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Thread: Interesting thread on FixScoliosis's blog

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    Interesting thread on FixScoliosis's blog

    Scoliosis surgery - is it a cure?

    First and as usual, I want to say I like Fix's blog site. I am a bit worried that he might be taking some comments personally. I just hope that isn't the case.

    Second, I would like to discuss this issue... is surgery a cure?

    Fix disagrees with calling surgery a cure and equates fusion surgery with multiple daily insulin injections for Type I diabetes. Thus he is saying fusion surgery is a treatment as opposed to a cure.

    I disagree with this equation for a few reasons.

    First, there is NO equivalence between multiple daily insulin injections for Diabetes and a single surgical fusion. If only one injection was required in one's life, then the comparison might be relevant.

    Second, if fusion surgery in fact:

    1. returns some patients to a state where there curve is stabilized over their lifetime (see item 2),

    2. they have the same incidence of ALL back issues as a person without scoliosis over their life (this of course assumes no pseudoarthrosis which is of course rare with the new instrumentation and in fact so rare that 95% of kids need no physical restrictions whatsoever to avoid a pseudoarthrosis),

    and

    3. they don't have to do a thing more or less than anyone without scoliosis to maintain it,

    would that be better described as a "treatment" or a "cure?"

    While hairs can be split, I think when you are at the point where the claim at least is that a patient is expected to have no higher incidence of ANY back problem over and above the general population, then I call that a "cure" and can still claim intellectual honesty.

    So I guess I'm left with the question... if this pans out (same incidence of all future back issues as the general population which we learn from Linda is ~85%) then would you consider that a "cure?"

    Or is the problem that nobody believes that could possibly be the case and so don't want to label it a "cure?"

    The latter has some ground to stand on as we do not have long-term studies with the modern instrumentation. But the former does not have any ground to stand on as far as I can tell.
    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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    Maybe it is only a cure if you are cured.

    For those that need revisions, maybe the surgery wasn't a cure. For those that do as well as the general population, maybe it it.

    As is true for most things, there is no "one size fits all".

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    Hmmm, good question...I see what you mean. I think that it can be considered a "cure" for many people. I view a cure as anything where it's a one time fix and then you're basically good to go for the rest of your life. So, if you get fusion and then have no future problems at all aside from normal back pain (that anyone might experience even with a "normal" spine), it is considered a "cure" for you. If you need future treatment, it wasn't really a true "cure."

    We "cure" a lot of things like cancer that then come back. We "cure" crooked teeth with braces, but then they can become crooked again. We "cure" a cold with antibiotics, but then you're guaranteed to have more colds in your life. So, we kind of use the term loosely, and I think there's many different ways to word stuff accurately so that it can be considered a "cure" or a "treatment" - just depends how good you are with words!

    I don't think it's like Type 1 Diabetes though (which my mom has) because that's truly daily maintenance. My mom has a pump attached to her at all times and is constantly monitoring her blood sugar, giving herself insulin when needed, etc. all day long.

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    Quote Originally Posted by PNUTTRO View Post
    Maybe it is only a cure if you are cured.

    For those that need revisions, maybe the surgery wasn't a cure. For those that do as well as the general population, maybe it it.

    As is true for most things, there is no "one size fits all".
    Yes I see that point.

    But I think Fix is saying surgery cannot be a cure in any instance IN PRINCIPLE.

    I hope he will correct me on that if I am mischaracterizing his position.

    Last, I think rather than fusion surgery, exercise, Clear, Schroth, etc. are a PERFECT analogy to ongoing daily insulin shots for Type I diabetes. You stop, you lose everything. Exercise is clearly a treatment and NOT a cure nor is it claimed to be a cure as far as I know.
    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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    Quote Originally Posted by Pooka1 View Post
    Last, I think rather than fusion surgery, exercise, Clear, Schroth, etc. are a PERFECT analogy to ongoing daily insulin shots for Type I diabetes. You stop, you lose everything. Exercise is clearly a treatment and NOT a cure nor is it claimed to be a cure as far as I know.
    I agree - if you do indeed get any curve reduction while doing Schroth, Clear, or other exercises, they will definitely have to be continued over one's life...which is fine...they are scoliosis management programs; not one stop cures. But, they are definitely not "cures"

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    Quote Originally Posted by MissEmmyF View Post
    I agree - if you do indeed get any curve reduction while doing Schroth, Clear, or other exercises, they will definitely have to be continued over one's life...which is fine...they are scoliosis management programs; not one stop cures. But, they are definitely not "cures"
    I, of course, agree with that but let's see what Fix says in re if he thinks surgery can't be a cure IN PRINCIPLE and whether he agrees with you that exercise can't be a cure IN PRINCIPLE.
    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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    I have yet to come across any publication or study by a scoliosis surgeon referring to surgery as a cure, even in principle. If I did, Id think him a quack.

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    Quote Originally Posted by CHRIS WBS View Post
    I have yet to come across any publication or study by a scoliosis surgeon referring to surgery as a cure, even in principle. If I did, I’d think him a quack.
    I have never claimed surgeons say fusion is a cure.

    What I don't understand is why they don't.

    If a surgeon told you your surgery placed you back in the general population on risk of ALL manner of future back problems, and you didn't have to do anything special over and above an unfused person to have the same risk, would you consider surgery a "treatment" or a "cure" at that point?

    If that isn't a cure then I don't know what the word means.
    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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    But we (at least adults who are fused) DO have to maintain our backs in a way that's different than the general population. Maybe kids don't, but adults certainly do. It's my understanding from my surgeon that if I engage in activities that might stress my fusion, like the kind of repetitive, thoracic bending one typically does while gardening, I will put myself at increased risk of developing problems.

    I don't think that spinal fusion puts you on the same playing field as the general population because most of us have at least SOME restrictions -- either suggested by the surgeon or self-imposed.

    If I could have gone back to the things I could do before I was fused without new and additional risk, I would consider myself cured. But I definitely consider myself treated. The progression of my scoliosis was arrested, but scoliosis as a condition is still very much with me.
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

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    Quote Originally Posted by Singer View Post
    But we (at least adults who are fused) DO have to maintain our backs in a way that's different than the general population.
    Ah, my understanding is this is entirely a function of where the fusion ends, NOT whether you are a kid or an adult.

    I specifically asked if my daughter had to do anything special to avoid problems above and below and he said no, there was nothing special she should do.

    He said she was back in the general population on risk for all future back issues. I am assuming he said this based on respecting the temporary restrictions (therefore no pseudoarthrosis likely) and where her fusion ended (L1) but I don't really know exactly what he thinks it.

    Pam's fusion ended at L1 also and I think her surgeon told her something similar.

    I am wondering if my one daughter shouldn't be fused at less than the magic 50* if it means not going past L1.

    Maybe kids don't, but adults certainly do. It's my understanding from my surgeon that if I engage in activities that might stress my fusion, like the kind of repetitive, thoracic bending one typically does while gardening, I will put myself at increased risk of developing problems.
    Your fusion ends at L5. Based on what our surgeon said about why my daughter is back in the general population, it sounded like it is almost completely a function of where the fusion ends but I don't know that. I suspect if my daughter's fusion ended at L5 he might not have said what he said though.
    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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    Linda Racine,

    Does this apply to adults only or adolescents as well?

    http://scoliosis.org/forum/showpost....90&postcount=2

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    Hi...

    I'm guessing that it applies to adolescents, but probably not as much as adults. Adolescents usually have really good core muscle strength, and so therefore could probably withstand a lot more stress on their spines than adults. I haven't heard a lot of surgeons addressing their adolescent patients, but I can't remember ever hearing a surgeon warn an adolescent about adjacent disc deterioration.

    Regards,
    Linda

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    Quote Originally Posted by LindaRacine View Post
    Hi...

    I'm guessing that it applies to adolescents, but probably not as much as adults. Adolescents usually have really good core muscle strength, and so therefore could probably withstand a lot more stress on their spines than adults. I haven't heard a lot of surgeons addressing their adolescent patients, but I can't remember ever hearing a surgeon warn an adolescent about adjacent disc deterioration.

    Regards,
    Linda
    I suspect my daughter is not alone in being told this.

    I specifically asked if she should do anything to avoid problems above and below the fusion and the answer was she didn't need to do anything to avoid problems specific to the fusion. I went in there assuming she would need an extension at some point and he said he did not expect her to need one, that it was "one-stop shopping" for surgery for her (his phrase) and that she needn't do anything special (except avoid bungee jumping).
    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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    What DrFix actually said was:

    I believe saying that surgery is a cure for scoliosis is equivalent to saying that insulin is a cure for Type 1diabetes.

    He then went on to explain why he didn't think insulin was a cure for Type 1 diabetes (obviously) - then asked what others thought (i.e, is surgery a cure for scoliosis).

    My take is that surgery like insulin is a treatment. Likewise any non surgical methods that achieve any success - are also treatments.

    Sadly - there are no cures.

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    Quote Originally Posted by mamamax View Post
    What DrFix actually said was:

    I believe saying that surgery is a cure for scoliosis is equivalent to saying that insulin is a cure for Type 1diabetes.

    He then went on to explain why he didn't think insulin was a cure for Type 1 diabetes (obviously) - then asked what others thought (i.e, is surgery a cure for scoliosis).

    My take is that surgery like insulin is a treatment. Likewise any non surgical methods that achieve any success - are also treatments.

    Sadly - there are no cures.
    What SPECIFICALLY do daily insulin injections and fusion surgery have in common? I can't think of a single thing.

    If a surgeon told you your surgery placed you back in the general population on risk of ALL manner of future back problems, and you didn't have to do anything special over and above an unfused person to have the same risk, would you consider surgery a "treatment" or a "cure" at that point?
    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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