Results 1 to 6 of 6

Thread: Instrumentation metals & Straight correction VS. balanced correction

  1. #1
    Join Date
    Jun 2013
    Posts
    13

    Instrumentation metals & Straight correction VS. balanced correction

    I just returned from taking my 13-year-old to see two surgeons on the West Coast.

    She has an S-curve--thorocolumbar. Both would fuse T10-L3.

    One said that because she is so flexible, he would correct to between 0 and 10 degrees.

    The other said he would correct to about 20 degrees, so her upper curve and lower curve would be balanced.
    (He hadn't viewed her bending xrays at that point, however, so I wonder if his opinion would change.)

    I was wondering if any of you had opinions RE QOL in straight corrections vs. balanced corrections.

    Also, I am concerned about the release of metals from implants, especially for girls who have their reproductive years ahead of them. From what I've read, stainless steel, titanium, and chromium cobalt all have their pros and cons. Do any of you have information on the safest metals?

    Thank you so much. I really appreciate your care, concern, and experience.
    Mary

  2. #2
    Join Date
    Jun 2013
    Posts
    13

    update

    My daughter's surgery is scheduled for December 18.

  3. #3
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Quote Originally Posted by laakea77 View Post
    I just returned from taking my 13-year-old to see two surgeons on the West Coast.

    She has an S-curve--thorocolumbar. Both would fuse T10-L3.

    One said that because she is so flexible, he would correct to between 0 and 10 degrees.

    The other said he would correct to about 20 degrees, so her upper curve and lower curve would be balanced.
    (He hadn't viewed her bending xrays at that point, however, so I wonder if his opinion would change.)

    I was wondering if any of you had opinions RE QOL in straight corrections vs. balanced corrections.
    Well that's pretty interesting. I can't have an actual opinion that matters because I am not a surgeon but I do have some data on this issue.

    Does your daughter have one structural curve or two? It sounds like only one based on the fusion levels.

    I have identical twin girls, both fused T4-L1 for thoracic scoliosis but one is now straight (no measurable scoliosis anywhere in the spine... she was hyper-corrected) and the other has two residual curves in the mid 20s. There is absolutely no difference in their quality of life that is apparent. They do the same things. Neither has any pain. The one with the two residual curves has no rotation but the one who was hyper-corrected has a slight bit that is noticeable if you know what to look for. So the one with the two residual curves looks slightly better but they both look normal to the unschooled eye.

    It is my understanding that flexibility determines how much straightening can physically occur (without osteotomies and such) but the curve type and other hyper-technical matters having to do with balance in various planes determines how much the curve should be corrected. So the kid with the two residual curves was very flexible and bent out the compensatory curve which was in the high thirties to 4 degrees if you can believe it. But she had a false double (looked like two structural curves but was only one). I have gleaned through reading that it is best to not hyper-correct this type of curve because if you do, it often results in a high left shoulder. I think that is why the surgeon left two balanced residual curves rather than hyper-correct her.

    The kid who was hyper-corrected had a pure thoracic curve that was highly rotated. That curve apparently is amenable to being hyper-corrected because her entire spine from skull to pelvis is now perfectly straight though she has a slight rotation as I have mentioned. So she is not "straight" in the transverse plane but her coronal and sagittal planes are normal range.

    So balancing the curves appears to be important but it is pretty clear that the less residual curve remaining in the unfused area, the less uneven wear and tear there will be over time. So while I do not worry about the unfused lumbar of the kid who was hyper-corrected, I do worry a little about the kid with the residual small curve in her lumbar. But that said, there are actually studies going out two decades showing the small curves in unfused lumbars thoracic fusions in a false double are stable.

    With respect to your daughter who is looking at a fusion to L3, I would be quizzing the surgeon very closely on the long term prospects of the unfused lower levels if a residual curve is left versus hyper-correcting. While there is an upside to maximal straightening in terms of even wear and tear (and Dr. Hey bangs on about this quite a bi), there may be a downside that the surgeon can talk to you about. You should ask. If there is no downside then I would go with the guy who will hyper-correct her so as to minimize the need to extend the fusion ever.

    Also, I am concerned about the release of metals from implants, especially for girls who have their reproductive years ahead of them. From what I've read, stainless steel, titanium, and chromium cobalt all have their pros and cons. Do any of you have information on the safest metals?
    Well I don't know about other issues but with respect to metal allergy, here is Dr. Hey discussing the issue on video...

    http://www.youtube.com/watch?v=nP773c0HrHk

    I think I have seen some papers showing elevated metal levels but I don't think anyone has linked that to any bad outcome. You need to talk to a researcher in this field to get some sense of this issue.

    Thank you so much. I really appreciate your care, concern, and experience.
    Mary
    I want to wish your daughter and you good luck with the surgery.
    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
    Join Date
    Jun 2013
    Posts
    13
    Thanks so much for your detailed reply. You would go with the guy who would hyper-correct? I was worried about that--he wanted to fuse her WHOLE spine!!

    We chose the other guy...but just found out last night he hurt his hand and the surgery is OFF...gotta find out more news, today I hope.

    I was under the impression she needed to get this SOON due to progression.

    Starting the surgeon search again from Hawaii is not easy...

    Thanks, I will reread your last post about 50 times.

  5. #5
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Quote Originally Posted by laakea77 View Post
    Thanks so much for your detailed reply. You would go with the guy who would hyper-correct? I was worried about that--he wanted to fuse her WHOLE spine!!
    That's not what you wrote. You wrote, "Both would fuse T10-L3."

    If the two fusions are different lengths then that changes things for me at least.

    We chose the other guy...but just found out last night he hurt his hand and the surgery is OFF...gotta find out more news, today I hope.
    Make sure you understand how long each guy wants to fuse.

    I was under the impression she needed to get this SOON due to progression.
    I believe that! Based on the fusion levels, your daughter appears to have a TL curve. Those are emergency situations in my opinion and we have testimonials where surgeons will lower the surgery trigger angle on those so as to save levels in the lumbar. It could mean the difference between needing only one surgery for life or needing more than one, possibly extending to the pelvis.

    Starting the surgeon search again from Hawaii is not easy...

    Thanks, I will reread your last post about 50 times.
    That's probably not necessary! What is necessary is absolutely understanding what these surgeons are suggesting and asking questions until you get to a comfort level.

    Raleigh, NC is pretty far away but Dr. Hey is pretty big on trying to save levels in the lumbar so as to hopefully avoid the need for an extension to pelvis at any point. I have never met him but his blog is very informative. If I was dealing with a TL curve on my kid, I would be looking to see if some surgeon can straighten the lumbar enough without going too low. It may not be possible but I would make sure of that.

    Again, good luck.
    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
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Quote Originally Posted by laakea77 View Post
    She has an S-curve--thorocolumbar. Both would fuse T10-L3.
    Mary,

    I think I misunderstood you. When you said thoracolumbar, I thought you meant one structural curve at the thorax-lumbar junction.

    But now I think you are saying your daughter has a double major curve... two structural curves. One surgeon will only fuse from T10 - L3 and the other will fuse lower and higher I assume from your later comment.

    You need some more opinions in my opinion about how best to save the most levels in the lumbar for the longest periods of time. I have noticed that surgeons will stop at about L3 per se on a young child whether or not the structural curve extends past that point. There is a reason they do that when they do that. Nobody but an experienced surgeon is going to be able to address that issue with you. And experienced surgeons might differ among themselves on what best to do.

    You need some answers.
    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."

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •