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Thread: Is surgery worth having?

  1. #1
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    Is surgery worth having?

    Hi everyone. Long time reader but first time poster. My question goes out to those of you who have had scoliosis corrective surgery already.

    A little bit of background:
    I am 22 years old, currently working full-time and going to school full-time. I was diagnosed with scoliosis when I was 12 years old and had an 11° thoracic curvature. Now at my current age I currently have a double curvature of 43°T and 35°L. However, over the last year, my curve has not progressed and my doctor claims that it most likely won't.

    As of right now I experience almost no pain and only minor discomfort. The thing that gets to me though is the cosmetic appearance of this condition. So my question is, is scoliosis surgery worth getting for mostly cosmetic appearances?

    I understand a lot about the surgery and even have a couple friends who have been through it themselves. I play hockey and go to the gym often and understand that I would have to give those up for the most part.

    All replies are appreciated!

  2. #2
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    Quote Originally Posted by Stefandamos View Post
    Hi everyone. Long time reader but first time poster. My question goes out to those of you who have had scoliosis corrective surgery already.

    A little bit of background:
    I am 22 years old, currently working full-time and going to school full-time. I was diagnosed with scoliosis when I was 12 years old and had an 11° thoracic curvature. Now at my current age I currently have a double curvature of 43°T and 35°L. However, over the last year, my curve has not progressed and my doctor claims that it most likely won't.

    As of right now I experience almost no pain and only minor discomfort. The thing that gets to me though is the cosmetic appearance of this condition. So my question is, is scoliosis surgery worth getting for mostly cosmetic appearances?

    I understand a lot about the surgery and even have a couple friends who have been through it themselves. I play hockey and go to the gym often and understand that I would have to give those up for the most part.

    All replies are appreciated!
    Hi there.

    Although you are an adult, you are a very young adult. Based on the testimonials I've read here which may not be representative, my guess is you would recover as fast as a teenager which is to say a few weeks to a (very) few months.

    Here are some questions I would be asking the surgeon if it was me:

    1. Is the lumbar curve structural? You only started with a thoracic curve and now you have a sizable lumbar curve. If the lumbar is still compensatory, would fusing the thoracic potentially save the lumbar from getting structuralized and needing fusion in the future? If you can hope to avoid a lumbar fusion by fusing now, how far down would the fusion go?

    2. The T curve progressed 32 degrees in 10 years. That is over 3 degrees a year. Do you know what it measured at the point of skeletal maturity? If most of that progression was before you were mature then that is one thing. If the curve tended to progress also after you were skeletally mature, that might be another thing irrespective if you have one year where the progression wasn't measurable.

    3. I don't think insurance companies pay for purely cosmetic scoliosis fusion. But you are close to surgical range so you may have the option of getting fused at some point. I think they should pay for fusions that are below the surgical threshold specifically to save levels in the lumbar. At least one pediatric surgeon does this for example.

    4. You should ask your surgeon about what you have to give up if you were fused. I seriously doubt you would have to give up going to the gym and I have to wonder if they would tell you to give up hockey. I doubt it. My daughters have no restrictions other than bungee jumping which apparently nobody should be doing, even those with healthy backs. Also, some surgeons don't place any physical restrictions even from day one after surgery. That's how good fusions can take in young people. That's why I doubt you will be restricted from the gym or hockey.

    These are all questions I would ask the surgeon if you were my kid.

    Good luck.
    Last edited by Pooka1; 08-17-2015 at 08:45 PM.
    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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    Quote Originally Posted by Pooka1 View Post
    Hi there.

    Although you are an adult, you are a very young adult. Based on the testimonials I've read here which may not be representative, my guess is you would recover as fast as a teenager which is to say a few weeks to a (very) few months.

    Here are some questions I would be asking the surgeon if it was me:

    1. Is the lumbar curve structural? You only started with a thoracic curve and now you have a sizable lumbar curve. If the lumbar is still compensatory, would fusing the thoracic potentially save the lumbar from getting structuralized and needing fusion in the future? If you can hope to avoid a lumbar fusion by fusing now, how far down would the fusion go?

    2. The T curve progressed 32 degrees in 10 years. That is over 3 degrees a year. Do you know what it measured at the point of skeletal maturity? If most of that progression was before you were mature then that is one thing. If the curve tended to progress also after you were skeletally mature, that might be another thing irrespective if you have one year where the progression wasn't measurable.

    3. I don't think insurance companies pay for purely cosmetic scoliosis fusion. But you are close to surgical range so you may have the option of getting fused at some point. I think they should pay for fusions that are below the surgical threshold specifically to save levels in the lumbar. At least one pediatric surgeon does this for example.

    4. You should ask your surgeon about what you have to give up if you were fused. I seriously doubt you would have to give up going to the gym and I have to wonder if they would tell you to give up hockey. I doubt it. My daughters have no restrictions other than bungee jumping which apparently nobody should be doing, even those with healthy backs. Also, some surgeons don't place any physical restrictions even from day one after surgery. That's how good fusions can take in young people. That's why I doubt you will be restricted from the gym or hockey.

    These are all questions I would ask the surgeon if you were my kid.

    Good luck.

    Thank you for the response! It definitely brings some light to my situation knowing that I may heal a bit faster. That was one of the biggest deciding factors for me. I can't stay out of work/school too long so if after 3-weeks I can start working again, I'd be content.

    I will make sure to cover these points my surgeon to see if he can provide answers to my questions.

    The surgeon I am going to is Dr. Skaggs at Children's Hospital Los Angeles and I have been told he is one of the best at what he does.

    Again, thank you for your response!

  4. #4
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    Quote Originally Posted by Stefandamos View Post
    Thank you for the response! It definitely brings some light to my situation knowing that I may heal a bit faster. That was one of the biggest deciding factors for me. I can't stay out of work/school too long so if after 3-weeks I can start working again, I'd be content.

    I will make sure to cover these points my surgeon to see if he can provide answers to my questions.

    The surgeon I am going to is Dr. Skaggs at Children's Hospital Los Angeles and I have been told he is one of the best at what he does.

    Again, thank you for your response!
    My daughters had T fusions as teenagers and were back in school full time at around 3 weeks post op. They felt back to normal in a few months.

    Here is a surgeon's blog about his patients. There are several posts about young people like yourself returning to sports, dance, etc. within weeks. Coincidentally, the first page has a few stories about people about your age. There are many others there.

    http://www.drlloydhey.blogspot.com/
    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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    By the way, I remembered a comment our surgeon made about physical restrictions and kids. He said about 95% of kids need no physical restrictions to get a good fusion. They can resume life as their pain and recovery permits, not according to any set schedule. It is only because they don't know who the 5% are who do need the restrictions to get a good fusion that he restricts all kids from certain activities for 8 months. I am guessing the surgeons who set no physical restrictions at any time are playing those very good odds.

    Once again, you are a young adult and not a teenager. I suspect you will group with the teenagers on fusion aspects and recovery time lines as you are only 22 but you would have to specifically ask the surgeon about that.
    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
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    Quote Originally Posted by Pooka1 View Post
    My daughters had T fusions as teenagers and were back in school full time at around 3 weeks post op. They felt back to normal in a few months.

    Here is a surgeon's blog about his patients. There are several posts about young people like yourself returning to sports, dance, etc. within weeks. Coincidentally, the first page has a few stories about people about your age. There are many others there.

    http://www.drlloydhey.blogspot.com/
    I've read through quite a bit of these testimonials/stories and I feel a lot better about getting the surgery. He seems to constantly stress about the important of catching it early on and I am hoping it is still early enough for me. I don't want to end up with a fusion through my entire lumbar spine as well due to the impairment on mobility that comes from it.

    Thank you for sharing this with me.

  7. #7
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    A top surgeon in this field stated that if you just need a T fusion that only goes to about T12 or L1 and the lumbar alignment is good, you will likely never need to fuse the lumbar. That is certainly what I am hoping for with my girls.

    I understand this drive to avoid surgeon and people waiting and waiting to the last minute. But I also see much longer fusions in older people compared to younger ones. Yes they live longer without a fusion but then they lose their lumber.

    I would ask the surgeon about that. Besides Dr. Hey, you don't hear much talk about that. I think it is just surgeons not wanting to buy trouble by operating below the threshold and I don't blame them. But at the same time patients may not be told enough to make a fully informed decision.
    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."

  8. #8
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    Steph

    I wanted to welcome you to the forum while sitting back at the table and letting Sharon lead the discussion about your future decision. Her research into the matter is years of data collection and thought from talking with surgeons, reading peer reviewed articles here, and from reading many posts and testimonials here on the forum. Of course, 2 surgeons can differ on methods, but its nice when they are in agreement. Its sort of like counting beans in a jar, if 2 counts are off, you have to count again. 2nd opinions are good things for piece of mind......and no surgeon should ever push us into surgery.

    Around here at NSF we have a group of elder very experienced scoli’s so your decision to post and ask questions was very wise. Please do so if any other questions arise, there are many of us reading and following.

    Please understand that there are pros and cons to our decision, and that we have to weigh all of these things out in our minds before submitting and setting our dates. Even though many of us have our surgeries and are very happy, there are those that are not happy for various reasons. Surgery can never be reversed so there is a 100% commitment that’s involved, for better of worse.....

    Surgery years ago was usually thought of as a last ditch effort. Of course, years ago, 50 years ago, medically speaking we were in the stone age. And actually today, we are still in the stone age, “with better results”. I waited 34 years for my surgeries waiting for technology, and that worked well for me, its one thing to consider when leaning in the non-surgical direction. The pros of having surgery young are that you will heal quickly, (approx 3 months if everything goes well) and save the agony of living with pain for many years like myself and having to have to do a much harder surgery or set of surgeries.

    I think that since you don’t have an emergency, that you should wait and think things over for a good period of time. This is not something you do to get done as if on a check list. Read and post here, read some books, become an educated scoli.

    If you tell your surgeon that you are not ready to commit, that’s ok, they will understand. You can always set a date later. I spent 2-1/2 years talking with my surgeon.

    If you decide to put if off, you will need to have that occasional x-ray to monitor your progression. Get your own copies of diagnostics burned to disc to keep in your possession, they are yours. They come in very handy down the road and surgeons like to see dated x-rays or MRI’s.

    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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    Quote Originally Posted by titaniumed View Post
    Steph

    I wanted to welcome you to the forum while sitting back at the table and letting Sharon lead the discussion about your future decision. Her research into the matter is years of data collection and thought from talking with surgeons, reading peer reviewed articles here, and from reading many posts and testimonials here on the forum. Of course, 2 surgeons can differ on methods, but its nice when they are in agreement. Its sort of like counting beans in a jar, if 2 counts are off, you have to count again. 2nd opinions are good things for piece of mind......and no surgeon should ever push us into surgery.

    Around here at NSF we have a group of elder very experienced scoli’s so your decision to post and ask questions was very wise. Please do so if any other questions arise, there are many of us reading and following.

    Please understand that there are pros and cons to our decision, and that we have to weigh all of these things out in our minds before submitting and setting our dates. Even though many of us have our surgeries and are very happy, there are those that are not happy for various reasons. Surgery can never be reversed so there is a 100% commitment that’s involved, for better of worse.....

    Surgery years ago was usually thought of as a last ditch effort. Of course, years ago, 50 years ago, medically speaking we were in the stone age. And actually today, we are still in the stone age, “with better results”. I waited 34 years for my surgeries waiting for technology, and that worked well for me, its one thing to consider when leaning in the non-surgical direction. The pros of having surgery young are that you will heal quickly, (approx 3 months if everything goes well) and save the agony of living with pain for many years like myself and having to have to do a much harder surgery or set of surgeries.

    I think that since you don’t have an emergency, that you should wait and think things over for a good period of time. This is not something you do to get done as if on a check list. Read and post here, read some books, become an educated scoli.

    If you tell your surgeon that you are not ready to commit, that’s ok, they will understand. You can always set a date later. I spent 2-1/2 years talking with my surgeon.

    If you decide to put if off, you will need to have that occasional x-ray to monitor your progression. Get your own copies of diagnostics burned to disc to keep in your possession, they are yours. They come in very handy down the road and surgeons like to see dated x-rays or MRI’s.

    Ed
    I have definitely seen the wealth of information,over the years, that exists here from the frequent posters. I have researched scoliosis more than most people my age would. From peer-reviewed journals to talking to surgeons themselves. I am fortunate enough to be connected directly to surgeon I mentioned, Dr. Skaggs, and have had many opportunities to casually discuss this.

    One thing I have personally come to the conclusion of as well is that there truly are pros and cons to waiting. I have waited 3 years already since surgery was initially mentioned and I have kept putting it off. I feel that if I wait any longer that I may compromise my lower vertebrae and I would prefer for that not to happen. The future of scoliosis treatment methods (not just surgery) are not entirely known right now.

    Due to the lack of pain I experience, I don't have an emergency situation. You are correct with that statement. However, I went from not noticing my curve to always being uncomfortable and being able to feel the asymmetry in my spine. In addition to that, the appearance of it is something that really bothers me. I feel as if I spend 90% of my day trying to hide my curve and don't feel comfortable in my own skin.

    I will definitely be putting more thought into this over the course of the next few weeks but I feel very prepared to go through with this surgery. I do understand it is a permanent decision that one can not reverse and that's the only part that makes me truly hesitant. I do know that there are more people happy about their surgery than not. Albeit anecdotally.

    If you have any more input, I would definitely appreciate it!

  10. #10
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    Steph: Welcome! My scoliosis and kyphosis occurred when I was in my early 60's, maybe 50's which is probably "old" to you [it is to me!], so I did not experience being a young adult with scoliosis. I remember being self-conscious as a young adult and I can only imagine how you must feel. You are open about your feelings on this forum which is great.

    Sharon's comments seem right on. She speaks as a parent and as an informed well read researcher/consumer.

    My thoughts on scoliosis surgery: Most surgery goes well and most people are happy and relatively pain free or pain free at some point postop. Almost everyone that has surgery imagines the "best case scenario". Most people have scoliosis surgery because of pain. While my kyphosis was ugly, I was in a lot of pain and had exhausted non-surgical options [injections, ablations, physical therapy, acupuncture]. There are also folks on the forum who have had surgery for large curves and no pain, but they are few.

    Your surgeon said that he felt that your curve would not progress, so that is not an issue. While probably generally true, there are others on this forum who would say otherwise.

    Does surgery now prevent future surgical necessity of extension of lumbar levels and possible limited mobility? Good question....I would ask a surgeon.

    Best of luck in your decision making. I wish you well.

    Susan
    Last edited by susancook; 08-19-2015 at 10:59 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

  11. #11
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    Quote Originally Posted by susancook View Post
    Steph: Welcome! My scoliosis and kyphosis occurred when I was in my early 60's, maybe 50's which is probably "old" to you [it is to me!], so I did not experience being a young adult with scoliosis. I remember being self-conscious as a young adult and I can only imagine how you must feel. You are open about your feelings on this forum which is great.

    Sharon's comments seem right on. She speaks as a parent and as an informed well read researcher/consumer.

    My thoughts on scoliosis surgery: Most surgery goes well and most people are happy and relatively pain free or pain free at some point postop. Almost everyone that has surgery imagines the "best case scenario". Most people have scoliosis surgery because of pain. While my kyphosis was ugly, I was in a lot of pain and had exhausted non-surgical options [injections, ablations, physical therapy, acupuncture]. There are also folks on the forum who have had surgery for large curves and no pain, but they are few.

    Your surgeon said that he felt that your curve would not progress, so that is not an issue. While probably generally true, there are others on this forum who would say otherwise.

    Does surgery now prevent future surgical necessity of extension of lumbar levels and possible limited mobility? Good question....I would ask a surgeon.

    Best of luck in your decision making. I wish you well.

    Susan
    I have no kyphosis right now. My spine is completely straight when looking at me from the side. This also means I have no lordosis. However, your degrees are relatively close to mine even at that later age. I'm hoping to never letmine progress that far!

    The psychological effects of this are pretty much the worst part for me. I model in the side to help pay my way through school and am constantly having to correct posture to not let it show in pictures. Overall, most people have no idea I even have scoliosis but it's something that I notice constantly.

    I am okay with dealing with some degree of pain for the rest of my life. I am an extremely active person and would not imagine some pain ever stopping that. Of course the risk of being a chronic-pain patient is possible, but that possibility is minimal from my current understanding.

    I hope to speak to another surgeon at my local hospital in the next 2 weeks (when I get new x-rays done) and get a second opinion. As of right now, I am definitely leanings towards moving forward with the operation.

    Thank you so much for taking your time to reply!

  12. #12
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    Stefan, I am very impressed by your thought process! It is obvious you have been researching and weighing your options.

    I think you are missing a key piece of information... whether or not your lumbar curve is structural. If it is then you might do one thing. If it isn't then you might do another. Ask if they can do bending radiographs. That is how they determine these things.

    Some other key pieces of info that I think you might be missing are the following:

    1. If you were fused today, where would the fusion end? (Note that this can't be answered exactly without bending radiogrpahs as far as I know.. he needs to see which is the lowest vertebra you can level on bending)

    2. Some surgeons will just fuse both curves if they are large. DO NOT accept this. Demand to know if the lumbar is structural.

    3. Ask if fusion is even an option now or if you are below the threshold. I think surgeons have different thresholds. Dr. Hey, almost alone, seems to be focused on avoiding future damage and so might operate sooner.

    My daughters have T4 to L1 fusions that they claim they don't notice much. That's because people don't generally bend much through that part of the back and because they probably didn't have a normal range of motion when they had the curves prior to surgery. They look completely normal because one was hyper-corrected to nearly straight and the other has small balanced residual curves.

    I certainly have reason to hope that because their lumbars are much straighter, the load on the discs will be more even. And because the fusion was able to end at L1, that is why our surgeon told my daughter that her surgery is "one-stop shopping."

    Here is a thread started by a guy only about 7 years older than you. There are several differing opinions that might interest you.

    http://www.scoliosis.org/forum/showt...thic-scoliosis
    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."

  13. #13
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    Quote Originally Posted by Pooka1 View Post
    Stefan, I am very impressed by your thought process! It is obvious you have been researching and weighing your options.

    I think you are missing a key piece of information... whether or not your lumbar curve is structural. If it is then you might do one thing. If it isn't then you might do another. Ask if they can do bending radiographs. That is how they determine these things.

    Some other key pieces of info that I think you might be missing are the following:

    1. If you were fused today, where would the fusion end? (Note that this can't be answered exactly without bending radiogrpahs as far as I know.. he needs to see which is the lowest vertebra you can level on bending)

    2. Some surgeons will just fuse both curves if they are large. DO NOT accept this. Demand to know if the lumbar is structural.

    3. Ask if fusion is even an option now or if you are below the threshold. I think surgeons have different thresholds. Dr. Hey, almost alone, seems to be focused on avoiding future damage and so might operate sooner.

    My daughters have T4 to L1 fusions that they claim they don't notice much. That's because people don't generally bend much through that part of the back and because they probably didn't have a normal range of motion when they had the curves prior to surgery. They look completely normal because one was hyper-corrected to nearly straight and the other has small balanced residual curves.

    I certainly have reason to hope that because their lumbars are much straighter, the load on the discs will be more even. And because the fusion was able to end at L1, that is why our surgeon told my daughter that her surgery is "one-stop shopping."

    Here is a thread started by a guy only about 7 years older than you. There are several differing opinions that might interest you.

    http://www.scoliosis.org/forum/showt...thic-scoliosis
    I just got the chance to read through that entire thread and realized a few things:
    1. No one has to live with your choice but you. This is probably the scariest part of this entire thing. As of right now, I can play hockey, sit/stand indefinitely, hike an "infinite" distance, drop 20ft+ into water, cycle long distance, lift heavy weights etc. Its impossible to know whether or not I can return to all of these post-op.

    2. Uncertainty is not an option. The "2-point test" that was posted proved I'm on the border, even in my own head. My surgeon did tell me that it was ultimately my choice, although he did recommend the surgery.

    3. Waiting IS an option. The chances of a severe curve increase at my age are close to nothing. I could technically wait until I graduate from University to go through with this.

    Where I am in my life right now seems like perfect timing to get the surgery. I have a great income that can support me even during a few months of not working, I have a dad and mom that can take off as much time as Id need and I could go through the majority of my healing process in a winter/summer session of school so I don't miss anything.

    I recall my surgeon mentioning that even after a Thoracic fusion that I will have some imbalance left in my Lumbar region. This leads me to believe that both of my curve ARE structural and that the lumbar curve is not compensatory.

    Would this increase my chance of a lower fusion in the future if the curve were to progress?

    I'm torn between moving forward with this surgery or not. When I ask myself, "Why do you want this so badly?", the answer that comes to my head is for cosmetic reasons and comfort. It seems like that alone would not be a justification to go through with the surgery.

    At times like this I wish I could have some sort of direction that told me which path would provide a happier lifestyle...

  14. #14
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    Quote Originally Posted by Stefandamos View Post
    I recall my surgeon mentioning that even after a Thoracic fusion that I will have some imbalance left in my Lumbar region. This leads me to believe that both of my curve ARE structural and that the lumbar curve is not compensatory.
    If both your curves are structural then both would be fused in an adult. If he said you will have some curve left in your lumbar after fusion, it might mean you have the same type of curve one of my daughters had. He had to leave ~25* curve or else she would have a high left shoulder the rest of her life. The other one had a different type of T curve and she was hyper-corrected and has a pretty darn straight spine. In BOTH kids, the lumbar was compensatory as proven on bending radiographs. The kid with the residual lumbar curve bent her high 30 degree curve to single digits as I recall. Clearly compensatory.

    They both had identical fusions in terms of length (T4-L1) on curves of nearly identical Cobb angle (high 50 degrees) of thoracic curves with compensatory lumbar curves but one was able to be hyper-corrected and the other wasn't.
    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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    Steph, When you see your surgeon, also address your lack of kyphosis and lordosis. I would ask about restoration of these curves. Will he do anything special in regards to this like osteotomy? Your young, but ask.

    Did he mention any fusion levels to you? or any other things like XLIF. Would it be a posterior only?

    Where will the autograft come from? Or allograft? Will he harvest bone off your pelvis?

    The scariest part for us is not knowing what is going to happen to us and when......We like to have direction and control, but that doesn’t always happen. I think to be happy, you want to swim with the tide, and go with the flow.

    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

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