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Thread: Curve Progression Post-op

  1. #1
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    Jan 2009
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    Curve Progression Post-op

    Has anyone had thier curves worsen after fusion?

    I have had a full fusion in 1999 - so 10 years ago, bringing my spine from a about *90*40 down to a *39*20. In 2006, my main T-curve increased to 45 degrees. But as of late 2008, these curves have worsened to *63*45. The lumbar now worse than what it is was pre-op. (Yet - I have always been told by multiple doctors that my fusion was a complete sucess.)

    I just to see if there are other people in the same situation? And, what their doctor's recommended - if they recommended anything?

    Thanks!

  2. #2
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    I don't see how an instrumented spine can continue to curve absent a pseudoarthrosis and subsequent hardware failure.

    As I understand it, they can't tell about the completeness of fusion from radiographs so I don't know how they can declare any fusion is a "success" unless, over time, there is no change in curvature or hardware breakage.

    Also, where did your fusion end? If above the lumbar then the lumbar can continue to curve depending if it was structural and not compensatory at the time of surgery. Some surgeons misjudge how far they should take the fusion apparently.

    Someone correct me if I'm wrong.

    Good luck.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  3. #3
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    Quote Originally Posted by Pooka1 View Post
    I don't see how an instrumented spine can continue to curve absent a pseudoarthrosis and subsequent hardware failure.

    As I understand it, they can't tell about the completeness of fusion from radiographs so I don't know how they can declare any fusion is a "success" unless, over time, there is no change in curvature or hardware breakage.
    I'd have to agree with Sharon that *something* must not have fused thoroughly (pseudoarthrosis) for the corrected/instrumented area of your spine to go from 39 post-op to 63 now.

    Less concerning is a compensatory post-op curve of 20 that moves to 40 when the structural/previously instrumented portion is moving. I don't believe it's decompensation: It seems more likely the curving fusion is forcing the compensatory to follow.

    BTW, decompensation doesn't affect the instrumented portion of the spine. It affects the remaining, *UNinstrumented* vertebra above and/or below a fusion. It wouldn't explain a fused area that continues to curve.

    My best advice is find yourself a good revision specialist. Don't take the word of doctors who are telling you nothing is wrong when CLEARLY there is.

    Best of luck to you.

    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  4. #4
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    Hi Lorrie...

    First, I would be sure you've got the right measurement. It's really difficult to measure curves in a fused spine, especially when the fusion has been there for awhile.

    Whether or not the curves have increased, if you're experiencing pain or other symptoms, it would be a good idea to see a surgeon with a lot of experience in treating patients with prior long fusions.

    Regards,
    Linda

  5. #5
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    Quote Originally Posted by LindaRacine View Post
    Whether or not the curves have increased, if you're experiencing pain or other symptoms, it would be a good idea to see a surgeon with a lot of experience in treating patients with prior long fusions.
    Yep ... find a good revision surgeon. Do not take "all is well" as an answer.

    Pam
    Last edited by txmarinemom; 02-10-2009 at 02:42 AM.
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  6. #6
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    Geneseo, NY
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    I have lost 2" of height since my fusion over 30 years ago. The scolio doc I saw recently said my rod had "peaked", shifted so it is no longer vertical. With procedures currently in use this would not happen. The symptoms I am experiencing are probably related to some degeneration at the base of my fusion. So I believe for this to happen there would have to be increased curvature above or below the fusion, but it hasn't directly caused any problems for me.
    1966 fusion in Buffalo of 11 thoracic vertebrae, with Harrington rod

  7. #7
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    I had this same question a couple of years ago.... I had a curve progression due to the surgeon not extending the fusion and instrumentation up high enough, so I ended up with "junctional scoliosis" aka, the top of the fusioin became part of the curve, which ended up being further up in the thoracic region.
    I ended up having revision, as the curve had been shown to have been progressing over several years. I had no guarantees from the surgeon that a revision op was the way to go, but it was all he could offer me. I also had increasing pain and was really debilitated (although I don't think I realised how badly as it had gradually gotten worse over time).
    Now, I have really good news. After my revision, my pain is really comparitively mild, still have the odd flare up, but the bad days are probably once every fortnight as opposed to it used to be having the odd day where I thought "wow, I've had hardly any pain today!" so, sometimes now I'm pain free! Still get pain, but I can live with it. My quality of life is so much better.
    So, everyones different, but the question about progression after surgery caught my eye, since that is just what happened to me.
    My first surgery was anterior, second posterior. They left all the original hardware in and added to it, going higher and lower.
    1994 curve at age 13, 70 degrees, untreated
    2000 Anterior fusion with instrumentation T9-L2, corrected to 36 degrees, 14 degree angle between fused and un-fused thoracic spine.
    2007 26 degrees junctional scoliosis
    Revision surgery, 6th December 2007 T4 to L3, Posterior approach.
    msandham.blogspot.com

  8. #8
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    Feb 2009
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    curve progression - new here

    Hi, I'm 23 years old and just found this site. I had my first surgery at 10 when i had about a 60 degree curve come on pretty quickly. They place herrington rods in. My spine curved around the rods, I guess that only happens about 5% of the time and pushed my ribs outward. I had a second surgery at 13 where they removed the rods and used hip bone to fuse my spine. At 20 I had a thoracoplasty performed, they removed 4 inch segments from 4 of my ribs. The results of that were great aesthetically, but I currently have a severe curve and require prescription strength non-narcotics to get through the day. I am however completely functioning and was lucky in that the curve is unnoticeable to the eye. So life can go on after a curve around a fusion!

  9. #9
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    Quote Originally Posted by skpauly View Post
    Hi, I'm 23 years old and just found this site.
    First I want to thank you for choosing this site. We realize you have a choice in scoliosis sites and hope this forum meets all your needs.

    Quote Originally Posted by skpauly View Post
    (snip) So life can go on after a curve around a fusion!
    Yes it can. When I knew my daughter was heading for her surgery, I was also encouraged by the testimonials from those who had revision surgery. I went into it with her hoping that if something went wrong, it could be fixed.

    Thanks for posting and welcome.
    Last edited by Pooka1; 02-13-2009 at 09:32 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #10
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    Feb 2009
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    Thanks Sharon!

    Thank you for the welcome! It's nice to see all of the discussion from people with scoliosis. I am a med student now and only personally know one other woman with scoliosis, a peer of mine in school. I don't know how old your daughters are but if they would like someone to talk to I am more than happy to speak with them. I did some of that in Ecuador last summer to children there who had scoliosis. I was able to be a state-ranked tennis player and downhill ski racer so I think younger women like to hear that it does not have to be a debilitating disease. Again, thank you for the warm welcome!

  11. #11
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    skpauly,

    Thanks for the offer to talk to my girls. They are only 14.

    And just to be clear, one was fused for the first time last March. I told her that if something went wrong, she can very likely have a revision that would fix it. Until I read the revision testimonials, I didn't realize how many people had them or how successful they often are.

    I'm very glad to hear you were able to perform at a high level in tennis. My one daughter wants to pursue tennis.

    Best regards,
    sharon
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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