Ten year follow up on fusion looks very good

[Pooka1]

Saw this posted on SSo. Note small sample size and that it only includes people fused to L3 or higher. This comports with what our surgeon said about no long term issues if you can stay above that level and explains why surgeons appear to stop there on kids with what appear to be frank L curves that include levels below.

http://www.redorbit.com/news/health/...good_longterm/

"We wanted to see how the patients were doing ten years down the road, specifically focusing on the part of the spine that didn’t have surgery. The standard belief was that the area of the spine just below the surgery would wear out, because of the increased stress that the surgery or the fusion would put on that part of the spine," Dr. Green said. "That isn’t what we found. We found that the area of the spine adjacent to the fusion was pretty healthy and didn’t show any major degeneration ten years later. While mild degenerative changes were noted in almost every patient, the severe changes that we were concerned that we might find were not there at all."
redOrbit

The investigators say the study results are good news for patients. Dr. Green also said the results may cause worry for investigators and companies who are trying to develop surgeries for scoliosis that do not involve fusing the spine. "There is a lot of research and investment being done looking for new technologies that do not use fusion," Dr. Green said. "This study would suggest that there is a challenge for those trying to do that because the patients doing fusion are doing well."

[jrnyc]

T12 to L3...???
why such a small area of the spine...?
besides the small sample size...seems like a small part of spine
was operated on...???
also, can the young age of the patients account for lack of
damage to spine below the fusion???
...or the fact that such a small
area was fused have anything to do with it....????

jess

[LindaRacine]

This is no surprise to me, as the cohort was teenagers. It is absolutely true that teens generally have great outcomes. I think the question is, what happens 20 or 30 years later? I hope they'll continue to follow these patients.

[Pooka1]

I don't think even Harrington rods showed problems just 10 years later in young people. It took longer then that for the problems to show up.

This applies only or mostly to lumbar as far as I know. Lumbar fusions have not been solved yet to anyone's knowledge.

[jrnyc]

hmmmmm....that is why i haven't gone ahead with the surgery yet...because most of correction i need is below the waist....
i cancelled my Lonner appointment this Thursday, Oct 25th...told them i
want to come in the spring...they said just call a month or two ahead...

jess...& Sparky

[Pooka1]

hmmmmm....that is why i haven't gone ahead with the surgery yet...because most of correction i need is below the waist....
i cancelled my Lonner appointment this Thursday, Oct 25th...told them i
want to come in the spring...they said just call a month or two ahead...

jess...& Sparky

Well I meant lumbar fusions that don't go to pelvis. It seems like they can't fuse below about L3 without triggering a countdown to pelvis. That's what I meant by solving lumbars.

And in re your earlier point, I think the original article refers to fusions that end between T12 and L3, not that extend from T12 to L3 but I can't be sure unless I read it. It would just seem weird to single out fusions from T12-L3 for this study. I mean I don't get the sense that many fusions are fro those exact levels.

[jillw]

10 years later - so maybe the people in the sample were somewhere between 24 and 28 (though it could go up to 30/ 31 years old) and yet almost every patient showed mild degenerative changes even though the fusion didn't extend well into the lumbar region? I wonder how many 25 year olds in the general population are walking around with degenerative changes already? That scares me to hear that so many post fusion patients in the studies were showing changes only 10 years out. What will happen in another 20 or 30 years much less the additional 60 years many of these patients are expected to live?

[jillw]

With further thought, It occurs to me that the degeneration may be due (at least in part) to the scoliosis itself and not the fusion?

[LindaRacine]

With further thought, It occurs to me that the degeneration may be due (at least in part) to the scoliosis itself and not the fusion?

Certainly possible, though the cause doesn't really matter if you end up needing more surgery. It's hard to know if an asymmetrical load is more of a problem than loss of discs to share the load.

--Linda

[Pooka1]

I haven't read the article but the comparison should always be to normals. A few years ago, there was an article about degeneration of the L5-S1 disc IIRC below fusions that ended at L1 or thereabouts. Then someone posted a cadaver study showing degeneration in that disc in normal folks who were age-matched. I hope I am remembering this correctly.

Anyway, DDD is are certain as death and taxes. It is impossible to talk about degeneration under or over fusions without age-matched normal controls.

A related thought error is what some chiros continually do... they compare surgical outcomes with normal folks. The correct comparison is with people with similar scolioses that haven't had surgery, some of whom are probably not traceable as they have died from the sequelae. So maybe surgical folks are having problems but none are in wheelchairs whereas a matched group might be mostly in wheelchairs. I am not sure if the chiros don't see the error in their logic or if they do see it and deliberately lie.

[jrnyc]

do you know of actual statistics on wheelchair and non wheelchair
for surgery and non surgery scoli patients...???

"There is a lot of research and investment being done looking for new technologies that do not use fusion," Dr. Green said. "This study would suggest that there is a challenge for those trying to do that because the patients doing fusion are doing well."
redOrbit (http://s.tt/1f0g0)

anyone know WHAT EXACTLY they are trying to develop?????

jess...& Sparky

[Pooka1]

[COLOR="#0000CD"]do you know of actual statistics on wheelchair and non wheelchair
for surgery and non surgery scoli patients...???

Nope. I don't think many people who refuse surgery end up in wheelchairs. I mentioned it because I have seen a few people on this site say they were having surgery because they didn't want to end up in a wheelchair so I assume their surgeon said that in their cases. Boachie gave a talk showing that untreated scoliosis doesn't kill very many people at all but I am not sure what he said about their disability level or their pain levels.

[jrnyc]

does anyone know what it was referring to when it mentioned research
trying to develop things for scoli that don't involve fusion...????

jess...& Sparky

[Kat3573]

Have a teacher who is fused from like T5-L2 or something like that she waw operated 32 years ago and is doing GREAT! She had 4 kids with no problem has no pain she doing great but that's just one person. Idk her exact levels but I know she's fused in the lumbar. She can do cartwheels,touch the floor, etc

[hdugger]

This comports with what our surgeon said about no long term issues if you can stay above that level and explains why surgeons appear to stop there on kids with what appear to be frank L curves that include levels below.

http://www.redorbit.com/news/health/...good_longterm/

I recently had a chance to revisit this article (while trying to get a feel for Dr. Boachie's (respected surgeon and co-author) opinion on changes below the fusion.)

The paper itself is far more modulated then this summary and Dr. Green's quotes would suggest.

What they found (surprisingly, to me, because I thought these problems were limited to lower fusions) was a good deal of degeneration at the lowest (lumbosacral) junction. When compared to normal (non scoliosis) controls of the same age, these young adults (in their 20s) had more than twice the rate of disc degenerative disease (DDD) "regardless of distal fusion level" When looking at the 9 (out of 20 total subjects) with severe DDD, there were no differences they could find between these subjects and the subjects with mild DDD. So, you couldn't look at a type of curve before surgery and say that that type of curve or that type of patient would be more of less likely to have the early DDD seen in these patients.

The good(ish) news is that none of these patients are showing clinical manifestations of problems. They're generally not in pain and not experiencing issues. But, unlike what I'd thought previously, they're seeing early signs of problems across all types of curves and all types of lowest instrumented vertebrae.

The conclusion of the study (from the full report - the abstract conclusion (IMO) leaves off the most important line (my emphasis below):

Conclusion

Despite demonstrating an accelerated rate of L5–S1 disc degeneration, our study group of patients with moderate AIS has good functional scores and maintenance of balance and correction over 10 years postfusion. In this long-term MR imaging follow-up study, disc degeneration was found remote to the lowest instrumented vertebra, not at transitional levels. Further longitudinal study will demonstrate the long-term significance of the apparently accelerated disc degeneration after spinal fusion for AIS.