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Thread: Question about possible surgery

  1. #1
    Join Date
    Mar 2004
    Location
    Pittsburgh
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    17

    Question about possible surgery

    Hi,
    This is my first post so let me give you a little background info. I am the mother of 2 girls with scoliosis. My 15 year old has a 55 degree curve and my 13 year old has a 47 degree curve. My question is about the 15 year old. Our doctor has said that at this point he recommends surgery because she has about a 90 % chance of her curve increasing at this point in her life. The surgery would be an easier surgery if it was done now (at 55 deg.) as apposed to 80 degrees possibly when she is 21ish.Does this make sense? In my heart I know they will both need the surgery but I just wonder if it has to be done now or can it wait until they are adults?

    Also, does anyone have any good ortho surgeon recommendations in Pittsburgh? (just in case)

    Thank you.
    Barbara

  2. #2
    Join Date
    Sep 2003
    Location
    Austin, TX
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    61
    Barbara,

    Your doctor is right on two points: statistically speaking, a 55 degree curve in a 15-year-old will *probably* continue to progress with age, and yes, the recovery time is less and the effectiveness of surgery better when the patient is younger.

    However, there isn't any urgency to your daughter's surgery, unless she's in pain now. Most curves progress, on average, only 1 or 2 degrees per year after skeletal maturity. If she waits until she's 21, her curve will most likely be in the 60-70 degree range. That's still not so severe that surgery won't provide a high level of correction. And the difference in recovery times for 15-year-olds versus 21-year-olds is generally not significant.

    I would suggest you carefully track your daughter's curve progression over the next few months. If it progresses rapidly, an earlier surgery date might be prudent. If not, she can probably safely hold off on surgery for a few more years.

    Best of luck!

    Dave

  3. #3
    Join Date
    Sep 2003
    Location
    Austin, TX
    Posts
    61
    Also, you might want to consult this this physician, who specializes in adolescent scoliosis:

    Vincent F X Deeney, MD
    Children's Hospital of Pittsburgh
    (412) 692-5530
    Dept of Orthopaedics
    3705 Fifth Avenue
    Pittsburgh PA 15213-2583

  4. #4
    Join Date
    Mar 2004
    Location
    Pittsburgh
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    Dave,
    Thanks for your reply.
    Actually Dr. Deeney is my daughters doctor.

    Barbara

  5. #5
    Join Date
    Oct 2003
    Location
    Utah
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    Hi Barbara,

    I just wanted to agree with Dave - the urgency of surgery isn't something you need to worry about, unless there are other complicating factors (i.e., pain, insurance issues, etc.). My daughter will be 18 in about 6 weeks and she has a lumbar curve of about 40 degrees. She has a significant rotation of the spine as well. Her ortho isn't pushing surgery, but has repeatedly told us that surgery before 21 is better for several reasons, mostly because of the recovery and the health of the bone structure. Also, many people have such a life-style change after 18 (college, moving away from home, possible loss of insurance, full-time jobs, etc.) that surgery before then just works out better. I'm not saying that anyone should take any surgery lightly or flippantly, but sadly, our lives are dictated by money, to some degree. My other thought was that you want her body to be as skeletally mature as possible before surgery. The statistics show better outcomes and less compliations later when the body is fully grown at the time of surgery. Lots to think about. Good luck!
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  6. #6
    Join Date
    Mar 2004
    Location
    Walla Walla. WA
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    2
    How do you know when someone is skeletally mature? My daughter is 15 1/2, started her periods 3 years ago and her ortho says she is skeletally mature. Her curves are 38 and 30, worsening 5 degrees in the last six months.

    She is going to Shriners in Spokane and they only treat children until 18, so we are thinking she should probably have surgery before then if it continues to worsen.
    Kate's Mom

  7. #7
    Join Date
    Oct 2003
    Location
    Utah
    Posts
    1,010
    Hi Kate's mom,

    There is a thing called a Risser score, which measure the skeletal maturity of the bone structure. You can read about it here:

    http://medstat.med.utah.edu/scoliosis/risser.htm

    If the Risser score is 5 (which I'm assuming your daughter's will be because of her menstration and the doc saying she is skeletally mature) then that means her bones are basically finished growing.

    Before agreeing to surgery, is there any way you can get a second (or third) opinion? Her curves are at that point where its not a clear cut decision to be made. My daughter is almost 18 (in May) and has a 40-ish degree lumbar curve with a 22-ish degree thoracic curve. She has a sore back all the time. We're not sure if she'll end up having surgery or not. Our ortho is suggesting waiting still. Your daughter still has a couple years before reaching 18 - I don't think there is an emergent decision that needs to be made right now. I'd wait until the next visit to see if there is still more progress. If so, then begin the surgery discussions.

    Good luck!
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  8. #8
    Join Date
    Sep 2003
    Posts
    48
    Hi, Barbara,

    We first found out about my daughter's scoliosis when she had just turned 14. Her curves were 63/50 then, and she was considered skeletally mature. We were horrified by the idea of surgery at that time, and her surgeon, who is a well-respected scoliosis specialist, told us that "she is at little risk for rapid progression" and that we should monitor her and wait until we were ready. We left things alone during her Freshman, Sophomore and most of her Junior year, but the appearance issues began to plague her more. We consulted another doctor, had new x-rays taken, which showed no curve progression at all, and were told again that there was no urgency to having the surgery. However, like was mentioned in previous posts, other issues can come play in making the decision as to whether to have the surgery or not. Like I said, she was beginning to be bothered by the appearance issues - mostly the shortened torso and right hip prominence - and we looked out into her future and decided that the time was right to take this little "time out" at the end of her junior year in high school. She had the surgery on March 18th and is progressing nicely. I guess the point I am trying to make is that for many of the kids with this condition, there is no urgency and you should be sure that you are ready and comfortable with your surgeon and the decision to proceed. One other comment, a five degree change in curvature is not considered significant - there is considerable variation between people measuring the curves, the time of day, whether it is done by hand or on a computer, etc. and five degrees is considered the margin of error. Just my two cents worth!

    Paula

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