I'm in agreement that surgical patients are overall glad that they had the surgery, I thought Linda summed that up well - did not regret surgery, but still, as the paper suggests, were overly optimistic about exactly how much better they'd feel.
I'm hesitant to call out any single group of scoliosis patients as guaranteed free from any further pain, revisions, complications, etc. I think any surgeon setting those expectations is doing a disservice to their patients. The Asher paper was really elucidating in this regard. What he said was that even a 20 year followup for these adolescent patients meant that you were looking at people in their 30s and 40s. That's not where the bulk of the problems happen - they happen to people in their 50s and above. Pedicle screws don't have patients who had the surgery in their teens and are now 50 or older. So, the long term outcome is silent. The hardware is certainly designed to address problems seen in previous hardware, but, I think the increasing rate of PJK (also called out by Asher) in these patients suggests that the newer hardware may have properties of it's own that we simply do not yet understand. I think we're all *hopeful* that these kids will go on and live their lives without ever having to visit a forum like this, but I'd be very circumspect about suggesting that there is a known outcome.
But the question of classification and expected outcome for different types of teen patients raises another question - what are teen surgical patients with a curve that extends into their lumbar spine told is their expected outcome? I had the sense that this was one of those "pediatric surgeon blindness" that we hear of so often on the forum. There's a whole lot of information and concern about where these kids will be when they hit their 18th birthday, but radio silence after that. We had that with my son - all his doctor talked about was keeping his curve below 50 at maturity. Nobody said boo about what might happen after that. Is the same thing happening with teen patients fused into their lumbar spine? Or are they told that they might expect to have additional surgeries down the road?
I'm hesitant to call out any single group of scoliosis patients as guaranteed free from any further pain, revisions, complications, etc. I think any surgeon setting those expectations is doing a disservice to their patients. The Asher paper was really elucidating in this regard. What he said was that even a 20 year followup for these adolescent patients meant that you were looking at people in their 30s and 40s. That's not where the bulk of the problems happen - they happen to people in their 50s and above. Pedicle screws don't have patients who had the surgery in their teens and are now 50 or older. So, the long term outcome is silent. The hardware is certainly designed to address problems seen in previous hardware, but, I think the increasing rate of PJK (also called out by Asher) in these patients suggests that the newer hardware may have properties of it's own that we simply do not yet understand. I think we're all *hopeful* that these kids will go on and live their lives without ever having to visit a forum like this, but I'd be very circumspect about suggesting that there is a known outcome.
But the question of classification and expected outcome for different types of teen patients raises another question - what are teen surgical patients with a curve that extends into their lumbar spine told is their expected outcome? I had the sense that this was one of those "pediatric surgeon blindness" that we hear of so often on the forum. There's a whole lot of information and concern about where these kids will be when they hit their 18th birthday, but radio silence after that. We had that with my son - all his doctor talked about was keeping his curve below 50 at maturity. Nobody said boo about what might happen after that. Is the same thing happening with teen patients fused into their lumbar spine? Or are they told that they might expect to have additional surgeries down the road?
Comment