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Thread: Scoliosis Surgery - The Worse you are PreOp, The Better you'll be PostOp

  1. #1
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    Scoliosis Surgery - The Worse you are PreOp, The Better you'll be PostOp

    You've probably heard me discuss this in the past...

    Postoperative Recovery After Adult Spinal Deformity Surgery: Comparative Analysis of Age in 149 Patients During 2-year Follow-up.
    Scheer JK1, Mundis GM, Klineberg E, Hart RA, Deviren V, Nguyen S, Protopsaltis TS, Gupta M, Bess S, Shaffrey CI, Schwab F, Lafage V, Smith JS, Ames CP; International Spine Study Group (ISSG).
    Author information
    Abstract

    STUDY DESIGN:
    Retrospective review of a multicenter, prospective adult spinal deformity (ASD) database.

    OBJECTIVE:
    We hypothesized that increased age and increased preoperative disability would negatively impact both the length of time needed to achieve maximal recovery and the amount of functional improvement achieved. In order to gauge the recovery process, a normalization process was used to calculate an integrated health state (IHS) during the 2-year postoperative period.

    SUMMARY OF BACKGROUND DATA:
    Elderly patients with ASD generally have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited, perhaps diminishing the health impact of the entire postoperative recovery experience.

    METHODS:
    Inclusion criteria included 18 or more years and ASD. Patient groups: young (≤45 yr), middle (46-64), elderly (≥65) as well as by baseline Oswestry Disability Index (ODI) scores: MILD (0-30), MEDIUM (31-49), and HIGH (≥50). Collected HRQOL measures included ODI, Short Form-36(PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1, and 2-year postoperative. All HRQOL measures were normalized to each patient's baseline scores. A 2-year IHS was calculated for each individual patient and the means were compared between groups.

    RESULTS:
    149 patients were included (≤45:32, 46-64:67, ≥65:50). All groups significantly improved in all HRQOL at 2-year compared with baseline (P < 0.05) except for MCS, ODI, and SRS activity for the 45 or less group (P > 0.05). Normalized IHS HRQOL for young patients was worse than elderly for ODI, PCS, MCS, SRS activity, pain and total during the 2-year recovery period from index surgery. The MILD ODI group had significantly worse 2-year IHS values than the HIGH group for all HRQOL measured (P < 0.05) except SRS appearance and satisfaction (P > 0.05).

    CONCLUSION:
    Contrary to our hypothesis, an IHS analysis suggested that the recovery process was significantly better for elderly patients than young patients and better for patients with high baseline disability.
    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
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  2. #2
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    Quote Originally Posted by LindaRacine View Post
    You've probably heard me discuss this in the past...

    Postoperative Recovery After Adult Spinal Deformity Surgery: Comparative Analysis of Age in 149 Patients During 2-year Follow-up.
    Scheer JK1, Mundis GM, Klineberg E, Hart RA, Deviren V, Nguyen S, Protopsaltis TS, Gupta M, Bess S, Shaffrey CI, Schwab F, Lafage V, Smith JS, Ames CP; International Spine Study Group (ISSG).
    Author information
    Abstract

    STUDY DESIGN:
    Retrospective review of a multicenter, prospective adult spinal deformity (ASD) database.

    OBJECTIVE:
    We hypothesized that increased age and increased preoperative disability would negatively impact both the length of time needed to achieve maximal recovery and the amount of functional improvement achieved. In order to gauge the recovery process, a normalization process was used to calculate an integrated health state (IHS) during the 2-year postoperative period.

    SUMMARY OF BACKGROUND DATA:
    Elderly patients with ASD generally have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited, perhaps diminishing the health impact of the entire postoperative recovery experience.

    METHODS:
    Inclusion criteria included 18 or more years and ASD. Patient groups: young (≤45 yr), middle (46-64), elderly (≥65) as well as by baseline Oswestry Disability Index (ODI) scores: MILD (0-30), MEDIUM (31-49), and HIGH (≥50). Collected HRQOL measures included ODI, Short Form-36(PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1, and 2-year postoperative. All HRQOL measures were normalized to each patient's baseline scores. A 2-year IHS was calculated for each individual patient and the means were compared between groups.

    RESULTS:
    149 patients were included (≤45:32, 46-64:67, ≥65:50). All groups significantly improved in all HRQOL at 2-year compared with baseline (P < 0.05) except for MCS, ODI, and SRS activity for the 45 or less group (P > 0.05). Normalized IHS HRQOL for young patients was worse than elderly for ODI, PCS, MCS, SRS activity, pain and total during the 2-year recovery period from index surgery. The MILD ODI group had significantly worse 2-year IHS values than the HIGH group for all HRQOL measured (P < 0.05) except SRS appearance and satisfaction (P > 0.05).

    CONCLUSION:
    Contrary to our hypothesis, an IHS analysis suggested that the recovery process was significantly better for elderly patients than young patients and better for patients with high baseline disability.
    Is this specifically talking about the patient's and doctor's personal outlook on the patient's own health?

    It seems odd that the younger-mild group was worse off than the rest. Am I reading this incorrectly?

  3. #3
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    Quote Originally Posted by Stefandamos View Post
    Is this specifically talking about the patient's and doctor's personal outlook on the patient's own health?

    It seems odd that the younger-mild group was worse off than the rest. Am I reading this incorrectly?
    No, it's based on health related quality of life questionnaires that the patients complete before and after surgery.

    Younger patients tend to have surgery with less pain and less loss of function. While they get improvement from the surgery, they're often unhappy because they're not perfect. Older patients tend to have surgery because they have extreme pain and disability. Ending up with less pain and more function makes them very happy.
    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.

  4. #4
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    My doctor basically said the same thing. He said if you're at a constant 4 on a 1 - 10 pain scale and you end up at a 6 after surgery, you'll NOT be happy. If you wait until you are at a constant 8 and come down to a 6, you'll be very happy.

    A word of caution out there for some who "think" they are at an 8 or for women who correlate everything to childbirth being a 10. You are probably underrating your pain. I will never say 10 even if I'm in the ER screaming because I know there could be something worse. At that point the doctor knows how much pain you are in. I had a doctor walk out of my trauma bay and say, "I'm not touching her until you get some pain meds in her!", and I never said 10.

    What's horrible about MY scoliosis pain is that it is constant, so I never get a break. But, that could be because it's neuromuscular. All this time I could never understand people who say scoliosis doesn't hurt. Mine has never quit hurting since I was a child. I have had to learn to distract myself. But it could be the ever cramping muscles pinching on nerves constantly. I always thought I would get relief if I just got it fixed. My musculature is so shortened on one side of my neck that a treatment of Botox to relax the spasms actually CAUSED more pain as my shoulder and arm dropped down into a more normal position. I'm all stretched out now, but WOW! I told my physiatrist (Ph.D., M.D. in muscle physiology) imagine if this hurt my shoulder and arm that bad just from that small amount of movement, I can't imagine how it feels after major correction. He agreed and said there is a lot of pain and adjustment the body has to go through.

    Not trying to scare anyone because my case is different and my muscles and nerves are messed up. But for me, it would be quite the ordeal I'm not so sure I'd ever want to tackle anymore. I was all mentally prepared on four different occasions where doctors told me surgery. I don't know if I could ever get there again, but I might have to...
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  5. #5
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    Quote Originally Posted by rohrer01 View Post
    A word of caution out there for some who "think" they are at an 8 or for women who correlate everything to childbirth being a 10. You are probably underrating your pain. I will never say 10 even if I'm in the ER screaming because I know there could be something worse. At that point the doctor knows how much pain you are in. I had a doctor walk out of my trauma bay and say, "I'm not touching her until you get some pain meds in her!", and I never said 10.
    While some women (and men) are stoic, there are far more who are not. Probably about 10% of people rate their pain at 10.
    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.

  6. #6
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    I've heard people say things like, if 10 is the worst mine's a 12 (or higher). An intake nurse at the trauma center told me that they were trained to put in 1/2 the pain rating that the person actually said. At that particular time, my heart rate and BP were up and I was rating an 8. He said you look like an 8 and put it in as such. It truly was one of the worst episodes I've ever had. At least with childbirth you know it's going to end and you are working at the pain for a good reason. I compare a 10 to my unanesthetized C-section. Even then I imagine it would still hurt a LOT worse to have spine surgery without anesthesia. Now that would be a 10!

    I find it hard to believe that only 10% of the population would say a 10. Maybe your group of people are tougher and know what real pain is. You don't have to post a paper to prove it. I believe you. But when you see these real-life trauma shows on TV, most of them WAY over exaggerate. People I know WAY over exaggerate.

    But, my DIL would cry at night because of pain, when I took her to the specialist for a check-up she said it was a 3. I was blown away thinking about her response to her pain and then rating it at a 3. But she compares her "10" to her post-op period. For her, nothing compares.

    For me, personally, once I hit 4 I'd better DO something to get it under control as it seems to escalate after that rather quickly. But, never a 10, yet. I think TiEd and some others on here have had 10's whether they would own up to it. Your body gets to a certain level of pain and shock sets in. People can have the worst injuries and say they have little to no pain as when my mom ran her fingers through a table saw completely amputating one an the others held on only by soft tissue. The night I went in with an 8 (back pain) I could barely breathe. However, when the pain hit rather quickly, I felt it and passed out and woke to my 8.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  7. #7
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    My baseline pain is a 8 without any narcotics. When its gets bad, it goes up to a 10.

    I have learned to live with it.

    Melissa
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  8. #8
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    Rohrer, this link will help describe pain and its ratings.

    https://lane.stanford.edu/portals/cv...Pain_Scale.pdf

    Some painful tidbits.....

    When I was a teen, I had little pain with twin 50’s. As I aged, and I do forget now, but I “did” have inversion boots in 1982 when I was 24..... I was skiing everyday, splitting and carrying firewood, and shoveling snow every day during a record winter at Lake Tahoe. My body was steel from the activities and exercise.....Scoliosis was not on the mind because I was having way too much fun. It snowed around 45 feet plus that season. I guess adrenaline plays a huge part in masking off pain. Big mountain extreme skiing can be a max stress situation, it depends on how you handle your stress.....I didn’t crash much, but when I did, they were usually hard impact equipment breaking crashes. Skiers or extreme skiers don’t think about crashing.....You don’t think about the consequences. You cant. Maybe its good prep for extreme surgery? Controlling stress is important.....and thinking about pain makes it worse. It’s a mindset, ignoring pain. Some of us get pretty good at it.

    I maintained my scoliosis pain from age 28 till age 49 with Chiro and it worked. After a set of high 40 foot pillow jumps on skis, I hit hard on one of them and finished off 4 lumbar discs. 4 herniation’s in a 70 degree curve is a lot of fun. That was the beginning of my “pain events”. I like to use the word event because spiking a high number usually doesn’t last. There is always going to be some sort of intervention to deal with the pain.....I started Celebrex and used Bextra during those days. 2002. I was having gastro issues and figured I better quit the NSAID’s and did that with ocean therapy. Exercising and de-weighting in the ocean worked....I was also scuba diving to try to relieve the pain. On the flights out to Hawaii, I would stand in the back of the plane for 5 hours.

    As degeneration and the other multiple pain producing problems progressed, I was offered shots, but didn’t do them due to scheduling issues.....It was a battle, but I kept going. Spikes of high level pain would come and go, and after age 45, those pain levels averaged a higher number. It was clear that surgery was needed, there was no choice since I tried everything to maintain through the years. I support non-surgical scoliosis management even though I sorely needed my surgeries. I did the best I could with this....

    My worst pain scenario was when I passed a huge 8mm kidney stone. Ureter inner diameter is 2mm. Renal colic is the worst and with large scoliosis curves it multiplies the pain levels. After that event, I demanded to be knocked out right away. My first experience with morphine......My body needed a shut down. On the renal sites, ladies that have had babies without anesthesia rate this as 1-5 times worse. Gall stone attacks are not as intense, but still very high. 6 hours and always at night for some reason.???

    I had a hand smash in a hydraulic device a long time ago, I’m lucky it was hydraulic and not mechanical.(My hand is ok) Shock sets in, and actually helps. When I broke my shoulder before my scoliosis surgeries, I was in a state of shock, laid out for 30 minutes and after skied out and drove home. I never made it to the hospital, my spine pain outweighed the shattered bone.....my arm didn’t work but that didn’t matter much, I could still work a mouse. My first 5 months worth of posts here were with my arm in that condition.

    My surgeon also made me beg for surgery.......I was whooped. The hospital told me that I was their most difficult case ever.......I also had cancer exploration done during my ALIF. There were a boatload of specialists there......It was do or die. I ended up with a hard patch of muscle like a deck of cards under my skin left of my anterior incision from the ALIF, my surgeon explained that was a denervation or nerve injury.....No problem.

    I started my precision manufacturing business, and sold that business due to scoliosis. I had 52 employees that I trained well enough to survive through the economic disaster of 2009. The last few years, I would go to work and do 8 hours work in 4 due to pain. I did multi million dollar defense bids on 100mg of Percoset here at the house right after my scoliosis surgeries. I have analyzed those after and I’m amazed at how well those projects went. It took about 4 times longer for me to do on meds.

    So, I guess I have done some pain.......and I don’t let this affect me much. When I told my surgeon that “I can hang” I meant it. When you are in major pain most of the time, surgery helps. In my case it helped a lot, it was a miracle. I also think that very high levels of pain help patients with their will and determination to survive. There is more of a reason to fight I guess. The revision patients of this forum prove that on a daily basis....

    I don’t know what’s next and I don’t worry about it. I cant anymore. My neck is hammered and my arm, hand, and legs sometimes go numb, but its ok.

    What’s funny is that if you are passed out, you cant cut the pain rating in half. “George, do you think he is a 10?”

    Yup, he’s a 10.

    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

  9. #9
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    Yes, we do learn to "live" with it. And definitely YES to coping mechanisms and doing things. It's also worse when you sit and think about it.

    I look at pain as an exponential and not the linear picture they have with a smiley face (pain a 0) at one end and a sad face with tears (pain a 10) at the other. I don't know how crying rates a 10. Maybe that's why I've heard so many people overrate their pain. I think it's a sad shame that when an ER patient comes in that they aren't "allowed" to rate their own pain.

    Yes, Ed, you have had a 10 more than once FOR SURE! That's why I mentioned you. Shock is a good thing when it's temporary. It's our body's way of protecting us from pain. I don't know that living with pain keeps me going. I'd sure like to try a day or two without it! I've had pain since I was a little kid. But it's like, "Oh, your back hurts, does it? Let me take this sledge hammer to your toe!" I'll tell you there are times I wouldn't have felt the hammer. But I'm at a steady 4 with my meds. I have a LOT of nerve and muscle pain. Over the last few years I've been getting the bone pain to go along with it.

    It's funny (not in a humorous way) that you mention gallbladder attacks. I had one at night that woke me up and lasted several hours. I know deep down that I had a bad gallbladder. But honestly, that gallbladder attack was NOTHING compared to my back "episodes". Most of the time I just felt like I had a mild bruise there. It was nothing compared to the back pain so I didn't even mention it to my doctor. The attack felt more like a deeper bruise. It wasn't until I had a laparoscopic surgery that it was confirmed that I had a bad gallbladder. It was white and shriveled instead of green and smooth. I've heard it said that gallbladder attacks hurt so badly that they send people to the ER. I'm so used to severe pain that I ignored it. It was life threatening. I had the sandy kind of stones where little pieces can get lodged into the pancreatic ducts and kill you. So living with a high level of pain is also dangerous if other things are going wrong and you ignore them because they don't compare. I'm sorry to hear about the 8mm kidney stone. I've heard that those can bring a grown man to his knees! I had spleen pain and that brought me to my knees! I didn't even feel the broken rib that caused it (irritated the nerve that goes to the spleen).

    And you are right calling them "episodes". That's exactly what I call them! I don't know how I would handle surgery. I'm losing my arms in strength and have frequent and very painful muscle spasms in my forearms. I have no clue if it's scoli related or the muscle disease. My dad never complained of pain. I honestly thought he had ALS by the way he went. Now I'm living it only with pain. My grandma's on both sides had chronic pain. My dad's mom had "fibromyalgia". Yes, I do know that there is such a thing and that pain didn't kill her, breast cancer did at the age of 82. She didn't develop the same neurologic symptoms as my me and my dad, or did she? She was riding a scooter around for the last decade of her life because she had difficulty walking...hmmm. She never had paralysis in her arms or legs, just weakness. We all attribute that to old age. She was relieved to get fentanyl when I mentioned it to her! I think older folks just suck it up more.

    I find that when I do things I am not always limited by pain as much as weakness these days. But when I play, I pay. My hubby has been getting after me for years because I insist on doing "men's work", moving heavy objects and tending to every aspect of the yard. While I'm at it, I do notice pain but ignore it. The next day I can't ignore it, let alone get out of bed.

    Melissa, I'm sorry you are at a constant 8 without meds. I hope you are able to take meds to bring you down from that level. An 8 is not functional. I don't know where I would be without my meds. I'm at a constant 4 with mine. That includes oxycodone, but there are two different muscle meds in there. Without them I don't know if I could get enough pain meds. The gabapentin really helped but I'm unable to take it. I had too many bad side effects. I don't know if surgery would help my pain or not. I imagine I'd be up there pretty high on the pain scale without the meds. But, if I can control it without surgery, all the better for me. And again, Ed, you are right about getting into the water. The water takes all the pressure off. For me it has to be WARM water or else my muscles stiffen up and pain goes up, at least until I get moving and used to the water temperature. The buoyancy is a real relief! That's the reason I take three hour baths! It hurts like the dickens to get out, though. I'm only a 120 pounder and I swear I feel like 300 pounds! For that reason alone I don't like water therapy. I don't want to get out! I should invest in a hot tub that I can actually float in. I'd live in there!

    Sorry Linda. I hope this isn't derailing your post. But it is about pain.

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

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