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Thread: Spinal Fusion Alternatives

  1. #1
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    Spinal Fusion Alternatives

    I have a 28 degree curve which if slowly progressing. I have been to about 4 doctors and they all say that bracing is not an option. My curve starts in L-5 lower lumbar and curves trying to correct at T-12 lower Thoracic. The doctors have said that we will talk about surgery if I pass 33 degrees. I have a follow up in 4 months and I was wondering if there are any (surgical) alternatives for spinal fusion. I am active (volleyball) and it seems like spinal fusion is a heck of a recovery.

  2. #2
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    Kyle:

    Your age is important. If you are not skeletally mature then bracing should be an option. As an active volleyball player you might want to check out the Spinecor brace.

    33 degrees sounds low to recommend surgery. Are there other factors the doctor has mentioned that make surgery necessary?

    Ruth
    Ruth, 50 years old (s-shaped 30 degree scoliosis) with degenerative disc disease, married to Mike. Mother to two children - Son 18 and daughter 14. Both have idiopathic scoliosis. Son (T38, L29) has not needed surgery to date. Daughter (March 08 - T62, L63).

  3. #3
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    Well I have tried Physical Therapy and I am 17. All of the doctors say bracing would not be an option because my bone growth has already pretty much matured as much as it is going to. They just said that we will talk about surgery at 33 degrees because if it gets to there then things are most likely to get worse.

  4. #4
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    I agree with Ruth, Kyle. I would recommend you have a look at the spinecor thread as your curve does sound low to recommend surgery. Even 33 which is when they said they would operate, they usually wait until the curve is around 45 I think. I have to be honest I am not that sure about bracing but if you are not yet skeletally mature as Ruth said I would give it a go., I am not a medical person tho.
    I dont know where you live but there are lots of threads on good doctors here and lots of general knowledge about scoliosis for you to sit and read, and I am positive it will help or at least give you something to think about.
    I just read your last post Kyle, please go to a scoliosis specialist that is recommended on this forum if possible for a second opinion, you are only 17.


    Macky
    Last edited by macky; 04-23-2009 at 08:25 PM.
    Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
    Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

  5. #5
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    Kyle:

    At 17 you are most likely skeletally mature. Has the doctor looked at your x-rays to tell you if you are or not?

    From what I have read though if your curves are under 40 degrees when you reach skeletal maturity the chances of progression are slim.

    Ruth
    Ruth, 50 years old (s-shaped 30 degree scoliosis) with degenerative disc disease, married to Mike. Mother to two children - Son 18 and daughter 14. Both have idiopathic scoliosis. Son (T38, L29) has not needed surgery to date. Daughter (March 08 - T62, L63).

  6. #6
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    Okay. And I have started looking into the Spinecor. Being that the brace is flexable, it looks like something I might try because my Volleyball is very intense with bends and dives. Right now I have muscle pain on my left side where they are trying to correct the curve, and some difficulty breathing which has been making things harder with sports.

    Thank you both for your help.

  7. #7
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    Hi Kyle...

    If you're skeletally mature, the Spinecor brace will be of no use in terms of keeping your curve from worsening. But, the good news is that, on average, your curve will not worsen to the point of needing surgery.

    Hang in there. Hope you're average!

    Regards,
    Linda

  8. #8
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    Lumbar versus thoracic surgery trigger angles

    I'm getting the impression that the surgery trigger angle is lower for lumbar curves than it is for thoracic curves. Is that correct?

    Maybe 33 is a common surgery trigger point for lumbar curves because curves at or above that angle usually progress as was mentioned by the OP's surgeon.

    On the other hand, lumbar curves don't tend to progress as often as thoracic ones do so there's that also.

    I don't know of the OP is male or female. If female, bracing for other than pain is likely futile. If male, a bone age determination would have to be done I think.
    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."

  9. #9
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    Quote Originally Posted by Pooka1 View Post
    I'm getting the impression that the surgery trigger angle is lower for lumbar curves than it is for thoracic curves. Is that correct?

    Maybe 33 is a common surgery trigger point for lumbar curves because curves at or above that angle usually progress as was mentioned by the OP's surgeon.

    On the other hand, lumbar curves don't tend to progress as often as thoracic ones do so there's that also.

    I don't know of the OP is male or female. If female, bracing for other than pain is likely futile. If male, a bone age determination would have to be done I think.
    Hi Sharon...

    I made an assumption that Kyle is male, but I could be wrong.

    According to the UofI curve progression study, lI think that umbar curves between 30-50 degrees are more likely to progress than thoracic curves.

    http://www.ejbjs.org/cgi/reprint/65/4/447.pdf

    Regards,
    Linda

  10. #10
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    Interesting.

    From a 1999 paper by Dickson in Spine discussing Nachemson.....

    One hundred and eleven braced patients were compared to 129 observed and 46 electrically stimulated. The failure rate was an increase in Cobb angle by 6. On this basis 36% of the braced, 52% of the observed, and 63% of the stimulated failed and these differences achieved statistical significance. The next paper in the same journal looked at factors that affect natural history and one of the most compelling features was that thoracic curves had a much worse prognosis than thoracolumbar curves. Looking now at the proportions of the more progressive thoracic curves in the three trial groups, 89% were thoracic in the stimulated group, 81% in the observed group, and a mere 68% in the braced group. Meanwhile, in the paper originating in Puerto Rico, 70% of the untreated group had thoracic curves and 46% of the treated group. It would be difficult to stack the odds better.

    So, which types of curves have a worse prognosis? Lumbar, thoracic, thoracolumbar?
    Table 1 from the Iowa study is a bit confusing.

    Or does the prognosis change with age. Iowa looks at data from maturity and beyond. And the paper that Dickson refers to looks at progression in youth.
    hmmmm

  11. #11
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    It seems to me that what we have is the following:

    In general, T curves tend to progress more than lumbar.

    Above 50, T curves will likely keep progressing unless halted by fusion.

    Above 30, L curves will likely keep progressing unless halted by fusion.

    Does that seem right?
    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."

  12. #12
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    Probably. I suspect that another element is that lumbar curves become far more likely to progress quickly in older individuals.

    --Linda

  13. #13
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    Quote Originally Posted by LindaRacine View Post
    Probably. I suspect that another element is that lumbar curves become far more likely to progress quickly in older individuals.

    --Linda
    Yes I think some of the testimonials support that observation.
    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."

  14. #14
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    Pookai thanks !!

    Pookai,

    thanks for summarizing up all this info. and numbers...appreciate it..am learning alot from this thread.

  15. #15
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    Quote Originally Posted by hope404 View Post
    Pookai,

    thanks for summarizing up all this info. and numbers...appreciate it..am learning alot from this thread.
    NO!

    That is NOT an informed summation!

    It's just what I have gleaned through a very cursory reading of random testimonials among the adults and is highly likely to not be totally correct.

    Some of it is correct (the T stuff). I am spitting in the wind on the L stuff as neither of my kids has a structural L curve.

    Sorry for the misunderstanding.
    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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