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Thread: Just what defines a " Good outcome from scoliosis surgery."

  1. #1
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    Just what defines a " Good outcome from scoliosis surgery."

    I have a question for many of the long standing members{the new members may not know the answer yet}Just what makes a surgery successful. Is it attitude ,or minamal problems,or problems coming up but can be fixed?Is it simply that you are satisfied? some of us have traded one pain for another. Is that where you stop? Is it learning to adjust to the difference in the body? Making the best and then moving on.
    I know Ed started a thread about adjusting to limited mobilty--A great thread--But how agout adjusting to different pain?
    Please way in with your answers,
    Jackie

  2. #2
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    Being completely pain free would be the ultimate goal....This is really what its all about. Cosmetics are secondary. Mobility is secondary when major “pain events” are happening on a daily basis. I would rather be completely fused than experience pain on the level I experienced before my surgeries. One day, I will have that ACDF I talked to you about on the phone, I am prepared. Pain is devastating, and disrupts ones life. It can completely ruin our lives.

    Trading pains is dependent on what kind of pain you are experiencing. Gripping or tightness without pain is an improvement, but after a long period can wear a person down and cause fatigue. And it grows old, unless a person can adapt.....

    I personally don’t feel that having to have to take medications is a good outcome. But that’s my point of view. Many take meds to maintain, and if it helps them do this, that fine as long as they know what meds do to a person for the long haul. Termination of meds should be a goal. If one can do this and maintain a pain free life, not require any revision surgeries, that would be the ultimate goal.

    That and becoming an “oil boy” also helps. (smiley face)
    http://www.youtube.com/watch?v=sLB-uMPj27s


    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  3. #3
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    My surgery was about 11 months ago. I was fused from T4 to S1 with pelvic fixation. I was age 67 at the time of my surgery. I consider myself very blessed to have had what I consider to be a very successful outcome to my surgery. I had a 67 degree lumbar curve with severe stenosis at several levels in that area. I had severe pain when I flexed that part of my spine and also a lot of discomfort as the lower rib on my left side was pressing down hard on my pelvis, and I had to walk with a walking pole to go anywhere. Now I can walk for 2-3 miles, can stand for hours without pain, don't have to worry about bumps in the road causing pain when driving, etc. My sciatic pain is not gone but is better. I do have some discomfort in my other hip if I walk too fast uphill which I think is from the pelvic screw. I don't feel particularly limited by my long fusion. I still use my grabber a lot but squat a lot now to pick up things. I do feel a new "tightness" in my lower back, but I like that feeling as it makes me feel stabilized and confident since I know a sudden jolt or bump will no longer hurt. I have been able to get back to some gardening, have even driven our boat over choppy waters this past week! I do have severe stenosis in the cervical spine but so far the surgery has not aggravated my neck. I am glad I had this surgery.
    Jane

  4. #4
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    To me, the way one should judge whether they have a good outcome is if they're significantly improved from before surgery. Being completely out of pain is probably not a realistic goal. I've heard enough surgeons talk to patients about goals that I think it's safe to say that they mostly say that the goal of surgery would be to stop progression, improve pain, and improve weakness or other neurologic symptoms. The trade off for those goals is usually loss of some flexibility and often, new pain. Thinking that there's a "perfect" is unrealistic, and can lead us to become a member of the Surgery of the Year club. We've seen it with participants here. They have surgery, and are left with some new pain or other symptom. Then, they have surgery for the new pain or symptom. It is not at all uncommon to hear of people who have up to a dozen surgeries, and are still not happy with their outcome. I can tell you from experience that new pain is often much harder to deal with than the old pain. Over time, our brains do a fairly good job of dealing with pain that we've had for a long time. It's nearly impossible to ignore new pain. With that said, pain is very subjective, and sometimes pain means there is really something wrong. It's up to each of us to try to judge whether more surgery will help. I can tell you that, statistically, with each additional surgery, the chance that the patient will be satisfied goes down.
    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.

  5. #5
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    I am only 2.5 months out, but for me it is improvement in quality of life. Before surgery I was sitting down or laying on the ground frequently. Sure, if I had some steroid injection or denervations, I could make it a couple of months, but then you need to go back again and long term steroids cannot be good for bones. Pain meds did not help preop and I am only take meds now if I am in a lot of pain before bed. My right leg is weak, but I am hopeful that it will improve. Am I better off than before surgery? Absolutely! Did I want a perfect outcome? Would be nice but totally unrealistic, especially when I read what was done in surgery. I just want to be in the mainstream of life! Before surgery, Dr. Hu gave me a 1/100 chance of dying with the surgery (my age and the 2 procedures). That outcome would have been a bummer. I chose my surgeon carefully and prayed. I was not aware of the postop problems preop. I know that she said a long list of things that could happen, but I really did not listen. I was so overwhelmed, and naively optimistic. I had a good outcome by my standards with a combination of a great surgeon and a lot of luck.
    Susan
    Of interest I was thinking last night of asking if ANYONE has absolutely no long term issue postop. This thread should also answer my question.
    Last edited by susancook; 06-09-2013 at 07:46 PM.
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

  6. #6
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    My goal was to be stabilized. My surgeon explained that the surgery was no panacea-- that half the world (well, he didn't say it that way) but tons of non-scolis have back pain also, so even if the pain from the scoliosis were to be resolved, that wouldn't necessarily mean a pain free back. He said there was the possibility of having more pain after than before.. and I am much better off now. He went over all of the caveats. I consider my surgery to be in the "good outcome" category because I seldom (maybe once or twice a year) take any kind of pain medicine for my back, feel content and happy with the results, there were no complications other than the ileus, I stand straight and have no kyphosis or postural problems. I have occasional lower and upper back aches when I overdo, but that is to be expected. I am one of the success stories-- at least in my own mind, even if I'm not competing in sports, etc.
    66 and still heartbroken...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
    2014 DXd w/CMT (type 2)

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  7. #7
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    Goal of surgery defined

    There is no definite definition of a successful surgery. I had my surgery over two years ago. I was one of those scoliosis patients who went into surgery having some headaches and some minor backaches, but a curve that was progressing. Yes, I could have waited to have the surgery and wait for my curvature to progress even further and for the pain to worsen. Instead, I elected to have the surgery to stop the curve progression at a time when my overall health was as good as it was going to get. The surgery would have to be declared successful because the curve progression has stopped and that was the main goal. Because of the surgery, I now deal with ongoing tightness especially in my thoracic area and there is the daily reminder that slouching is no longer an option thanks to the rods. The fact that I can still play tennis pretty well following my surgery is a nice post-op surprise. No, my back isn't perfect and I am dealing with new discomforts, but at least the progression has been addressed.
    Donna
    Female - 49 yrs old at surgery
    Surgery 5/5/11 - Dr. Bridwell, St. Louis
    Fused T3-L3
    60 degree thoracic curve corrected to 30 degrees
    Tennis player & returning to the courts!
    http://s1050.photobucket.com/profile/walkingmom1/index

  8. #8
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    Hi to all and thanks for all of the input. Linda, I can relate to everything you said. I am still asking myself if I am better then before the surgery. Some of the low pain is better for sure. I guess I just had some complications that are hard. Since I has first fused t10-pelvis,then fractured through t-9 six days later. Then I had to have surgery to fix C5,6,7. And then due to kyphosis caused by the fracture of t9,I was fused t2-to t10. Now it seems a trade off of discomfort--all around c7-t-1,2 and in the chest wall around t10,9 .You are right about old pain ,you get used to it. It has been hard for me to get used to the upper right neck,thorasic problem,The Dr just said it is going to hurt. I hope he did not mean forever!
    Thanks again for all of the info!

  9. #9
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    I have to be honest and say that on some days my pain is worse.
    I have posted before about the ongoing pain in the middle of my back-scans reveal no problems and because I have very protruding screws my surgeon is pretty sure my hardware is the problem.
    Some days I feel better but on days when I've been busy boy do I hurt! Its gripping, digging, pressure and it can be very draining-just like my pre op pain was but the benefits are I'm straight, my hump has completely gone, I can stand in a queue without feeling like my spines going to collapse and my back rests flat against a chair. The main thing is that worries of progression have gone too.

    My surgeon told me he will remove my hardware if that's what I want but he can't guarantee anything so I'm thinking do I want to take this gamble then live with the worry of re curving (I've been told by 10-15%)? Im pulling more towards being satisfied with what I've got because after all there was no guarantee of becoming pain free in the first place.
    Fused T2-L4 with costoplasty on 3/11/10

  10. #10
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    Dear Bluestone,
    An interesting thing about hardware removal---my surgeon said he could do it{at the t10 level}before the last surgery was done. He did say that I would not be happy with him and when I asked why he said---It will most likly not help with the pain. That is a good point--if it won't help and may cause a progression of curve--why do it. In my case we had to add t2-t10 hardware that you already have. I will say once that healed it was less painful then hardware right below a fracture. my spine curved 20 degrees in one year after the fracture. It wasted no time!

  11. #11
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    i thought once the spine is fused...
    a year or two after surgery...that a fused spine cannot re-curve...
    even without the hardware...
    unless you are talking about curving above or below the area that is fused....??????

    jess

  12. #12
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    Not true. Without the hardware it can start bending back over time. I have a friend who was fused without hardware back in those days -- 60s?? (like Karen) and she is probably at 110º now. Karen had revision surgery a little while ago for hers. There have been others on here also. There definitely is an advantage for keeping your hardware unless you have a problem.
    66 and still heartbroken...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
    2014 DXd w/CMT (type 2)

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  13. #13
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    I think the comments about being able to remove the implants may mainly pertain to kids because here are a few papers showing some adults do lose correction. Previously, I saw a paper showing that some rotation (transverse plane) tends to return with implant removal but the coronal and sagittal corrections didn't change much. That may have been in kids only.

    http://www.ncbi.nlm.nih.gov/pubmed/11013496

    Spine (Phila Pa 1976). 2000 Oct 1;25(19):2453-60.
    Loss of sagittal plane correction after removal of spinal implants.
    Deckey JE, Court C, Bradford DS.
    Source
    Southern California Complex Spine and Scoliosis Center, Whittier, California, USA.
    Abstract
    STUDY DESIGN:
    A retrospective review of a clinical series was performed.
    OBJECTIVES:
    To evaluate the incidence of adult patients who experienced spinal collapse after spinal implant removal after a long spinal arthrodesis, and to assess the various factors that may influence the likelihood of collapse after implant removal.
    SUMMARY OF BACKGROUND DATA:
    Published reports describing the benefits or complications of spinal implant removal do not exist. Spinal implant removal, often considered a benign procedure, is even required by the Food and Drug Administration (FDA) for certain implants.
    METHODS:
    The medical records and radiographs of 116 consecutive adult patients with long posterior instrumented fusions (>5 segments) were reviewed. The information obtained included original diagnosis, patient age, number of previous surgeries before implant removal, levels of anterior and posterior fusion, time from fusion to implant removal, time from implant removal to failure, and reason for hardware removal. Radiographs also were assessed including scoliosis, lordosis, and kyphosis measurements before implant removal, after hardware removal, after failure, and after revision surgery.
    RESULTS:
    Of 116 patients, 14 underwent spinal implant removal. Most of these patients reported prominent implants either proximally in the thoracic spine or distally in the ilium (Galveston technique). Of these 14 patients, 4 experienced increased pain and collapse after implant removal despite thorough intraoperative explorations demonstrating solid fusion.
    CONCLUSIONS:
    Spinal implant removal after long posterior fusion in adults may lead to spinal collapse and further surgery. Removal of instrumentation should be avoided or should involve partial removal of the prominent implant.

    http://www.ncbi.nlm.nih.gov/pubmed/15549484

    Eur Spine J. 2004 Nov;13(7):645-51. Epub 2004 Jun 26.
    Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases.
    Muschik M, Lück W, Schlenzka D.
    Source
    Seehospital Sahlenburg Orthopaedic Hospital and Center for Spinal Surgery, Nordheimstrasse 201, 27476, Cuxhaven, Germany. Muschik@seehospital-sahlenburg.de
    Abstract
    A retrospective follow-up study of patients who, having undergone instrumented posterior spinal fusion for scoliosis, experienced late infection and then underwent either implant removal alone or implant removal and instrumented refusion. We conducted this study to determine whether it is possible to avoid loss of correction by a single-stage implant removal and reinstrumentation procedure. There have been a few reports of late-appearing infections after spinal instrumentation. Implant bulk, metallurgic reactions, and contamination with low-virulence microorganisms have been suggested as possible etiologic factors. The clinical symptoms include pain, swelling, redness, and spontaneous drainage of fluid. Complete instrumentation removal and systemic antibiotics is usually curative. We retrospectively reviewed 45 patients who underwent instrumented posterior spinal fusion for scoliosis and experienced development of late infections and, after a mean of 3 years after the initial procedure, either underwent implant removal alone [ n=35, instrumentation removal (HR) group] or additionally underwent reinstrumentation and fusion [ n=10, reinstrumentation and fusion (RI&F) group]. Three patients were reinstrumented 1.5 years after instrumentation removal, and seven underwent a one-stage rod removal and reinstrumentation/refusion procedure. Allergic predisposition, protracted postoperative fever, and pseudarthrosis appear to increase the risk of late-developing infection after posterior spinal fusion. All wounds in both groups healed uneventfully. Preoperative radiographic Cobb measurements showed no statistically significant between-group differences. At follow-up, however, outcome was clearly better in the RI&F group: Loss of correction was significantly smaller in reinstrumented patients. Thus, the thoracic Cobb angle was 28+/-16 degrees (range 0-55 degrees ) in the RI&F group versus 42+/-15 degrees (21-80 degrees ) in the HR group, and the lumbar Cobb angle was 22+/-11 degrees (10-36 degrees ) in the RI&F group versus 29+/-12 degrees (13-54 degrees ) in the HR group. The results of our study demonstrate that wound healing is usually uneventful after instrumentation removal for late infection, also when patients undergo instrumented refusion in a one-stage procedure. Reinstrumentation appears to achieve permanent correction of scoliosis.

    http://www.argospine.org/2008/PDF/26...lebarger_2.pdf

    Deformity Recurrence after Implant Removal

    Potter BK, Kirk KL, Shah SA, Kuklo TR. Loss of coronal correction following
    instrumentation removal in AIS. Spine 2006;31:67-72.

    Mean 10 degree loss in coronal plane, sagittal no change
    Ho C, Skaggs DL, Weiss JM, Tolo VT. Management of infection after
    instrumented posterior spinal fusion in pediatric scoliosis.
    Spine 2007; 32:2739

    Mean 9 degree loss in coronal plane, 20% with increase kyphosis
    Clark CE, Shufflebarger HL. Late developing infection in instrumented
    idiopathic scoliosis. Spine 1999;24:1909

    4 of 22 (18%) progressed requiring later revision
    Deformity recurrence reality!!
    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."

  14. #14
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    Jul 2008
    Location
    west midlands, UK
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    Thats very interesting reading thank you.

    I had a 76 degrees very stiff curve and my surgeon said it was extremely hard work-my surgery lasted 10 hours and he had to group some pretty big screws in the apex to get it straight-these are the ones that protrude so my concern is if these are gone I could re curve. I'm starting to think less and less about removal since I've been told its 50/50 regarding easing my pain. I wake up sore everyday but i just don't think its bad enough.if it was to get worse than yes it would have to come out.

    I can't find Any positive stories regarding hardware removal so for me at the moment its just too big a gamble.
    My surgeon said there's no rush in making a decision because the longer I wait the harder the fusion will be and if he had to chip it out its good because its as hard as it can be.
    I'm still praying things could ease even more over time
    Last edited by bluestone; 06-17-2013 at 04:05 AM.
    Fused T2-L4 with costoplasty on 3/11/10

  15. #15
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    May 2009
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    3,745
    hi bluestone...
    so sorry you are in such pain....

    what about just screw removal...???
    i think, if you type in "screw removal" at top of page where it says "search" you will find some patients who did well after having one or more screws removed...especially the screws that are in hip area...
    "Admoul"...Annne...is one patient who had screws removed by Dr Lonner,
    the surgeon in Manhattan who did her original surgery...i believe she did
    great after she healed...
    perhaps you could investigate whether just taking out some screws might
    relieve some pain...

    best wishes...
    jess

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