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  • When to Operate and When to Say No

    Hi...

    I was trying to find some information about the natural history of Degenerative Scoliosis, and found a good PowerPoint presentation about if/when to do surgery. I believe it's meant for medical professionals, but it should be fairly easy to understand for many of you.

    When to Operate and When to Say No

    --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

  • #2
    Thanks, Linda, this was very interesting, even though some of it is over my head. But overall, it is pretty clear what conclusions are drawn.
    Stephanie, age 56
    Diagnosed age 8
    Milwaukee brace 9 years, no further treatment, symptom free and clueless until my 40s that curves could progress.
    Thoracolumbar curve 39 degrees at age 17
    Now somewhere around 58 degrees thoracic, 70 degrees thoracolumbar
    Surgeon Dr. Michael S. O'Brien, Baylor's Southwest Scoliosis Center, Dallas TX
    Bilateral laminectomies at L3 to L4, L4 to L5 and L5 to S1 on April 4, 2012
    Foramenotomies L3 through S1 in August 2014

    Comment


    • #3
      Linda

      They sure stress the sagittal plane..... “Not coronal cobb angle” (page 15)

      They mention the lordosis component a few times, and they don’t like these curves too large..... (grim face)

      On Pg 40, I’m in the winners column! Major pain and disability(Yes), male (yes), subluxation>6mm (Don’t know), Lost lumbar lordosis, (I know I was way less than 40 deg)Osteotomy (Wasn’t used) My sagittal views didn’t change much from my surgeries....I had slightly lower kyphosis and lordosis cobb’s from normal.

      Thanks for posting, I found this very interesting!

      Ed
      49 yr old male, now 63, the new 64...
      Pre surgery curves T70,L70
      ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
      Dr Brett Menmuir St Marys Hospital Reno,Nevada

      Bending and twisting pics after full fusion
      http://www.scoliosis.org/forum/showt...on.&highlight=

      My x-rays
      http://www.scoliosis.org/forum/attac...2&d=1228779214

      http://www.scoliosis.org/forum/attac...3&d=1228779258

      Comment


      • #4
        Ed...

        It's what I've been telling Jess for years. (I think she finally has it. :-) Cobb angle becomes useless after skeletal maturity. Things like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.

        --Linda
        Last edited by LindaRacine; 10-28-2014, 05:12 PM.
        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

        Comment


        • #5
          Am a bit confused re. the lordosis component. It says lordosis >40 as the consideration - it doesn't mention loss of lordosis ( flatback). I have 27* in lumbar spine. Normal lordosis is considered as being between 40-60*. Why is the consideration here >40*?

          Comment


          • #6
            Originally posted by burdle View Post
            Am a bit confused re. the lordosis component. It says lordosis >40 as the consideration - it doesn't mention loss of lordosis ( flatback). I have 27* in lumbar spine. Normal lordosis is considered as being between 40-60*. Why is the consideration here >40*?
            I couldn't find anywhere that had anything negative about lordosis >40. The author is showing that lordosis >40 is a good thing, and that patients with good lordosis had worse surgical outcomes than patients with less lordosis. (That's another thing I've been saying for awhile. People who are worse off prior to surgery do much better than people who have little to gain.)

            Make sense?

            --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

            Comment


            • #7
              hmmmm.....WHAT?

              i cannot walk anymore....i am guessing that counts...?
              i have flatback tho i never knew...thought everybody had similar
              spine...never looked, really....
              i have stenosis, arthritis, listhesis, DDD and herniated disc....
              bursitis in hip (caused by "uneven loading of spine")
              and oh yeah.....the PAIN

              so ASIDE from ANGLES....i got reasons...

              is that what you guys are referring to....???
              but my legs are OK...guess that would rule me out for certain
              surgeons. and that, to me, is absolutely ludicrous.

              now...i am sorry if that sounds a wee bit like "attitude"
              but i am quite well aware that curve alone does not surgery need...
              it is function....i know people with curves same size as mine who function
              fine....SO FAR....but....they are also younger than i am...sooooo....
              am not a betting woman....if i were, i would lay odds the curves will
              catch up with their function in another 5 or 10 years, give or take a year....
              and the pain will creep up on them, too.

              jess...and Sparky, the bravest sweetest dog in the world

              j.
              Last edited by jrnyc; 10-28-2014, 04:12 PM.

              Comment


              • #8
                Originally posted by LindaRacine View Post
                Ed...

                It's what I've been telling Jess for years. (I think she finally has it. :-) Cobb angle becomes useless after skeletal maturity. Thinks like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.

                --Linda
                Ah, so this is why Dr. O'Brien never talks about or seems interested in my Cobb angles, but talks about my curve balance, pain level and level of function.
                Stephanie, age 56
                Diagnosed age 8
                Milwaukee brace 9 years, no further treatment, symptom free and clueless until my 40s that curves could progress.
                Thoracolumbar curve 39 degrees at age 17
                Now somewhere around 58 degrees thoracic, 70 degrees thoracolumbar
                Surgeon Dr. Michael S. O'Brien, Baylor's Southwest Scoliosis Center, Dallas TX
                Bilateral laminectomies at L3 to L4, L4 to L5 and L5 to S1 on April 4, 2012
                Foramenotomies L3 through S1 in August 2014

                Comment


                • #9
                  Originally posted by jrnyc View Post
                  hmmmm.....WHAT?

                  i cannot walk anymore....i am guessing that counts...?
                  i have flatback tho i never knew...thought everybody had similar
                  spine...never looked, really....
                  i have stenosis, arthritis, listhesis, DDD and herniated disc....
                  bursitis in hip (caused by "uneven loading of spine")
                  and oh yeah.....the PAIN

                  so ASIDE from ANGLES....i got reasons...

                  is that what you guys are referring to....???
                  but my legs are OK...guess that would rule me out for certain
                  surgeons. and that, to me, is absolutely ludicrous.

                  now...i am sorry if that sounds a wee bit like "attitude"
                  but i am quite well aware that curve alone does not surgery need...
                  it is function....i know people with curves same size as mine who function
                  fine....SO FAR....but....they are also younger than i am...sooooo....
                  am not a betting woman....if i were, i would lay odds the curves will
                  catch up with their function in another 5 or 10 years, give or take a year....
                  and the pain will creep up on them, too.

                  jess...and Sparky, the bravest sweetest dog in the world

                  j.
                  Jess... think you probably missed this:

                  Originally posted by lindaracine
                  Things like imbalance (even slight) too little lordosis, vertebral rotation, pain, and loss of function mean so much more.
                  The only reason I mentioned you is that you always seemed to question whenever someone with a small curve was considering surgery. :-)
                  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

                  Comment


                  • #10
                    no...i did not miss that sentence.

                    i do not think anyone can make a blanket statement...
                    however, i was told that my bursitis in hip is from uneven
                    loading of spine...so am i to believe that smaller curves have
                    as much uneven loading of spine as larger curves do...?????

                    i realize there are alot of things that are looked at when a
                    fusion surgery is being considered.....and that not all large
                    curves need surgery, and not all small ones do not...

                    however....i do believe that larger curves make the spine
                    weaker....and lead to more risks of other problems occurring.
                    .
                    jess...and Sparky

                    Comment


                    • #11
                      Originally posted by jrnyc View Post
                      no...i did not miss that sentence.

                      i do not think anyone can make a blanket statement...
                      however, i was told that my bursitis in hip is from uneven
                      loading of spine...so am i to believe that smaller curves have
                      as much uneven loading of spine as larger curves do...?????

                      i realize there are alot of things that are looked at when a
                      fusion surgery is being considered.....and that not all large
                      curves need surgery, and not all small ones do not...

                      however....i do believe that larger curves make the spine
                      weaker....and lead to more risks of other problems occurring.
                      .
                      jess...and Sparky
                      Hi Jess...

                      As far as I know, no one has studied that. My tronchanteric bursitis didn't get back until after my spine had been straightened. I think we can agree that curve size is a consideration, it's minor compared to pain and function. And, we can also probably agree while that most people with big curves end up in surgery and maybe most people with small curves do not have surgery, there are plenty of exceptions to both rules. Curve size does not correlate directly to pain or loss of function.

                      --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

                      Comment


                      • #12
                        Thanks forms ting, Linda!

                        Comments about presentation about "my people":

                        First of all, this surgeon needs a new person to do his Power Point! How embarrassing and unprofessional to show such a poorly done layout for his presentation. (If the surgeon did his/her own presentation....unsure what to think of his surgical skill).

                        Interesting, his balance of "reasonable to operate" that he had at the R side of the curve "sure success"....nobody ever has SURE success.

                        Can't remember that he separated out the 2 groups: of de novo and previous adolescent curve. While both certainly can have lots of degenerative changes, they may be very different. The former group would definitely be older.

                        How do factors like severe osteoporosis, preoperatively high score of on measure for catastrophizing, and pre-operative long term use of narcotics affect outcomes?

                        Susan
                        Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

                        2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
                        2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
                        2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
                        2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
                        2018: Removal L4,5 screw
                        2021: Removal T1 screw & rod

                        Comment


                        • #13
                          Originally posted by titaniumed View Post
                          They sure stress the sagittal plane..... “Not coronal cobb angle” (page 15)
                          Surgeons in USA doesn’t recommends always surgery (when is possible to do it) for every curve >50° regardless any other condition ??

                          Comment

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