Complications in Degenerative Scoliosis Surgery

[theizzard]

I was not screened as a child in England and did not know I had scoli until in my 40's. I had a laminectomy when I was 37 and the surgeon said nothing about having scoli. Perhaps it grew after age 37!! I must have had it as a child because my mother would yell at me to stand straight when she was hemming my clothes. She assumed that one hip was higher than the other because I wasn't standing correctly. I still have scoli because my kyphosis was the main concern when I had my surgery. When I saw my xrays and saw the curve was still there I was very upset. Dr. Rand did not feel that my scoli had anything to do with my pain since I had pronounced kyphosis, stenosis and who knows what else. I mentioned it to him at a follow up and my impression of that conversation was that it would be very problematic to fix. I seem to think that because I have 2 artificial hips it would have thrown them off. I have the unfortunate problem of sometimes not remembering what is said to me. Next time I am taking my mp3 voice recorder with me instead of my husband who remembered even less than I did.
avis

[Confusedmom]

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

Linda,

Thanks for this. Do you know how "late-onset idiopathic scoliosis" is defined? What is the age of first diagnosis? It seems like this study uses "LIS" the same way "AIS" is commonly used now (which I think is defined as scoliosis first diagnosed at age 11 or later).

If I'm reading this correctly, this article suggests that most untreated AIS causes no more problems than more frequent back pain and cosmetic deformity for most people (except for those with very large or severely rotated thoracic curves).

Evelyn

[LindaRacine]

Linda,

Thanks for this. Do you know how "late-onset idiopathic scoliosis" is defined? What is the age of first diagnosis? It seems like this study uses "LIS" the same way "AIS" is commonly used now (which I think is defined as scoliosis first diagnosed at age 11 or later).

If I'm reading this correctly, this article suggests that most untreated AIS causes no more problems than more frequent back pain and cosmetic deformity for most people (except for those with very large or severely rotated thoracic curves).

Evelyn

Hi Evelyn...

I've heard it used on and off, but only know what I've found on the internet. For example?

The term infantile scoliosis is used specifically to describe scoliosis that occurs in children younger than 3 years. Other terms for scoliosis also depend on the age of onset, such as juvenile scoliosis, which occurs in children aged 4-9 years, and adolescent scoliosis, which occurs in those aged 10-18 years. These terms, however, are now being replaced by the broader terms early-onset scoliosis and late-onset scoliosis, depending on whether the scoliosis occurs before or after 5 years of age.

From another site:
Scoliosis diagnosed in patients aged between 10 and 18 years is termed late onset scoliosis. By far the most common type of scoliosis in the adolescent period is one in which the cause is not known and is called idiopathic or adolescent idiopathic scoliosis (AIS). Although important research continues in this area, including into the genetic basis for AIS, there are no identifiable causes for this condition. Nevertheless, there are accurate methods to determine the risk of curve progression and good methods of treatment.

But, what about this?
Adolescent idiopathic scoliosis (AIS) is defined by the Scoliosis Research Society as scoliosis whose onset occurs after ten years of age and whose cause is essentially unknown. It is a relatively common condition among adolescents.

Not that it really makes much difference, but I'll see if I can find any MD who will go on record on the subject.

[Back-out]

What's the natural history of my spine? Is height a good measure of curvature?

Being 64, I belong to a generation that wasn't screened in school for scoliosis - not that it would necessarily have been caught.

The last consult I had (Weds.), the surgeon kept questioning me about when I was diagnosed with scoliosis. I guess he was trying to figure out same as me, when it started and when it got worse. Since I'd said I was told in my early 20s I had scoliosis he wanted to know what my curve was then - what had the doctor said, the one who had made the diagnosis?

I had to admit that it was only an exercise instructor at the local Y who had told me I had scoliosis. Actually, she told me at the same time she told the class, using me as an example ("if Amanda can do these exercises so well, with her scoliosis, why can't the rest of you?")

Great! Except no one attended to it - most importantly, I guess, not my parents who could have sent me to a specialist. My mother was keen on having my bunions corrected even then (they were unsightly), but nothing about this problem with all its future functional ramifications.

So hard to track my history! I guess I would have been nagged if the scoliosis had been severe since it would have affected my ability to wear nice clothes. Unlike me, she cared a lot about this. Don't remember the dress-maker doing anything special to make adjustments, but then would she have said anything? Doubtful.

I only went to spinal specialists when my back started to hurt and that came and went depending on whether I was stressing it - traveling a lot, carrying many heavy bags...I am guessing since my height remained stable at 5'6 1/2" until about a decade ago, that the curve itself was also steady. But then again, I can't remember whether or not my GPs ever actually measured me, or whether they just took my word for it. Only my weight and blood pressure were definitely checked.

As I shrunk (now I measure 5' 2 1/2" - 3"), I GUESS my back was twisting more and more. I'm struggling now to figure out what happened, when. The local hospital isn't much help. They've been reporting my scoliosis as "mild to moderate" ever since my first spinal Xrays are documented - starting only around 2000. Recently, with no degree changed noted, they suddenly called it "severe"! (They still have me down as Cobb 44 deg!) It's as if I went abruptly from adolescence to senior-hood with nothing in-between - from being a Senior in HS to being a Senior in a different demographic!

I wasn't even told there was such a thing as a "scoliosis series" or "study" until then, so all prior Xrays are piecemeal - patched together, from thoracic and lumbar views. Not a single one imaged my total spine. But then, this geographical area is "special" - not in a good way.

Most of all, I wonder what difference it makes now for surgery. Why does the surgeon care? Usually diagnosis determines treatment and prognosis; dx -> rx. But did/does it with me? Was there ever a missed intervention that could have spared me this radical solution? And does treatment now differ in any way depending on the origins of my condition?

[Confusedmom]

Hi Amanda,

Since I am getting the same questions from the docs, I can relate to the drill you are going through (except it sounds like I have more documentation). Basically, I think they are trying to establish beyond a doubt that your curve is still progressing. That is how they justify surgery. If your curve is not progressing, they might just want to treat you will pain management and PT.

Evelyn

[Tall Paul]

Also I watched referenced and discussed a video of a M. I. lumbar fusion (done by Dr Fessler of U Chicago). He specifically said that:

a) lumbar fusion surgery could be done very successfully using a M.I approach as long as the surgeon was extremely experienced in the technique - someone like him. The difference the surgeon makes in outcomes with ALL radical spinal surgery is hardly news, though it cannot be overstated for those of us still in the arranging/deciding end of things!

Dr. Fessler said that
b) current state of the Art does NOT permit doing a longer fusion using a M I. approach (This is what I especially took from the interview, regretfully. One always remembers what is personally relevant, I guess).

Incidentally, Dr Fessler was actually interviewed while he was performing a M.I lumbar fusion! I've tried several times since to retrieve the video-interview. Unfortunately, though, it seems to have been deleted from the U. Chicago's online reference library. Shame, as the contents don't appear available in text form.

Here is the video:
http://www.spineuniverse.com/profess...asive-approach