question about continued curve

[sweetness514]

I didn't have kyphosis above my fusion(before I had surgery) and I'm starting to get it now. Wonder what exercises would help, but it's hard to keep the head straight, but I try when I think about it.

I do see that a LOT of people without scoliosis or fusions do have kyphosis in many areas. I think we tend to notice our back problems more since we check ourselves and go to see orthos. So I'm trying to not let it bother me too much. The other day I noticed Madonna has kyphosis for sure.

[always smilin']

I am one of those lucky ones whose curve is developing both above and below the fusion (I'm fused T2-T12). My spine just wants to do what it wants to do. I am looking at a possible revision surgery in the next couple of years. (Oh, and I go to one of the best surgeons in the U.S. - maybe even the world So, I don't fault the surgeon...just my body.

Always Smilin'

[Snoopy]

Suzy,

Jamie's surgeon told us before surgery that Kyphosis above the fusion was a possiblity (just like the possibility of being paralized, etc.), but he was going to take every possible precaution to prevent it. I know when we first saw her new Kyphosis, it really shook up her surgeon. He was visibly shaken and totally at a lose as to why it happened. He made it a point to use extra hooks/wires at the top to try to avoid it and he also explained before surgery that he had to be cautious as to how far to fuse to avoid this.

I'm not sure if having Kyphosis before surgery makes you more prone to it after surgery or not. I'd be interested in knowing how many people actually develop Kyphosis above their fusion. As for the thought of staying fit to avoid Kyphosis, I don't know what to think about that.

At this point, Jamie's Kyphosis has held steady for the past few months and we've agreed unless it gets really bad, we won't even consider surgery. Most people don't even notice the Kyphosis. We hope and pray that it doesn't increase. The last thing we want to do is face more surgery.

Mary Lou

[LindaRacine]

Spine. 2006 Feb 1;31(3):299-302.

Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention.

Lowe TG, Lenke L, Betz R, Newton P, Clements D, Haher T, Crawford A, Letko L, Wilson LA.

Woodridge Spine Center, Wheat Ridge, CO 80033, USA. woodridgespine@aol.com

STUDY DESIGN: This is a retrospective multicenter analysis of a subset of 375 patients with thoracic adolescent idiopathic scoliosis (AIS) treated with either anterior (238) or posterior (137) fusion with preoperative or postoperative distal junctional kyphosis (DJK) >or=10 degrees . OBJECTIVES: To determine the incidence of DJK before and after surgery in patients with AIS undergoing either anterior or posterior thoracic fusion, and provide recommendations for prevention. SUMMARY OF BACKGROUND DATA: DJK following surgical treatment for AIS may result in pain, imbalance, and unacceptable deformity. The true incidence of DJK following selective anterior or posterior instrumentation and fusion is unknown, as are "risk factors" for its development. METHODS: Mean age at surgery was 14.4 years (range 9.1-20.9) in the anterior group and 14.7 years (range 10.2-20.7) in the posterior. Analysis included the Cobb and instrumented levels of the thoracic curves, and sagittal measurements, all on preoperative and 2-year follow-up standing 36-in radiographs. RESULTS: In the anterior group, the incidence of preoperative DJK was 4.2%, and postoperative DJK was 7.1%. In the posterior group, the incidence of preoperative DJK was 5.0% and 14.6% after surgery. When postoperative DJK developed in the posterior group, mean postoperative T10-L2 was +17 degrees kyphosis compared to +2 degrees in the posterior group without DJK (P < 0.001). When postoperative DJK developed in the anterior group, mean postoperative T10-L2 was +12 degrees kyphosis compared to +2 degrees for the anterior group without DJK (P = 0.006). DJK was significantly more likely to occur in the posterior group if the Cobb was instrumented to less than Cobb +1 (P < 0.001). CONCLUSIONS: It appears that both posterior and anterior instrumentation for thoracic curves must include the junctional level to prevent postoperative DJK when postoperative DJK is present. The presence of increased kyphosis after surgery in the T10-L2 region seen in both anterior and posterior groups that had postoperative DJK develop constitutes a "risk factor" for the development of DJK.

[lbloodojunkieg]

Thank you everyone for your thoughts and opinions. I have surgery set on July 13th. Thank you for the artice LindaRacine.

[berta@aloha.net]

Berta in Hawaii

This is my first time on this forum and not sure I'm doing this right! My curvature has progressed rapidly now that I'm in my 50's and I only began to have constant pain within this last year. I'm reading everything I can get my hands on and realized, contrary to what I've always been told, that it isn't too late for me!! And I don't want to end up more crippled over this last stage of my life! I need feedback from "older" patients mostly, but welcome all. I'm scared!

[SandyC]

Berta,
I had my A/P in in'01. I'm now 56. Just make sure that your doc has done a LOT of adult scoli revisions. I had mine done at UCSF by Dr. Deverian, who is in with Dr's. Hu and Bradford. It was had, but having said that I would do it again without question. Good Luck