DD recently diagnosed -- any suggestions?

[Pooka1]

Last update ever, at least barring something very unforeseen -- just in time for a spiffy new board!

Annual check last week. Same 40T/32L as the year before. Risser 5. He said that she doesn't need to come back annually any more. Any progression now will be very slow -- too slow to measure except in 5-10 year timespans. He said at this point, she can either not do anything and just come back to him (he follows his patients as adults if they want) or another doc if the curves become symptomatic years down the line, or if she wants to be more proactive, it's fine to check every 5-10 years. But it will be up to her, since she'll be an adult.

So that's the end of it as far as I'm concerned. Hope everyone is well!

Very good news. I admire how you managed her case.

We had people on here with even 50* T curves that didn't progress for decades.

[Concerneddad]

Last update ever, at least barring something very unforeseen -- just in time for a spiffy new board!

Annual check last week. Same 40T/32L as the year before. Risser 5. He said that she doesn't need to come back annually any more. Any progression now will be very slow -- too slow to measure except in 5-10 year timespans. He said at this point, she can either not do anything and just come back to him (he follows his patients as adults if they want) or another doc if the curves become symptomatic years down the line, or if she wants to be more proactive, it's fine to check every 5-10 years. But it will be up to her, since she'll be an adult.

So that's the end of it as far as I'm concerned. Hope everyone is well!

[titaniumed]

Nope, never a bending x-ray. His view is that unless you are at the point where surgery is on the table, better not to subject them to the extra radiation.

My benders were done by my surgeon leading into surgery. I don't know how much I bent out, don't think it was all that great....

I have shot a lot of x-rays over the years....Hard to say, maybe 75. Also a few CT's and Flouroscopy before and during surgery. I have a few x-rays from a few days after surgery from strange angles I guess looking at the lumbar implants. They would always do the diagnostics during the grave shift and I liked those since I got out of the room and would go on a hallway trip. Lots of sliding across big tables on big x-ray machines. Laying down of course.

Cancer is a whole different program. Usually it takes time, some of it acts fast, some of it acts slow. Like Prostate cancer in men.....After age 50 in men, I have seen some large numbers. I have a friend who has had lymphoma for about 50 years. He told me that he set the record....He is 83 now.

Ed

[titaniumed]

But because the top curve is now about 25% bigger, much more displaced, and a bunch more rotated, the doc thinks that it's probably a primary thoracolumbar curve, with a mostly compensatory lumbar curve at the bottom. In the unlikely event that she did need to be fused in the next few years, he thinks that they would just need to do the top one. The only problem there is that even the top curve is low enough that they'd probably need to go to L2, which is when the bad stuff starts to happen. (If it came to that, we'd probably see if there was an alternative that would spare that level like an anterior approach or a hybrid.)

My curves were pretty much matched over the years. That why I asked. 50/50, 60/60, 70/70. Within about 3 degrees....

My lumbar curve ended up getting extremely stiff and I had to do a lot of stretching over the years. I had a professional $1800 stretching chair that my Chiro bought for me, and an arch table. I was told it could be fused "as is" by my surgeon.

It was similar to this model...
https://www.4mdmedical.com/sp1000-stretch-partner.html

http://www.inversion-table-therapy.c...Bench/2327/1/1

The arch table looks simple but is very effective and you have to be very careful how much time you spend laying on this. The weight of your legs pulls hard on your lower spine depending on your exact position laying on the arch. Just 5 minutes and you will really notice it.

She has a lot of years ahead of her....I started Chiropractic at age 28, that when my scoliosis pain became focused, if that's the right word.

It's hard to say what will happen technology wise in 25-30 years. It keeps improving.

Ed

[titaniumed]

Nope, no such law (then or now). The only reason they'd wake a patient up for permission is if they either didn't know they'd stage the surgery, or they forgot to get permission prior to anesthesia.

It probably was because I did not sign an advanced directive or medical power of attorney at the hospital. It's also stated in my hospital reports. I know, this isn't the norm....and was surprised when he woke me up. They obviously had permission for the first surgery.

I wanted myself or my surgeon calling ALL the medical decisions, not my family, friends, heirs, state, lawyer, legal document or a court. I guess I could get into it but it would be a really long post.

Funny since a lot of people would think that a family member would be the right thing to do, but I can give an example where it isn't.... especially in end of life decisions.

I had 100% trust in my surgeon.

Ed

[Concerneddad]

I thought the way they tell if it is structural is how much it bends out, no? Did your surgeon do bending films?

Nope, never a bending x-ray. His view is that unless you are at the point where surgery is on the table, better not to subject them to the extra radiation.

[LindaRacine]

I thought the way they tell if it is structural is how much it bends out, no? Did your surgeon do bending films?

That's pretty much it.

https://pubs.rsna.org/doi/10.1148/rg.307105061

"Because of vertebral morphologic changes (eg, wedging and rotation), a structural curve is not correctable with ipsilateral bending. By contrast, no vertebral morphologic changes take place in a nonstructural curve, which is a mild compensatory curve enabling sagittal and coronal truncal balance; therefore, it is correctable with ipsilateral bending. A nonstructural curve does not usually progress. However, a nonstructural curve may progress to a structural curve if ligament shortening results from growth retardation on the concave side of curvature (8)."

[LindaRacine]

I think they did wake her up but I don't have the notes. Are there other ways to check?

It's typically either in the notes, or on the anesthesia record.

[LindaRacine]

My surgeon woke me up for 10 seconds (between surgeries) to get permission to continue on to the 2nd surgery. (By Law) This only proved that the jaw worked, not the toes. (Smiley face)

Nope, no such law (then or now). The only reason they'd wake a patient up for permission is if they either didn't know they'd stage the surgery, or they forgot to get permission prior to anesthesia.

[Pooka1]

I thought the way they tell if it is structural is how much it bends out, no? Did your surgeon do bending films?

[Concerneddad]

CD, Thats very good news...

Is she an "S" curve? I think I might have asked that question but don't remember.

This is actually an interesting question. She is an S-curve, and initially they thought it was a true double curve because both were about the same at diagnosis. But because the top curve is now about 25% bigger, much more displaced, and a bunch more rotated, the doc thinks that it's probably a primary thoracolumbar curve, with a mostly compensatory lumbar curve at the bottom. In the unlikely event that she did need to be fused in the next few years, he thinks that they would just need to do the top one. The only problem there is that even the top curve is low enough that they'd probably need to go to L2, which is when the bad stuff starts to happen. (If it came to that, we'd probably see if there was an alternative that would spare that level like an anterior approach or a hybrid.)

[titaniumed]

Yes, SSEP and MEP spinal monitoring

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072895/

History of spinal cord monitoring

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072901/

Some worry about waking up but for me, it was like a dream....I woke up and saw my surgeons face with the mask, the next thing I was out. I didn't feel a thing.

Ed

[Pooka1]

I think they did wake her up but I don't have the notes. Are there other ways to check?

[titaniumed]

With my one daughter, there was only a small compensatory curve which may have been incompetent to prevent the huge T rotation. The surgeon did not get our hopes up on fixing the rotation completely but he must have been hedging because you can't see it unless you know what to look for. I think they were shooting for the moon as she had a neuro episode when they woke her so they may have backed off on the rotation correction. They did not back off on the straightening as she came out less than 10 deg no scoliosis per the rad report.

Interesting.....They did a wake up test? (In 2008) Do they still do these today?

My surgeon woke me up for 10 seconds (between surgeries) to get permission to continue on to the 2nd surgery. (By Law) This only proved that the jaw worked, not the toes. (Smiley face)

They did not wake me up for the 2nd surgery.

Ed

[titaniumed]

Also, one thing that the doc did say that I hadn't heard before: her rotation is a lot less than he'd expect in a 40 degree curve. He said that he'd normally expect 20+ degrees, but hers is only 8-9 degrees. He said that this is often a good indication as to whether it will progress as an adult -- if he has kids with smaller curves but a lot of rotation, he'll be concerned that even if they hit maturity in the high 20s or 30s, they'll still progress a lot more quickly. I haven't seen that in the literature before, so no clue if it's just his experience or whether that's a documented thing. (He also said that the fact that her curves are reasonably well-balanced is a big plus, because those also tend to progress less/more slowly in adulthood, but I had heard that before.)

CD, Thats very good news...

8-9 degrees rotation....not bad. Below is my CT to show what rotation looks like in scoliosis (After surgery) I dont know if you have seen this. You can see the screws and the angle of about 30 degrees at the apex "after correction". Of course this was starting with a 70/70 S curve. My surgeon drove those screws in almost sideways....(Picturing this on the operating table) The left screw looks like it's at about a 45 degree angle. I don't know what my rotation was before surgery, but it was bad. The view is looking "feet to sky".

The CT was shot looking for gall stones, not a scoliosis problem.

Is she an "S" curve? I think I might have asked that question but don't remember.

Here is a 2008 paper on Rotation measurement....Starting With Dr Cobb (1945?) using spinous processes. (Old School) and other methods used through the years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587463/

Today I did some searching for an EOS machine (Low Dose radiation) for someone in NJ. (New School) The company has a locator map.
https://www.hss.edu/condition-list_eos-imaging.asp

https://www.youtube.com/watch?v=nNSu...el=WVUMedicine

Was she shot in an EOS machine?.....I would imagine the software calculates the vertebral rotation...(with more accuracy).

Ed