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Thread: "standard of care"

  1. #1
    Join Date
    Jan 2005
    Northern California

    "standard of care"

    Hi all,

    A question about the medical "standard of care" for scoliosis.. my understanding is that if a person with scoliosis sees an orthopedic doctor, and certain conditions exist, the "standard of care" (aka industry standard, or common recommendation among most or all ortho docs/ surgeons) would be to have surgery.

    If this is true, what are the conditions? I'm guessing degree of curvature, progression, level of pain? Anyone know?

    28 year old female, 68T and 43L degree curves considering surgery

  2. #2
    Join Date
    Jul 2004
    Northern California
    Hi Marian,

    The million-dollar question! You will read on the message boards that surgeons can have different opinions about when surgery becomes necessary... but from what I have gathered from my own experience with different surgeons and through reading, surgery is generally thought to become necessary when a curve looks like it will continue to progress past about 60 degrees, or when substantial pain can be reliably believed to be coming from the curve (this is difficult to ascertain, as back pain is hard to figure out, but such pain often goes hand in hand with fast progression).

    Good luck. I am happy to communicate by email if you would like.
    Last edited by lrmb; 01-30-2005 at 07:43 PM.
    Upper curve around 55
    Lower curve around 35

  3. #3
    Join Date
    Sep 2003

    indications for surgery

    Here is an article I researched from the National Library of Medicine:

    1: Presse Med. 1999 Nov 27;28(37):2075-85. Related Articles, Links

    [Spinal deformity in the adult]

    [Article in French]

    Guigui P.

    Service de Chirurgie orthopedique, Hopital Beaujon, Clichy.

    PROGRESSIVE DEFORMATION DURING ADULTHOOD: Though not commonly recognized, lumbar and thoracoscoliosis can progress during adulthood. This slow, insidious evolution concerns not only the anatomic configuration of the spinal curatures (three dimensional angular deformation) but also spinal function (development or aggravation of spinal or radicular pain and/or impaired equilibrium). This fact emphasizes the importance of regular prolonged surveillance of all patients with spinal deformations. RADIOLOGICAL CHANGES: Three anatomic elements affecting function are evidenced on serial x-rays: development of rotational dislocation, stiffening of the main curvature, especially in the lumbosacral spine, and progressive instaliation, thoracolumbar kyphosis. TREATMENT: Three types of treatment can be proposed: physical therapy, orthopedic treatment, surgery. Physical therapy and orthopedic treatment can relieve pain and improve equilibrium but cannot change the progressive pattern of the spinal deviation. Surgery also provides effective symptom relief and has the advantage of definitively stopping the progression of the deformation. INDICATIONS: Indications are much more complex than simply determining an angle of deformation beyond which surgery is needed. For each case, indications are established on knowledge of the type of deformation, its extent, potential or ongoing modifications in the main curvature and compensatory curvatures, the patient's age, as well as the functional impairment and the patient's general status.

    Publication Types:
    Review, Tutorial

    PMID: 10605482 [PubMed - indexed for MEDLINE]


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    Jan 25 2005 16:15:24
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

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