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Thread: Compensatory Curves

  1. #1
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    Compensatory Curves

    Hi,

    I'm new to the forum and have a question regarding compensatory curves. When I went for a second surgical opinion, the surgeon insisted that my 45* thoracic curve was structural and my 50* lumbar curve is my compensatory curve. Now I know that my lumbar curve is structural, as this is the curve that was treated while I was a teenager. By the time I had finished growing my lumbar curve measured 36* and I did not have a thoracic curve; that came later. The surgeon also told me it is unusual to have a compensatory thoracic curve, usually it's the other way around.

    Another surgeon told me he would only fix my lumbar curve and let the compensatory thoracic curve self correct.

    Perhaps this is a question Linda could answer.

    Thanks,

    Diane

  2. #2
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    Quote Originally Posted by danicaf View Post
    Hi,

    I'm new to the forum and have a question regarding compensatory curves. When I went for a second surgical opinion, the surgeon insisted that my 45* thoracic curve was structural and my 50* lumbar curve is my compensatory curve. Now I know that my lumbar curve is structural, as this is the curve that was treated while I was a teenager. By the time I had finished growing my lumbar curve measured 36* and I did not have a thoracic curve; that came later. The surgeon also told me it is unusual to have a compensatory thoracic curve, usually it's the other way around.

    Another surgeon told me he would only fix my lumbar curve and let the compensatory thoracic curve self correct.

    Perhaps this is a question Linda could answer.

    Thanks,

    Diane
    Hi and welcome, Diane.

    I am wondering if there was some miscommunication with the surgeon. The larger curve is never the compensatory curve to my knowledge. And the only way he could determine that is if you did bending films. Did you do bending films?

    It is not unusual to have a thoracic compensatory curve with a structural lumbar curve to my knowledge. What kind of doctor was this? I am guessing this was not an experienced orthopedic surgeon who knows spine. None of this is making sense if you are reporting it accurately.

    The surgeon who said he would only fuse the structural curve is correct as far as I know. I would never allow a surgeon to fuse a non-structural curve on my kids.

    So your lumbar was 36* at maturity and progressed to surgical range in how many years?

    I hope you get some competent opinions from now on.

    And finally, yes, Linda can answer this. :-)
    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."

  3. #3
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    The second opinion was from a surgeon listed with the SRS. He is a neurosurgeon, as well as an orthopedic surgeon. He recommended fusing me from T2 or T3 to the pelvis, which would hit both curves. He ordered bending films which, I'm assuming, will bear out that my lumbar is indeed the structural curve.

    I was around 15 when I stopped growing, and 5' 2 3/4" tall. I am now 55 and 5' 1", in the morning. So, I have lost almost 2 inches in height. I know we shrink as we get older but this loss in height came on pretty quickly.

    The first surgeon I saw did his fellowship with Dr. DeWald from Rush in Chicago. He wanted me to get the second opinion from DeWald but my insurance sent me to Loyola. The original surgeon wants to perform a minimally invasive surgery and only fuse me T5 to L4 or 5. The second surgeon from Loyola doesn't believe that minimally invasive techniques are appropriate for this type of surgery and that the corrections are poor. He also feels not to fuse to the pelvis would only lead to revision down the road.

    I think I'll seek that third opinion from Dr. DeWald at Rush.

    Diane

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    Well I am dying to hear what Linda says. And also what Dr. DeWald says, especially if you relate the statements from the other surgeons that you related here. It just doesn't make any sense. Could the second surgeon have said your thoracic curve is now ALSO structural? It seems like some single structural curves become double structural curves if not fused in time. You probably only originally had a structural lumbar curve and a compensatory thoracic curve.
    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."

  5. #5
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    Smile

    Quote Originally Posted by Pooka1 View Post
    Well I am dying to hear what Linda says. And also what Dr. DeWald says, especially if you relate the statements from the other surgeons that you related here. It just doesn't make any sense. Could the second surgeon have said your thoracic curve is now ALSO structural? It seems like some single structural curves become double structural curves if not fused in time. You probably only originally had a structural lumbar curve and a compensatory thoracic curve.
    Surgeon #2 was pretty insistent that my structural curve was thoracic. I liked everything else he had to say, well, except fusing me to the pelvis...that I didn't care for too much.

    I have xrays and an MRI that I need to attach. I find them distressing to look at...I look much better on the outside!

  6. #6
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    Quote Originally Posted by danicaf View Post
    Surgeon #2 was pretty insistent that my structural curve was thoracic.
    Yes but did he say your lumbar was not also structural?
    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."

  7. #7
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    No, he felt my lumbar was the compensatory curve.

  8. #8
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    Have you had bending films yet? Without them, there's no way to be sure that either curve is compensatory.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  9. #9
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    These comments from these surgeons make little sense in my opinion. How can he think the lumbar was compensatory when you were treated for a structural lumbar as an adolescent and didn't have much of a thoracic curve at that point? Structural curves don't magically become compensatory just because another curve becomes structural. Furthermore the lumbar is still the larger curve. To say what he said he has completely left the reservation on curve classification.

    This makes NO sense.
    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."

  10. #10
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    Linda: I have an order for bending x-rays, additional MRI views, a CAT scan and a stress test.

    Sharon: I totally agree. I told him the lumbar curve was structural and he told me I was wrong. I called my mother to ask what she remembered and she agreed it was a lumbar curve all those years ago. Now I'm wondering he if was looking at my films? He did not look at the films or MRI in the examining room. You're right, it is confusing.

  11. #11
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    Diane,

    Welcome. I have a very high and tight structural curve that goes into my cervical vertebrae. I did develop a second structural curve that used to be compensatory. It can happen. I believe your doctor got them turned around. However, in my case, the original compensatory curve is quickly catching up in size to my primary structural curve. They are now within 5o of each other. I won't be surprised if the compensatory curve doesn't pass the structural curve in magnitude. This curve goes into my lumbar, ending at about L2. If it does pass in magnitude and I went to a fresh doctor without giving a history (I know you didn't do that), I'm pretty confident that s/he would insist that the lower curve was the original curve since the lower curve is a right thoracic curve. A right thoracic curve is the most common curve type.

    So my question to you is: Is the compensatory thoracic curve a convex right curve? If it is, then this may be why he is insistent that it is the original structural curve despite being slightly smaller in magnitude.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  12. #12
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    Quote Originally Posted by rohrer01 View Post
    Diane,

    Welcome. I have a very high and tight structural curve that goes into my cervical vertebrae. I did develop a second structural curve that used to be compensatory. It can happen. I believe your doctor got them turned around. However, in my case, the original compensatory curve is quickly catching up in size to my primary structural curve. They are now within 5o of each other. I won't be surprised if the compensatory curve doesn't pass the structural curve in magnitude. This curve goes into my lumbar, ending at about L2. If it does pass in magnitude and I went to a fresh doctor without giving a history (I know you didn't do that), I'm pretty confident that s/he would insist that the lower curve was the original curve since the lower curve is a right thoracic curve. A right thoracic curve is the most common curve type.

    So my question to you is: Is the compensatory thoracic curve a convex right curve? If it is, then this may be why he is insistent that it is the original structural curve despite being slightly smaller in magnitude.
    Hi rohrer,

    You are correct, my lumbar curves to the left and the thoracic curves to the right. Perhaps this is the cause of all the confusion. He said it would be a rare case if my lumbar levoscoliosis were the structural curve. Maybe he thought I was one of those people who discovered they had scoliosis later in life and didn't know which way they curved. There was so much information being passed back and forth I decided to let it slide for the time being. I would love to post my xrays but I'm having a tough time loading them onto my computer. I have enlisted the aid of my tech savvy, 19 year old son but even he too is having a trouble with the disc from the doctor.

    I have read about your unusually high curve on the forum. Neck pain really trumps all. I have had neck pain, on and off, over the years and I hate when my head feels like a giant bowling ball (I'm of Eastern European descent so I really do have a large noggin!)

    Thanks for the reply and the welcome!

    Diane

  13. #13
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    You're welcome, Diane.

    Left convex primary curves are "rare" in comparison to right curves. So your doctor is right about it being rare. That doesn't make it not true just because it is rare. I hope you get to the bottom of things and can get some help.

    There are a few of us "lefties" on here. :-)

    Take Care,
    Rohrer01
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  14. #14
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    Actually of the structural lumbars, aren't most of them left? Most thoracic curves are right.
    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."

  15. #15
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    Hi,
    My understanding matches Sharon's. I thought I had read that the majority of structural lumbar curves were to the left. I believe that the majority of structural thoracic and thoracolumbar curves are to the right.

    When I had finished growing in my teen years, my right thoracolumbar curve had measured at 40 degrees. At 43 years of age, when I saw a surgeon, he said I had a 70 degree right lumbar curve. I was surprised to have my curve labelled as lumbar. (The apex of my curve had lowered, so technically, he might have been right.) But, when I consulted with Dr Lenke and he called me out immediately as a right thoracolumbar, I knew he was the surgeon for me! :-).

    I hope you can get your questions resolved. I, too, would want a clear and consistent understanding of which curve was structural and which was compensatory.

    Kathy
    Kathy
    46 yrs at surgery, now 50
    71 degree thoracolumbar curve corrected to 34 degrees
    8/2/2010 surgery with Dr. Lenke

    posterior T9 to sacrum with pelvic fixation

    4 osteotomies and 1 cage
    http://s1066.photobucket.com/albums/...athK_08022010/

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