percentage of 1st Scoliosis surgery rlater require revision?

[Scared]

As I’m looking at my 1st Scoliosis surgery & Reading about so many revision threads makes you think about your future. I know its a crap shoot but there’s gotta be research out about this. If anyone knows please share sources. Thanks Nancy

[titaniumed]

Most of us do well with scoliosis surgery. If there was no improvement, they wouldn't be fusing people for over a century. Most get done, come out ok, and don't post anymore, or pop in every once in a blue moon. Here is a happy I had surgery thread....
http://www.scoliosis.org/forum/showt...-Sticky-Thread

Go into the Surgical first time threads and glance at Linda's sticky threads up at the top. The top 5 are slightly shaded.

Linda had posted studies with percentages in the past. They are here....(someplace) If you have trouble finding these, I will dig for you.

Ed

[Scared]

Most of us do well with scoliosis surgery. If there was no improvement, they wouldn't be fusing people for over a century. Most get done, come out ok, and don't post anymore, or pop in every once in a blue moon. Here is a happy I had surgery thread....
http://www.scoliosis.org/forum/showt...-Sticky-Thread

Go into the Surgical first time threads and glance at Linda's sticky threads up at the top. The top 5 are slightly shaded.

Linda had posted studies with percentages in the past. They are here....(someplace) If you have trouble finding these, I will dig for you.

Ed

Sorry Ed tried to find Linda’s thread on research but maybe it’s been awhile—am recovering from PT pain now-will try to look further in research forum (should have posted there to start) thanks Nancy

[LindaRacine]

If you're talking about patients who had scoliosis surgery as adults, no one has really done anything with enough follow-up. I believe you'd need at least 30-40 years to get a meaningful number. There is one study that showed a revision rate of 20% at 10 years. I'm guessing that with 30+ years of follow-up, there's probably a 25%+ revision rate. There are so many factors that come into play (age at first surgery, skill of surgeon, type of surgery, comorbidies, etc.), that I'm not sure that number is really helpful.

https://www.ncbi.nlm.nih.gov/pubmed/26964785

--Linda

[Scared]

If you're talking about patients who had scoliosis surgery as adults, no one has really done anything with enough follow-up. I believe you'd need at least 30-40 years to get a meaningful number. There is one study that showed a revision rate of 20% at 10 years. I'm guessing that with 30+ years of follow-up, there's probably a 25%+ revision rate. There are so many factors that come into play (age at first surgery, skill of surgeon, type of surgery, comorbidies, etc.), that I'm not sure that number is really helpful.

https://www.ncbi.nlm.nih.gov/pubmed/26964785

--Linda

Thanks for info

[titaniumed]

I was thinking stats on complications.....

Infection and pseudarthrosis stats....

Ed

[LindaRacine]

I was thinking stats on complications.....

Infection and pseudarthrosis stats....

Ed

I don't know how many surgeons would be honest about this, but I've heard many of them say that complication rates for adult scoliosis surgery is likely to be somewhere around 70%. Most studies record relatively few potential complications. Any medical complications peri-operative are usually not included.

The SRS collects stats ONLY on infection, neurologic damage, and death.
https://www.ncbi.nlm.nih.gov/pubmed/26693670

[Pooka1]

I think it is the case that other than infection which is institution versus surgeon related, the other complications scale with age and condition of the patient. It is a cruel irony that people and their surgeons try to postpone surgery as long as possible though that increases the chances of a complication. Adult patients are almost always faced with this terrible dilemma.

[titaniumed]

Regardless of the stats, when adults are in pain, a lot of pain, its not really going to affect the decision. I was guaranteed 100% complications and did my surgeries anyway. Every other surgical member here did the same thing. Its the chance we have to take.

On the 70% value, I think that many surgeons get really affected by outcomes. When you don't have an answer on something, that has to be hard. I told Crystal many years ago that she was going to see things as a (Ped Emergency trauma surgeon) and they wont be pretty. She told me years ago that they talk about this sort of thing in Med school, and she is aware, but now she has seen things that have made her psyche so much more serious. She doesn't smile that much anymore and is in really deep thought, all the time. Off in space.....There are things she wont discuss with me anymore, its just too heavy. She almost has that 3 mile stare that Marines get after battle.
There is a lot of pressure on our surgeons....

I did a post about a British Neurosurgeon here years ago who did brain surgeries with high serious complication rates....I even posted his photo, he was suffering from severe depression from all of this.....This sort of thing will result in doubts, and if asked, complications will be high. I think that since we do some pretty severe procedures around here, we will witness some of this....Its hard to ask a surgeon about failure. I know because I have done that, and felt bad, and could see the distress through the mask, I am an expert at reading people. Its ok, they are people too. The body is just so complicated. I hope everyone understands what I am saying here.

70% is too high. Its understandable. I have seen the head shaking.

Ed

[titaniumed]

I think it is the case that other than infection which is institution versus surgeon related, the other complications scale with age and condition of the patient. It is a cruel irony that people and their surgeons try to postpone surgery as long as possible though that increases the chances of a complication. Adult patients are almost always faced with this terrible dilemma.

I am thankful I was in pain. If I wouldn't have had the heavy pain when I did, and had it kick in 20 years later, that would have been a problem. The biggest reason why adults wait is because they are SCARED.....when my surgeon asked me why I waited so long, I didn't have an answer. I didn't think I needed to answer. Scoliosis surgeons also need to be aware that we need time to absorb the surgical process. Its not easy.

Many of us have some sort of pain and we get used to it. Then if things are bad enough as adults past age 40, the neuropathic pain kicks in which is an elevated nerve related pain (sciatica, and arm and hand pains from herniation's and stenosis). We sort of get used to that too. But what happens is that you can only do that battle for so long. If you manage to reduce these pains, they really are temporary since the damage and degeneration is still there waiting to be triggered by some sort of event. (Lifting, twisting, or STRESS) Stress is a killer, no doubt. I did that for around 6 years taking NSAID's Prescription anti-inflammatories (Celebrex, Bextra) and hot water therapy for pain. Diclofenac is a good one for pain also. You have to get these from a Medical Doctor. Opioid's do not solve the problems of inflammation, they just mask pain and constipate you. Muscle spasms are also warnings, you really need to know why you have the pain you have....?????? Truly know your scoliosis.

If one is a surgical candidate going through neuropathic pain, it either isn't bad enough or the person hasn't experienced it long enough to commit to surgery. If the pain is bad enough, no-one is going to tell us to not have surgery because we essentially give up. We capitulate.

Neuropathic pains are signals. Warning signs for adult scoliosis patients with large curves or degenerative problems. Burning and incredible acute pains, I guess are the bulk of it. I am forgetting this now since all of this was resolved by surgery. They are also warning signs for fused scoliosis patients under fusion masses.

There is no rushing into surgery, but when its needed, its needed. Neuropathic pain is your indicator. Scoliosis surgeons will also offer shots trying to avoid surgery, but if ones situation is bad enough and you have that scoliosis train wreck, they seem to be hard to justify when you truly are a surgical candidate.

I ignored my scoliosis for many years waiting for technology. If I had to re-do the whole process again, I would do it 10 years sooner and skip the major pain period of my 40's.

Ed

[Tina_R]

I don't know how many surgeons would be honest about this, but I've heard many of them say that complication rates for adult scoliosis surgery is likely to be somewhere around 70%. Most studies record relatively few potential complications. Any medical complications peri-operative are usually not included.

The SRS collects stats ONLY on infection, neurologic damage, and death.
https://www.ncbi.nlm.nih.gov/pubmed/26693670

Statistics are tricky. That 70% might be over a lifetime. And it might be from all possible complications.

Besides complications like infections I wonder if the fix, spinal fusion, isn't just limited in its effectiveness. I have heard that it fails eventually, it's not good for the rest of one's life.

There's a site checkbook.org/surgeonratings that rates surgeons and their individual statistics on this matter. I'm not sure I trust the site since it rates many other things besides surgeons, its search function doesn't work well, and the number of doctor ratings is small. From it I found out (after my surgery) that my surgeon has a redo rate which is higher than the average of 18% for all doctors who perform the kind of surgery he does. I was appalled by that number. But maybe my surgeon takes on the toughest cases. Maybe he works on older people than most other doctors. And I don't think the site specifies any time limit -- is that redo within a few months of surgery, years, or over the patients' lifetimes? It makes a big difference.

Incidentally, I unfortunately require a return to the operating room myself. So I am one of the statistics. 5 months after my spinal fusion surgery my spine is curving in new places (that weren't fused). It's a rare complication called "adding on". It likely wasn't caused by anything my surgeon did wrong.

[LindaRacine]

Statistics are tricky. That 70% might be over a lifetime. And it might be from all possible complications.

Besides complications like infections I wonder if the fix, spinal fusion, isn't just limited in its effectiveness. I have heard that it fails eventually, it's not good for the rest of one's life.

No, most patients fuse properly and their fusions are not expected to fail. I've known dozens of people who have had long fusions which have held for 30 or more years.

There's a site checkbook.org/surgeonratings that rates surgeons and their individual statistics on this matter. I'm not sure I trust the site since it rates many other things besides surgeons, its search function doesn't work well, and the number of doctor ratings is small. From it I found out (after my surgery) that my surgeon has a redo rate which is higher than the average of 18% for all doctors who perform the kind of surgery he does. I was appalled by that number. But maybe my surgeon takes on the toughest cases. Maybe he works on older people than most other doctors. And I don't think the site specifies any time limit -- is that redo within a few months of surgery, years, or over the patients' lifetimes? It makes a big difference.

You've nailed the problem. Many surgeons do almost no long surgeries or revisions, while other surgeons do almost entirely complex surgery. At UCSF, our average patient age and complexity of procedure were significantly greater than other major centers that have reported these numbers.

Incidentally, I unfortunately require a return to the operating room myself. So I am one of the statistics. 5 months after my spinal fusion surgery my spine is curving in new places (that weren't fused). It's a rare complication called "adding on". It likely wasn't caused by anything my surgeon did wrong.

Actually, it's one of the most common complications. Instead of adding on, do a search on adjacent segment disease. ASD usually indicates degeneration above or below the existing fusion, but can include new curves above and below. Sorry to hear that you need more surgery.

--Linda

[Tina_R]

No, most patients fuse properly and their fusions are not expected to fail. I've known dozens of people who have had long fusions which have held for 30 or more years.


You've nailed the problem. Many surgeons do almost no long surgeries or revisions, while other surgeons do almost entirely complex surgery. At UCSF, our average patient age and complexity of procedure were significantly greater than other major centers that have reported these numbers.


Actually, it's one of the most common complications. Instead of adding on, do a search on adjacent segment disease. ASD usually indicates degeneration above or below the existing fusion, but can include new curves above and below. Sorry to hear that you need more surgery.

--Linda

Thanks for replying, Linda. It's encouraging that you know of so many positive results. I have read some rather negative things about fusion online, rod breakage and that kind of thing, but again you've got to be careful. Some of these online articles are years old and things have changed for the better. Other articles have an agenda to promote some therapy or other over fusion and surgery.

I figure a spinal condition is like a heart condition. It requires major surgery. It's never completely cured and always has to be watched. We'll probably be getting spine checkups for the rest of our lives. I think they will come up with better and less radical remedies than fusion that will become commonplace.

A young person who has fusion surgery can live 50-80 or more years with the results. It would be interesting to see data on how well things hold up over so long. A young person will be in good shape for a long time and be able to take repeat surgeries. An older person, not so much. Which makes it so hard to decide when to have surgery and when to keep putting it off.

I will look up ASD, thanks.

[LindaRacine]

A young person who has fusion surgery can live 50-80 or more years with the results. It would be interesting to see data on how well things hold up over so long. A young person will be in good shape for a long time and be able to take repeat surgeries. An older person, not so much.

https://www.ncbi.nlm.nih.gov/pubmed/31053312

https://www.ncbi.nlm.nih.gov/pubmed/22037534

https://www.ncbi.nlm.nih.gov/pubmed/26964785

https://www.ncbi.nlm.nih.gov/pubmed/23595075

[Scared]

How to find individual Dr outcomes?

I don't know how many surgeons would be honest about this, but I've heard many of them say that complication rates for adult scoliosis surgery is likely to be somewhere around 70%. Most studies record relatively few potential complications. Any medical complications peri-operative are usually not included.

The SRS collects stats ONLY on infection, neurologic damage, and death.
https://www.ncbi.nlm.nih.gov/pubmed/26693670

Linda, Is there a way to find individual Surgeons outcomes? Especially for Dr Munish Gupta's? Thanks Nancy