Fusion levels

[tkare]

I was wondering how to make sense of differing opinions on fusion levels. What would be long term problems with fusion too little versus too much? Also, would the difference be more important
In the thoracic levels or the lumbar levels or both? Other than the obvious longer surgical time with more levels fused.

[Pooka1]

I was wondering how to make sense of differing opinions on fusion levels. What would be long term problems with fusion too little versus too much? Also, would the difference be more important
In the thoracic levels or the lumbar levels or both? Other than the obvious longer surgical time with more levels fused.

Hi. A surgeon would be best to answer these questions. But there are some general rules out there that don't take into consideration individual situations that require deviation from the rules...

- fuse as little as possible to preserve the most flexibility
- fuse only the structural curve(s)
- long term problems come from various things including: not fusing the entire structural curve, not picking the correct end vertebra and triggering adding on, not balancing the fusion in all three planes, going below about L3, going above a certain T vertebra or not fusing high enough above a lumbar fusion to avoid proximal junction kyphosis, etc. etc.

Too little and you'll be back in the OR I guess or else everyone would go too little.

Too much and you lose flexibility that you didn't need to lose.

That's my understanding .

[tkare]

Thanks Pooka. Wow a lot to figure in. Kind of tricky when two trusted surgeons offer different opinions on fusion levels. It will be a question we ask at the pre op for sure.

[tampamom]

This is totally where we are in our son's situation, trying to preserve the Lumbar and understand if it is structural or not. Oh and then we worry about the long term consequences of going too short. Having just read up on SSBOB etc.....

I will share the results of our consults. We have 4 in the next 30 days: Hey, Lenke, Mason, Lebwohl. I pray we get consistent recommendations and come away confidence on how to proceed with the best surgery plan.

Probably overkill to meet with 4 surgeons but since we have no history with a specialist and this has such a life changing effect I need to be thorough.

Thanks for starting this topic. All the best,

-C

[tkare]

It is great that you have appointments lined up so you can get opinions and make the best decision. We realized that with all of the opinions we sought out, only one doctor told us which levels he would fuse. With that we felt we needed to just double check it before proceeding. Our biggest concern was with lumbar. However, it seems that the second opinion was similar in lumbar levels but differed in thoracic. I wasn't sure the risk of fusing to little in the thoracic area although I think I have some understanding of the issues with the lumbar levels. Since both opinions come from well respected surgeons we are a bit confused.

Best of luck with your upcoming appointments! Keep us posted!

[leahdragonfly]

Hi,

This topic is covered in Dave Wolpert's book, The Patient's Guide to Scoliosis Surgery. He talks about his varying opinions and how he made his decision, although I am sure there are differences between adult scoliosis surgery vs adolescent.

That said, part of the equation is definitely finding the "right" doctor that you trust, that communicates well with you and your child, in an office that will be easy to work with for follow-up care and questions. I don't see anything at all wrong with getting so many top opinions---you should come out of those 4 appointments with a very good understanding of your options. It can also be helpful to ask for the names and numbers of 2-3 other families whose children have had surgery with the surgeon you are considering. Ask the other parents about communication between the parents and the doctors, pain control, thoroughness/ease of aftercare, and hospital experiences good or bad.

Best of luck to you with your appointments and decisions. You are leaving no stone unturned and your child will be thankful someday.