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  • Shorter fusions??

    Do any of you moderators know anything about shorter fusions being done for AIS? We live in Southern California and see Dr John Brown. He has discussed the possiblility of doing a 3-4 vertebrae fusion on my daughters lumbar curve which starts somewhere above L2.
    Thank you,
    Kim
    Kim

  • #2
    Hi Kim...

    I'm not sure I know enough to help you figure out if it's a good option. If you like Dr. Brown, and feel comfortable with him, I'd encourage you to trust that he's choosing the best procedure. You may want to ask him if he can provide studies that address the issue. Here are a few references I found:

    http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12131717
    http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10416389

    Do you know whether Dr. Brown is talking about anterior or posterior fusion?

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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    • #3
      Linda,
      Thanks for the reply. I do have confidence in Dr Brown. I feel he has brought up the possibility that Catherine might require surgery in order for us to consider the possibility. Our discussions did not get to anterior vs posterior yet. I asked him lots of questions which he thoughtfully and willingly answered. He said that with the short fusion her flexibility would not be affected very much. He said that her lower curve would probably be straight and that her waist asymetry would be resolved too. He said that if we get to the decision for surgery she would need to get bending xrays. He thinks her spine is flexible and that by fusing the lower curve her upper curve will straighten out some and not progress any further. Is is true that fusions in younger people can be stronger than when done in adults? What do you know about the risk of disc problems in people who live with non operative curves in the high 30's, low 40's as adults? Is it true that they are more at risk for disc degeneration? She is active and rides horses for about 2 hours week. She does have occasional right lower back pain which shows up more related to brace adustments.

      Her scoliosis was diagnosed August 2003. Her curves were 33/31 at diagnosis. She was put in a TLSO for 16 hours/day minimum. She wears it any where from 16 to 18 hours day. she has been followed every 3 months and this August 2004 her curves were 32/34 out of the brace for 48 hours. She grew 3 inches in height during the year. Since August this year she grew 3/4 inch and subsequently outgrew the brace. She was cast for her new brace and we had an xray taken this week to confirm the new brace's level of correction. The xrays were 28/38 IN the Brace. Her orthotist was there and not satisfied with the brace correction so she is being recast tomorrow for another brace. We don't know if the lumbar curve has taken off or if it is a combination of a poorly fit brace and margin of error in the measurement. The plan is to see how the next brace corrects and go from there. I am preparing myself for the possiblilty that she might need surgery. I have been very proactive with providing pilates and stretching for her and anti-surgery up until this point.
      Another major factor is that she is 12 /12 , premenarche still, and has a risser 3. She is 5'6'' tall already. He said surgery would give her another inch height and that the rest of her spine would grow with any remaining growth. So much to take in.......
      Kim
      Kim

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      • #4
        Hi Kim,

        I understand how pro-active we parents need to be with our kids. Researching and knowing as many of the options as possible is good. You are doing a great job. I just wanted to ask why the doc is even talking surgery with her moderate measurement numbers... My daughter is now 18 and has a lumbar curve of about 35 degrees. At one point it measured 40 degrees, with an upper curve of 26 degrees and a "significant rotation" which the doc says is the reason for the asymetry of her waist and the visible appearance of scoliosis. Now that she is skeletally mature, the ortho told us that the statistics show her chances of progression are about the same as the average non-scoliotic person. Hopefully he's right. She does have chronic back discomfort - mostly in the upper back between her shoulderblades. We believe this is from the rotation issues she has. We continue to hope that with regular exercise and back strengthening techniques, the discomfort will go away.

        My point is that it sounds like your daughter is getting excellent care - good observation, good bracing options, good overall care. I will send my best wishes your way that she will never need surgery. Keep an eye on things, but in my very humble opinion, there is no need to rush into a surgery decision at this point. Her curves are moderate, but not severe.

        I'll try not to ramble so much next time... please know you are not alone. Take care and best wishes to you!
        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/

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        • #5
          Thanks Carmell,

          We are definitely thinking alike. It is my assessment that Dr Brown has raised the option for surgery if her lumbar curve gets into the 40's, so that we know our options. He is not recommending it at this point. I am so thankful that the bracing prevented any significant progression of her curves for a year with 3 inches of growth! The question at this point is why did the last xray show an increase and if there really has been an increase in the lumbar. Today she is getting recasted for a new brace and will have that brace checked by xray in about 3 weeks. If the new brace gives an acceptable correction amount, we will wait 3 months and take an xray out of the brace for a few days. Again, she has not reached skeletal maturity nor has she gotten her period, so we can assume she is in a stage of growth. I do appreciate you sharing from your personal experiences and knowledge and pray the best for your children.
          Kim
          Kim

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          • #6
            Thanks for the clarification Kim. I think I left my brain at home this morning... LOL

            Continued best wishes to you. I hope the new brace does the job and that as she continues to grow, the scoliosis will remain stable. Keep us posted.
            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/

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