A reason to do surgery earlier rather than later

[titaniumed]

Mehera

We are not debating anything here, just acknowledging what some surgeons are saying.....
My question pertains to patients after 40.....Dr Hey is saying “young adult”.

I would have had a long fusion as a kid so I guess I might have benefitted by waiting. I did have my share of pain. It would be interesting to know if I could have avoided my anterior if I would have had my surgery 10 years sooner. I do know that I truly did run out of time and was slipped in just in time. I have met scolis that were not as fortunate, they waited too long. (osteoperosis)

My curves did hold for many years and I did monitor with x-rays. I had twin 50’s that held for about 20 years, it was in my 40’s that the signs, the pains, really started getting bad. When the 10 level spasms and sciatica set in, it’s a signal that something is seriously wrong.....

Its good that you posted, these decision making threads really are the hardest ones here. Every surgical candidate or parent needs to consider all this information. Complications from surgery, OR not having surgery, all need to be considered. The scales can be tipped in either direction.
Ed

[Pooka1]

From Lenke et al. (2002)
(http://www.ncbi.nlm.nih.gov/pubmed/11884908)

Total = 606 cases

Type 1, main thoracic (n = 305, 51%)
Type 2, double thoracic (n = 118, 20%)
Type 3, double major (n = 69, 11%)
Type 4, triple major (n = 19, 3%)
Type 5, thoracolumbar/lumbar (n = 74, 12%)
Type 6, thoracolumbar/lumbar-main thoracic (n = 17, 3%)

So single thoracic accounts for half of all curve types. Now we need some data on potential for each type of curve to progress.

Okay here's some data on progression potential...

http://www.scoliosisjournal.com/content/1/1/2

Natural history/deformity

At an average of 40.5 years after skeletal maturity 68% of the 133 curves in 102 patients in the Iowa series progressed [23]. Curves initially 30°or less tended not to progress whereas curves more than 30° usually progressed. Single thoracic curves between 50° and 75° were the most likely to progress, an average of 29.4° or about 0.73°/year (29.4°/40.5 years). Others have noted that thoracic curves were the most likely to progress [34]. Additional risk factors for progression of single thoracic curves were those with apical vertebral rotation of more than 30 per-cent and Mehta-angle, a measure developed to differentiate resolving and progressing infantile idiopathic scoliosis [35], of more than 20° [23]. The lumbar components of double major curves were more likely to progress than the thoracic component. Right lumbar apex curves were twice as likely to progress as left apex lumbar curves. Lack of L5 deep seating and greater than 33% apex rotation were risk factors for progression [23].

Okay combining the data sets, thoracic curves are not only more prevalent but more likely to progress. So that means T curves continue to lead the league in progression potential even past maturity.

For now, I am simply noticing that although there are a few adults here who get a T fusion, the majority are not in that group. They get longer fusions.

More digging...

[progress]

Hope so too!

Wow you got a top shelf correction! Hammerberg must be in that top eschelon.

I wish I knew more about this stuff. Did they tell you if all the damage to the lumbar could have been avoided if the TL curve as stabilized much sooner?

It's interesting that you are actively trying to protect the last two discs. I hope that works. It would be interesting to see some stats on how long fusions to L4 last before needing to be extended. Maybe you can extend it for the next several decades and never need more surgery. There have been a few testimonials where folks went about 30 years before needing an extension. And one parent was told there was only a 15% chance her teenage son would need an extension even though he was fused to L4 and was very young. So maybe things have been improved with the advent of pedicle screws.

I'm hoping that's the case My well respected Dr in Sydney doesn't seem to think I will need further surgery (fused to either T3 or T4 in two weeks), is there any info on the pedicle screws saving the lower discs? My lower discs are good at the moment.
Kelly
55 deg thoroculumbar
49 yrs

[Pooka1]

I'm hoping that's the case My well respected Dr in Sydney doesn't seem to think I will need further surgery (fused to either T3 or T4 in two weeks), is there any info on the pedicle screws saving the lower discs? My lower discs are good at the moment.
Kelly
55 deg thoroculumbar
49 yrs

I think there is some chance Linda might have a feel for that from her work.

I wonder what the data show? I have asked our surgeon this a few times but I am still not sure about the bottom. I think he doesn't have enough data to say one way or the other. That said, for what it is worth, my understanding and impression is that:

1. distal end of L1 or L2 is thought to avoid the need for extension further distally in a lifetime.

2. distal end of L3 and going down, chance of needing an extension goes up.

3. the further distal the fusion ends, the higher the chances go up of needing an extension.

That said, surgeons are telling patients and parents of kids fused down to L4 that they only have a small chance of needing an extension. That is why I think pedicle screws may be changing the landscape on this. Hopefully Linda will chime in.

Good luck.