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View Full Version : Earlier fusion for TL curves to save levels



Pooka1
07-31-2011, 06:18 PM
Two cases:

First case - He fused a 40* TL curve (only 6 levels fused) specifically to spare levels...

http://drlloydhey.blogspot.com/2011/07/13-yo-girl-w-40-degree-thoracolumbar.html

In this second case, Dr. Hey talks about how the earlier fusion plus some special effort on his part to de-rotate the lumbar and use osteotomy to help it straighten has allowed him to end the fusion at L3. I gather from various sources that L3 appears to be a critical level that seems to separate being or not being in a countdown situation until the lower discs give out...

http://drlloydhey.blogspot.com/2011/07/14-yo-young-man-with-thoracolumbar.html

Dr. Hey is not the only surgeon doing earlier fusion on TL curves to hopefully avoid going below L3... there are other testimonials on here to that effect. The stakes are higher in TL curves.

Pooka1
07-31-2011, 06:50 PM
I have to say after reading what he did with the second case to keep the fusion above L3... if I had a kid with a TL curve >30*, I would go straight to Dr. Hey. He seems like he's focused like a laser on saving levels in these TL curves and indeed all curves with his previous comments about fusing earlier before any collapsing can occur. The question is how often do collapses occur.

Maybe he is at the forefront of getting data to see if fusing at smaller Cobb angles is the way to go to save levels for life. Maybe anything past 30* for TL curves should be fair game for fusion for the purpose of saving levels even not knowing if progression will occur.

LindaRacine
07-31-2011, 10:35 PM
I have to say after reading what he did with the second case to keep the fusion above L3... if I had a kid with a TL curve >30*, I would go straight to Dr. Hey. He seems like he's focused like a laser on saving levels in these TL curves and indeed all curves with his previous comments about fusing earlier before any collapsing can occur. The question is how often do collapses occur.

Maybe he is at the forefront of getting data to see if fusing at smaller Cobb angles is the way to go to save levels for life. Maybe anything past 30* for TL curves should be fair game for fusion for the purpose of saving levels even not knowing if progression will occur.
Sharon...

Hard to believe you'd buy into this without having a control. We don't have any clue how many kids with 30 degree curves would go on to need ANY surgery. And, of those who go on to need surgery, we don't know how many of them would need fusion to the lower lumbar levels. My original fusion went to L3, by the way.

Surely you see that this is really no different than the argument to put kids with 20 degree curves into braces.

Regards,
Linda

Pooka1
08-01-2011, 06:50 AM
Sharon...

Hard to believe you'd buy into this without having a control. We don't have any clue how many kids with 30 degree curves would go on to need ANY surgery. And, of those who go on to need surgery, we don't know how many of them would need fusion to the lower lumbar levels. My original fusion went to L3, by the way.

Surely you see that this is really no different than the argument to put kids with 20 degree curves into braces.


The stakes are simply higher for TL curves. They are different. For curves >30*, if it is "not unusual" to progress as one surgeon stated, and if it is known that some large(?) percentage of these curves, even 30* range ones, will damage the lumbar over time if not fused, then it might be unethical not to fuse TL curves >30* if they can end at L3 or above. We need the data. It could cut that way from what appears to be known now.

By the way, I think some surgeons count L3 as being in "countdown" territory as far as I can tell but some don't as you probably know. L4 seems to be clearly in countdown territory per some surgeons. We need the data.

Just my opinion.