
Originally Posted by
Pooka1
That is a very disconcerting scenario. The comment by your present surgeon about going down to L2 is very strange for at least a few reasons and I am SHOCKED he stated that. I would pay money to hear him address...
1. Going down to L2 is within the level that the "countdown" (to fusion of the entire lumbar) starts. That is, according to Boachie (world class expert), you have to really stay above L1 and really T12 (meaning the CURVE stopped there and not just the fusion). I would like to see the stats of needing an extension with the first fusion ending at L2. I am guessing it is pretty high and NOT "I don’t think you would have ever had to deal with another fusion."
2. It is possible your first surgeon did think he should fuse to L2 but knew he would put you into a countdown to having the rest of your lumbar fused if he did and so hoped for the best.
In either case whether fused too short or correctly, if you needed to be fused down to L2 there is no guarantee you wouldn't be in a countdown. I encourage you not to get down over this because it doesn't seem like you missed any boat. Of course I am a lay person and what do I know but *I* would not beat myself up over this given what you stated.
Do you have bending radiographs? I wonder if they ruled out the lumbar also being structural then. That might explain why your lumbar is so bad now as a young adult.
Your ability to be one-and-down is a function not just of where the fusion (correctly) ends but how straight the lumbar is driven by fusing the T spine. I suspect your second surgeon thinks that the L spine would be dead straight or close to it if your first surgeon went to L2. That is as may be but L2 is in the countdown range according to Boachie so it is not like you had a slam dunk escape hatch from a second surgery in my opinion (but what do I know?).
In re your first surgeon telling you that you were one-and-done (if indeed your curve ended at T12), that is not beyond the pale and our surgeon told that to one of my twins. He did NOT tell that to the other twin because although they are both had pure T curves and are both fused T4-L1, only one ended up with a very straight lumbar and the other didn't (different types of T curves).
I just can't fathom why your second surgeon told you what he did.
In response to “1.” My fusion as it currently stands ends at T12 but I had a second curve under my thoracic in my lumbar. It started at 25 and only corrected to 20 after the fusion was in place.
Also, I am almost positive I had bending x rays done but because they weren’t digital and they were so long ago the original hospital no longer has those images. If on those bending images the curve corrected and didn’t persist that would mean it isn’t or wasn’t structural which means it wouldn’t or shouldn’t persist correct? I guess is there a chance your saying that this curve is not a “true” structural curve and instead is under the manipulation or control of muscles? Just trying to understand this portion of your reply.
Can I have an official definition of curve classifications?
Feb 2003 - Diagnosed C (35) T (45) L (25)
Dec 2003 - T2-T12 Fusion correcting to C (8), T (14), L (20)
Oct 2019 - Lumbar curve progressed to 40
Nov 2019 - Thoracic curve progressed to 31
June/July 2020 - T10-S1 Fusion with SI fixation