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Thread: Ten year follow up on fusion looks very good

  1. #16
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    A cadaver study demonstrated similar in normals. This is why you have to have controls. You don't understand this point it seems. It is not related to the fusion.
    Last edited by Pooka1; 01-11-2014 at 06:32 PM.
    Sharon, mother of identical twin girls with scoliosis

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  2. #17
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    Quote Originally Posted by Pooka1 View Post
    A cadaver study demonstrated similar in normals. This is why you have to have controls.
    As always, I have no idea what you're talking about. Except that, again, as always, it has something to do with insulting me.

    They compared these patients to an historical cohort of normal patients. And they found that the rate of DDD in this population was twice the rate of that seen in age-matched controls who did not have scoliosis. Only 38% of the age matched normal controls had early DDD changes compared to 85% of the fused patients.

    Hence the conclusion that fused patients, no matter what level they were fused to, had an accelerated rate of DDD. That is, fused patients of all kinds are *not* dropped back in to the normal population of back problems after surgery. Even if their fusion ends above the lumbar spine, they are experiencing a much higher rate of DDD in their 20s than controls without scoliosis.

    Will they continue not having clinical symptoms? We all hope they will. But according to this study, the experts do not yet know the long term significance of the accelerated degeneration.
    Last edited by hdugger; 01-12-2014 at 12:24 PM.

  3. #18
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    You don't know if that is due to fusion or the condition.

    Also other studies show the SAME rate of degeneration far distally in normals as in fused to the top of the lumbar. That may be why that point wasn't emphasized. You have no depth in this field to know what to do with that statement but you repeat it like a robot.
    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. #19
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    Quote Originally Posted by Pooka1 View Post
    You don't know if that is due to fusion or the condition..
    Yes, that is a fact. Not a fact that has anything to do with *this* topic, but a fact, nonetheless.

    This topic has a statement from you in the original post, to which I am responding.

    From you: "This comports with what our surgeon said about no long term issues if you can stay above that level "

    This study does not appear to support *that* statement - the one we are discussing. In fact, the study finds issues even after 10 years and even in patients only fused to T12.

    Quote Originally Posted by Pooka1 View Post
    Also other studies show the SAME rate of degeneration far distally in normals as in fused to the top of the lumbar.
    Could you provide a link to one of those other studies so that we can see if they're comparable - are they using MR images? are they looking at controls in their 20s? etc. Without being able to see those studies, I'd have no way of knowing if they have bearing on the reported result.

  5. #20
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    How does the level of degeneration compare to people with similar scoliosis who were NOT fused? What if it is better? How would you determine that? Is that important to know?

    You are not approaching this question like a researcher would so you are just spinning your wheels.

    Here is a blurb on why controls are needed in research... it's wiki answers but that should due for now.

    http://wiki.answers.com/Q/Why_do_sci...ments?#slide=1


    On the larger issue, there have been SEVERAL articles and threads on this topic. Picking one at random and in isolation and thinking you have discovered something important is just naive.

    If you are so interested in this topic do a thesis on it. I don't give a hoot about your thoughts on the matter. Knock yourself out.
    Last edited by Pooka1; 01-11-2014 at 08:22 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. #21
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    I would also respond to this quote from Dr. Green, emphasized in the original post:

    "We found that the area of the spine adjacent to the fusion was pretty healthy and didnít show any major degeneration ten years later. While mild degenerative changes were noted in almost every patient, the severe changes that we were concerned that we might find were not there at all.""

    While this is true and supported by this research, it sort of misses the punchline (IMO). Yes, surprisingly, it was not the *adjacent* disk where they found the problems. The adjacent disc looked pretty good. However, the L5-S1 disc did *not* look good. That's why they stress that disc in their conclusion, and why they say that the degeneration was remote to the lowest fused vertebrae. The good piece of news from their study was not (again, IMO) that the adjacent disc had not deteriorate. That was surprising, but the good news part of it was counterbalanced by the bad news at L5-S1. the good news is that, even though they're seeing accelerated degeneration in this disc, they're not (yet) seeing clinical problems:

    Main conclusion (abstract): Despite demonstrating an accelerated rate of L5ĖS1 disc degeneration, our study group has good functional scores and maintenance of correction over 10 years postfusion. In this long-term MR imaging follow-up study, disc degeneration was found remote to the lowest instrumented vertebra.

  7. #22
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    Quote Originally Posted by Pooka1 View Post
    How does the level of degeneration compare to people with similar scoliosis who were NOT fused? What if it is worse? How would you determine that? Is that important to know?
    And, again, we're dashing off to a different topic. If you would like to start a topic about how fused patients compare to non-fused patients, please feel free to do so. In *this* topic, I'm restricting my comments to *this* topic.

    The topic at hand: Are patients with higher fusions likely to be spared problems below their fusion? The opening post quotes from part of the research (well, actually, I think it only quotes from Dr. Green's discussions about the research) to address that question. I'm quoting from the full paper because I think it provides a more complex picture.

    I have no idea, still, why you're quoting Wiki links on controls. The controls they've selected appear appropriate, to me, in addressing the statement from the opening post - can these kids expect to have problems in their spine long term after fusion? The jury is still out (because of how new the hardware is) but 10 years out their backs are already very different. Hopefully, as Linda says earlier, they'll follow up in another 10 years.

    And then there's the usual puddle of unpleasantness, for which I am (as an Oregonian) lithely puddle-jumping.

  8. #23
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    Quote Originally Posted by hdugger View Post
    The topic at hand: Are patients with higher fusions likely to be spared problems below their fusion?
    I have only read this post of this thread, but if the question is if fused vertebras represents a problem to the below ones, I think it has a well know answer. If necessarily they are always affected in a negative way or not, surely is not well known, but ii's similar to asking if wear a backpack every time would be bad for the spine..

  9. #24
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    Quote Originally Posted by Pooka1 View Post
    A cadaver study demonstrated similar in normals.
    They can't use cadavers as controls in this study because they're looking at the rate of change over 10 years. So they use living controls who can show a rate of change. using this control group, they show a doubling in the rate of degenerative changes between their subjects and an historical cohort of age-matched controls.

    The paper does a good job of summarizing the previous research, explaining why they believe they're seeing the results they report. For anyone interested, the full report is available online.

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