural then it would be a 2B.

    If you ask the surgeon, can you please report back?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  13. #13
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    Quote Originally Posted by hdugger View Post
    Linda, if you're still on-thread, I had a question about second opinions.

    I'd always figured we'd wait to get a second opinion until someone recommended surgery (which hasn't really happened yet). Now I wonder if we ought to get a second opinion before that - in case we're somehow missing some urgency in getting him to surgery.

    His background is that he's seen three doctors, but his main pediatric one really was not a spine guy. Several years back, he saw one of the main SRS guys up here, who didn't feel like he'd reached the surgical trigger at that point, and who also felt that his curve was stable. And then last year (and again next week) we see Hart, who says he *can* have surgery and that it would improve and stabilize his curve, but isn't really pushing for it in any way (in fact, he was ready to release him for 5 years with no follow up).

    But, I don't have anyone really expert up here, and I do wonder if I shouldn't somehow get him into someone who's done tons of surgery to make sure we're not somehow missing something important. On the other hand, the poor guy has had xrays and doctor visits every six months to 1 year for the last 7 years, and has been stable for the last 4, so I'd kind of like to give him a break from the whole thing if nothing comes up on our next visit. Also, he's just recovering from major jaw surgery, so, again, I'd kind of like to let him live his life post-medical-patient for awhile.

    On the other, other hand, our last obvious window for surgery is this summer. After that, he'll likely have a full-time job and it won't be so easy to take off for awhile.

    Anyway, if Linda or anyone else wants to weigh in on this, I'd would welcome some opinions.
    The only risk in waiting to go to surgery that I've heard a specialist mention in the past 5-10 years, is that thoracic curves become thoracolumbar curves, and the fusion goes from being a short one to being a long one. If you have a series of films over time, I'd be happy to show them to one of my docs to get an opinion.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  14. #14
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    Quote Originally Posted by hdugger View Post
    Thanks, Leah. That's our strong inclination. He's been such a trooper about being the constant "medical patient" for the past 6 years, that we feel like he should just get a chance to *not* be a patient for awhile (as long as his xrays continue to show no progression).

    We're at Hart's later in the day - at 4. If you're still there that late, my kid is the immediately identifiable one because he has a wealth of hair - lots and lots of long curly hair on the top, and a full beard. But he's still my little baby
    Hi there,

    sorry we will miss you, we hope to be out of there and off to pick up a yummy sandwich at Zupan's by early afternoon! We just love that place (Zupan's that is, not the dr's office haha).

    I really think it is important to let these kids/young adults have as normal and non-medical childhoods as possible. My daughter got extremely sick of medical appointments and brace fittings (sadly at age 6 and 7). Now that she has been stapled, she rarely mentions her back and I think she does not think about it, so I try hard to do the same.

    No worries about the name--Leah is actually my daughter's name!
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

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