Complications in Degenerative Scoliosis Surgery

[Back-out]

no one's back is identical to another's...so i would not predict what ANY surgeon will advise one patient based on what that surgeon advises another patient...no patient's overall health is the same as another's...nor their weight, nutritional profile, number of discs degenerated, degree of rotation, amount of stenosis, degree of arthritis, or anything else...nor is a prediction of how the patient will tolerate the surgery, the liklihood that patient will need revision in the future, their lifestyles, or anything else!

jess

Of course, it's not a real prediction. It's just a probability assessment based on increasing understanding of what different surgeons appear to recommend on the conservative-aggressive continuum, as defined in context.

Funny that among the top East Coast surgeons, it is seeming a bit generational. Small personal sample, and the rest by hearsay. We'll see. Nothing I'd base a decision on. Just means I'm starting to understand where they're coming from. Some of it is empirical. I can't really understand all the research behind it, of course, but I don't think it's my imagination that there are groupings based on surgical philosophies - maybe even fellowship programs or exposure to a certain body of research.

[CHRIS WBS]

Amanda,

I considered the surgeon I saw at Rush and the one I saw at Northwestern conservative in their thinking. Both are older surgeons who perform a lot of surgeries. They recommended a traditionally more invasive surgery for me based on the severity of my scoliosis…a thoracoabdominal surgery and a posterior surgery from T2 to the pelvis staged a week apart. I believe their recommendation was based on years of experience and proven long term results; and I don’t think either of these surgeons would be open to change. They will stick with what has proven to be most successful for their patients long term. And that’s why I view them as conservative. When I saw Dr. Bridwell, he told me that he has pretty much backed away from performing thoracoabdominal surgeries. I viewed Dr. Bridwell and my surgeon as more progressive and cutting edge. On his website the following is stated, “Dr. Bridwell formulates the least invasive and least risky procedure for each patient, taking into account their surgical goals and what their body can handle.” And I believe this is true of my surgeon as well. I’m not sure cutting edge is necessarily better though. It’s tough trying to assimilate it all and make a decision that you feel is best for you.

FYI, Dr. Fessler is with Northwestern and not U. of Chicago.

[Back-out]

Chris,

I had pretty much the same approach as you are describing semantically, viewing "tried and true" as meaning conservative. "Conservative" as in politics - meaning resistant to change.

It seems that surgically, though, "conservative" refers to less surgery. ...even if it's a breakthrough technique or riskier per se.

But what risk is one trying to mitigate?

BTW I was curious abt Dr Fessler re your comments and looked him up, finding this

http://nmhphysicians.photobooks.com/...stname=fessler

He was recruited relatively recently from the U Chicago to Northwestern. Not sure just what this means in terms of his geographic availability. (He sure is a lot better looking without surgical scrubs obscuring his handsome face! Kind of like removing hijab!)

[CHRIS WBS]

Maybe you should select your surgeon based on how good-looking he is. You seem to have a thing about hunky surgeons. I recall Karen Ocker mentioning that there was a surgeon who ended up marrying his patient.

[Back-out]

Maybe you should select your surgeon based on how good-looking he is. You seem to have a thing about hunky surgeons. I recall Karen Ocker mentioning that there was a surgeon who ended up marrying his patient.

haha. I'm afraid surgeons have a greater array to select from than an almost Medicare age broad! Unless he wants a practice dummy, that is.

I used to think it would be cool to marry a plastic surgeon, but now I admit I'd find it handier to marry a great scoli surgeon. I doubt they'd ever operate on a spouse, though, even if a bottle genie brought me such a loon!

(Actually, anyone with good insurance would suit me just fine )

[Confusedmom]

When I saw Dr. Bridwell, he told me that he has pretty much backed away from performing thoracoabdominal surgeries.

Chris,

This is interesting. Do Dr. Bridwell say if that is simply because the surgeries are harder to recover from, or is there new evidence that posterior-only is just as successful? Maybe it has something to do with BMP? Just wondering if you knew any more about this change.

Thanks,
Evelyn

[LindaRacine]

Chris,

This is interesting. Do Dr. Bridwell say if that is simply because the surgeries are harder to recover from, or is there new evidence that posterior-only is just as successful? Maybe it has something to do with BMP? Just wondering if you knew any more about this change.

Thanks,
Evelyn

Hi Evelyn...

When they say they're no longer doing the thoracolumbar approach, they're referring to the big slash openings that many of us had. Now, they simply do multiple ALIFs, TLIFs, and/or XLIFs.

--Linda

[Susie*Bee]

I considered the surgeon I saw at Rush and the one I saw at Northwestern conservative in their thinking. Both are older surgeons who perform a lot of surgeries. They recommended a traditionally more invasive surgery for me based on the severity of my scoliosis…a thoracoabdominal surgery and a posterior surgery from T2 to the pelvis staged a week apart. I believe their recommendation was based on years of experience and proven long term results; and I don’t think either of these surgeons would be open to change. They will stick with what has proven to be most successful for their patients long term. And that’s why I view them as conservative.

Chris- Dr. H (for the rest of you--the one at Rush) was going to do A/P a week apart with me too. We had it all scheduled. Then about a month beforehand, he decided he could do it with just the posterior. Sometimes they change their minds...

[Back-out]

Hi Evelyn...

When they say they're no longer doing the thoracolumbar approach, they're referring to the big slash openings that many of us had. Now, they simply do multiple ALIFs, TLIFs, and/or XLIFs.

--Linda

Feeling very out of the loop but nevertheless hoping the old rule of thumb still holds ("the only stupid question is one you know the answer to") -

what do these (to me) new acronyms mean?

Thinking not for the first time, that this specialty website (like others in various fields) needs its own glossary...

[LindaRacine]

Feeling very out of the loop but nevertheless hoping the old rule of thumb still holds ("the only stupid question is one you know the answer to") -

what do these (to me) new acronyms mean?

Thinking not for the first time, that this specialty website (like others in various fields) needs its own glossary...

They're all types of interbody fusion. All done with different, minimally invasive techniques (anterior, transforaminal, and lateral).

[Pooka1]

It's possible that she knew that she had scoliosis when she was younger. We see a lot of older patients with scoliosis who don't know if they had scoliosis when they were younger, and as far as I can tell, it's not always easy to know which it is.

I'd like to know if a single patient with long-term untreated scoliosis ever escapes degenerative scoliosis. It may be that virtually everyone with untreated scoliosis will also develop degenerative scoliosis, including most subsurgical folks. That would be important to know I think.

[leahdragonfly]

Pooka

Hi Sharon,

I'm totally guessing here, but I think a plausible reason my lumbar curve increased from 35 to 47 in the last year is due to severe degeneration. I have severe spinal arthritis, facet joints are massively enlarged, spinal instability, spondylolisthesis and stenosis. I was diagnosed with a double curve at 13, with 32 and 33 degrees. Withstood "successful" bracing, with curves both reduced to around 20 at 3 months out of brace. A few years ago, when my back started giving me trouble at age 40, my curves were 35 lumbar and 21 thoracic. A few months ago they were measured at 47 and 28 degrees. I just turned 43. I am scheduled for fusion T10-pelvis on October. I am told by my surgeon that I will be at risk for having continued degeneration above the fusion, with eventual fusion extension maybe needed of the thoracic curve too.

Interesting thread...

[LindaRacine]

I'd like to know if a single patient with long-term untreated scoliosis ever escapes degenerative scoliosis. It may be that virtually everyone with untreated scoliosis will also develop degenerative scoliosis, including most subsurgical folks. That would be important to know I think.

http://jama.ama-assn.org/cgi/content/full/289/5/559

JAMA. 2003 Feb 5;289(5):559-67.

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV.

Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. stuart-weinstein@uiowa.edu

Comment in:

J Fam Pract. 2003 Jun;52(6):451-2.
JAMA. 2003 May 28;289(20):2644; author reply 2644-5.
JAMA. 2003 Feb 5;289(5):608-9.

Abstract
CONTEXT: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. OBJECTIVE: To present the outcomes related to health and function in untreated patients with LIS. DESIGN, SETTING, AND PATIENTS: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). MAIN OUTCOME MEASURES: Mortality, back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. CONCLUSIONS: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

PMID: 12578488 [PubMed - indexed for MEDLINE]Free Article

[LindaRacine]

Hi Sharon,

I'm totally guessing here, but I think a plausible reason my lumbar curve increased from 35 to 47 in the last year is due to severe degeneration. I have severe spinal arthritis, facet joints are massively enlarged, spinal instability, spondylolisthesis and stenosis. I was diagnosed with a double curve at 13, with 32 and 33 degrees. Withstood "successful" bracing, with curves both reduced to around 20 at 3 months out of brace. A few years ago, when my back started giving me trouble at age 40, my curves were 35 lumbar and 21 thoracic. A few months ago they were measured at 47 and 28 degrees. I just turned 43. I am scheduled for fusion T10-pelvis on October. I am told by my surgeon that I will be at risk for having continued degeneration above the fusion, with eventual fusion extension maybe needed of the thoracic curve too.

Interesting thread...

There's a huge difference between the average spine of a 40 year old and the average spine of a 60 year old. Since I started seeing so many xrays on a daily basis, I became aware of that difference. I was shocked, recently, to see my latest xrays, which made me look and feel very old. I don't think anyone knows if people with curved spines see more general degeneration (that is, degeneration unrelated to assymetrical loading). I suspect it's more a function of bone density and other factors.

--Linda

[jrnyc]

hi Linda
i was doing fine with my scoli until i herniated discs....then all went downhill and more and more problems came out! am wondering how much discs contribute to acceleration of degeneration of the spine in general...

jess