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Thread: Large Curves May Not Be Fully Reduced

  1. #16
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    Quote Originally Posted by Tina_R View Post
    In this latest thread here is a young person who was fused at lumbar = 45, and 45 is lower than 50.

    http://www.scoliosis.org/forum/showt...evision-needed

    However I was wrong when I thought people were regularly getting fusion below the 40's. I'm sure you're right. Part of my problem was that I didn't realize very young people could have very large curves. I didn't, my scoliosis was always there but didn't get severe until my early fifties.

    I am turning into one of those idiots that it's annoying to argue with. So I'll do more listening to people who know more than I do.

    So what are the rules for surgery, it's not quite clear. Is it:

    Young adult - Think about fusing at 50 regardless of other problems?

    Older adult - Don't fuse, even at high angles, unless there are other problems?

    Why the difference?
    Ha Ha... well said.

    There really aren't any "rules", but most of the top docs start to think of fusing skeletally immature kids when they are mostly grown and when their curves reach around 50 degrees. For skeletally mature kids who hit 50 degrees, the kid and their parents are usually given the option to decide if/when they have surgery. Those are typically the guidelines for adolescent idiopathic scoliosis. Other types of scoliosis frequently don't fall into those guidelines. And, sometimes there are underlying issues that affect the decision.

    Younger adults (say <40 years old) are sort of treated like skeletally mature adolescents. These people may be able to avoid surgery the rest of their lives, so the decision to have surgery is left to the individual, and can be put off for years. It used to be that older adults were told to wait and see how much their curves progressed over a period of time (typically 5 years). Now, I think most of the top specialists wait for the patients to tell them if/when they're ready. It's almost always based on pain and loss of function, and not curve magnitude. Some people with very small curves can have a lot of degeneration. And, some people with very large curves can have no pain. The only time I hear surgeons talk about curve magnitude as part of the surgical decision in this population is when a patient has large curves, and there is proven progression. For example, a 40 year old with a 50 degree curve is expected to progress at about 1-1/2 degrees a year. That means that when that patient is 80 years old, they could have a 110 degree curve. At the point, that patient will likely start having heart and lung issues.

    Hope that helps clear it up.
    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

  2. #17
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    Quote Originally Posted by Tina_R View Post
    However I was wrong when I thought people were regularly getting fusion below the 40's.
    That was true at one time, by at least some surgeons. Thankfully, we know a lot more about the natural history of scoliosis now.
    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

  3. #18
    Join Date
    Sep 2019
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    132
    Quote Originally Posted by LindaRacine View Post
    Ha Ha... well said.

    There really aren't any "rules", but most of the top docs start to think of fusing skeletally immature kids when they are mostly grown and when their curves reach around 50 degrees. For skeletally mature kids who hit 50 degrees, the kid and their parents are usually given the option to decide if/when they have surgery. Those are typically the guidelines for adolescent idiopathic scoliosis. Other types of scoliosis frequently don't fall into those guidelines. And, sometimes there are underlying issues that affect the decision.

    Younger adults (say <40 years old) are sort of treated like skeletally mature adolescents. These people may be able to avoid surgery the rest of their lives, so the decision to have surgery is left to the individual, and can be put off for years.

    Hope that helps clear it up.
    Seems like I'm reading about quite a few younger adults with degeneration though, Linda. Not just here, on other sites. Younger people also have plenty of time to develop degeneration eventually.

    Is it fair to say that surgery very often, most often, leads to future surgeries?

  4. #19
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    Quote Originally Posted by Tina_R View Post
    Seems like I'm reading about quite a few younger adults with degeneration though, Linda. Not just here, on other sites. Younger people also have plenty of time to develop degeneration eventually.

    Is it fair to say that surgery very often, most often, leads to future surgeries?
    That's one of those Catch-22 questions, right?

    There's no question that spinal fusion surgery is risky in terms of the necessity for additional surgery. You may hear of younger people having degeneration, but I think it's still relatively rare that younger patients have degeneration bad enough to require additional treatment. In the hundreds of patients I got to know at UCSF, I don't remember anyone under the age of 40, who needed surgery for adjacent level degeneration. It's possible that some surgical techniques lead to faster degeneration, so maybe some less experienced surgeons end up with more patients like this.

    I found one paper that addresses the age issue:

    https://jointoperations.co.uk/wp-con...urnal-2011.pdf

    "Increasing age was also found to be a risk factor for SxASD in the present series. Other authors have commented
    on increasing age as a risk factor for ASD [15–17,35]. Minet al. [13] found the opposite to be true and Ghiselli et al.
    found no correlation with age in their study. When the patients in the present study were stratified into three age groups
    (!45, 45–60, and O60 years), and these groups were subjected to both K-M and Cox analysis, a significant difference
    was observed in the rates of SxASD among the groups. In the under 45-age group, only five of the 130 patients required
    SxASD. Although there may be a tendency for younger patients to have fewer segments fused or a different pathology
    to older patients at the index surgery, the multivariate Cox regression analysis confirmed age to be an independent covariate.
    It would, therefore, appear to be an important factor to note when comparing the results of different published studies.
    For example, Wai et al. [33] have questioned the role of fusion on the development of ASD after anterior lumbar interbody
    fusion but in a relatively young patient population."
    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

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