Surgeon's notes from first consult

[Pooka1]

Pooka1 makes an interesting point that reminded me of a comment Dr. Boachie said at my initial consult. He mentioned that if I had fused my thoracic curve say about 15 years ago, I might not have needed to go the full T4-sacrum now. Since I didn't want to go backwards with 'what-ifs' I didn't pursue the statement with him. Unfortunately I didn't know how bad my curves were until January of this year. My curves were so minimal at 12 and 30 years old, I was told both times not to worry, it's nothing. I'm now 60 with two 60+/-* curves. Who knows how fast and when.

This is in keeping with the observation I have made from the testimonials from adults that what should be the majority type of fusion is not what is the majority type of fusion for adults though it is for kids. Single right thoracic curves are both the majority of cases that exist in kids and the most likely curve type to progress. That combination should result in the VAST majority of adult fusions being for single right thoracic curves. But that isn't what we see in the testimonials though they are not necessarily a representative sample of the entire population. Unless many of the adults being fused do not have AIS but rather adult onset scoliosis, then there is some conversion going on between single thoracic curves and double majors resulting in much longer fusions. Double majors tend to progress a lot also but they are a much smaller percentage of the total AIS cases. So that can't account for the observation if it is representative.

I have also noticed that the relatively few adults here with single thoracic curves that were fused had somewhat quicker/easier recoveries than the folks with longer fusions into the lumbar. Maybe that accounts for some of the differences between the average recovery for kids and that for adults which don't overlap much as far as I can tell though the general age difference still probably accounts for most of the average difference.

If enough data is gathered on conversion of untreated thoracic curves to double majors, lumbar collapses under even sub-surgical thoracic curves, etc., I think there might be new ethical questions about when to fuse thoracic curves, protective trigger angles, etc. etc..