DD recently diagnosed -- any suggestions?
Hi. Daughter (just turned 13) was recently diagnosed. S-curve. Three docs have all measured her curves differently, but they average out to 32T/32L (one doc had the thoracic bigger, one had the lumbar bigger, and one had them the same). The ortho that she saw said it's 50-50 whether they'd progress to needing surgery if left untreated, so he prescribed a brace, which he said probably cuts those odds in half (if she complies). She gets that next week. Some concerns/questions:
1.) The one thing I wasn't super happy about at her ortho appointment was the assessment of her skeletal maturity. When I asked, the doc just said "oh, her growth plates are still wide open, she has a lot left to grow." He did that without asking about menarche, growth spurts, etc, and he didn't do hand/wrist x-rays.
This is important because I think she could be a lot more skeletally mature than he thinks -- her period was almost a year ago, and her peak growth velocity was probably about 16 months ago (we measured monthly and the markings are on the wall). Her growth also has slowed pretty significantly in past months (about six inches from 11 yo to 12 yo checkups, but only 2.5 inches from 12 yo to 13 yo). Based on that, just statistically speaking, I'd guess that she's more like Risser 2-3 and Sanders 5-6, which as I understand it, makes the possibility of significant future progression a lot less likely. Also, based on her lumbar image, it looks to me like there is "fuzz" running on the top of her iliac about a third of the way from the outside in -- though the scan cuts out the entire outside edge of the hip, so it's hard to know for sure. Unless that's a random shadow, that would mean she's well into Risser 2, right?
2.) If she is as immature as the doc assessed, if she progresses even a few more degrees over the next few months, would she be a VBT/ASC candidate? My BIG concern is that the bottom curve is really low (centered at L3/L4), so if she had to get fused for the lumbar curve, it could be pretty catastrophic in terms of reduced mobility. She's also a super competitive athlete, to the point that her coaches have advised that while it's a long way off, she's currently in the range of girls who play in college in her sport. We definitely want to avoid fusing that low so she can keep playing (as well as avoiding the long recovery).
3.) Any other suggestions? She has an appointment with another ortho in a few weeks to get a second opinion, so in addition to the above, we'll have the opportunity to ask additional questions if there is anything important.
Thanks in advance!
DD recently diagnosed -- any suggestions?
Quote:
Originally Posted by
titaniumed
Yes, as far as tethering is concerned, the timing has to be right.
The data Sharon posted mentioned that the tethering candidates are 1 out of 5. Only 20% of these kids are accepted for VBT.....
What sport?
Ed
Hi, thanks guys. Her second opinion is with a scoliosis-specific doc who (I think) is the only one to perform VBT surgery in our state. It's totally fortuitous -- he's the one our pediatrician recommended from the outset -- it's just he was scheduling so far out that we wanted to get her seen sooner. Her other doc is also a pediatric ortho, and I was generally fine with him (he came recommended), he seemed kind of cookie cutter in how to go about treatment. I'm just concerned that that ends up in a long fusion if bracing doesn't work, which isn't really what we want if there are any other options.
I was playing a little coy on the sport, but oh well, she's a very good basketball player. 5'9" in her bare feet (so 5'10-5'11" for basketball roster purposes), with three-point range out to Kansas. If she can stay healthy, my guess is that she'll be a pretty good, big shooting guard in college. She's extraordinarily tough and smart, and again, the range is just wow.
My concern on the maturity isn't so much eligibility for VBT/ASC surgery, it's that I think she's probably almost done growing. If she is, great. She's (probably) out of the woods, and we'll probably brace for six months or so, but just as a precaution. This is just a problem she'll need to monitor into adulthood. If she isn't almost done growing, also great, but it's something we need to be a little more proactive on, because there is risk of it getting worse, and there are things we can do now if we're diligent about it. I guess it's good we have the opinion with the second ortho!
Thanks again for the advice...
