A Chiropractor helping to avoid surgery

[LindaRacine]

You cannot tell how large someone's curve is by how they look. I had a 50+ degree thoracic curve before my surgery and my back did not look as deformed as this woman's curve. In fact, the first time I had an appointment with a surgeon, he looked at my back and said that my scoliosis was not large enough to be seeing a surgeon. He was surprised when he looked at my xrays.

[Pooka1]

You cannot tell how large someone's curve is by how they look. I had a 50+ degree thoracic curve before my surgery and my back did not look as deformed as this woman's curve. In fact, the first time I had an appointment with a surgeon, he looked at my back and said that my scoliosis was not large enough to be seeing a surgeon. He was surprised when he looked at my xrays.

Yes I agree with that. I have been tentative in talking about her curve other than I think it is very big.

Smaller curves escape detection frequently for this reason. When you can easily see the curve and rotation in Fraser's back, it is an indication that the curve is truly large. Given you comment about your back, I am going to suggest her curve has to be north of 60 or more degrees.

If she was 32 as a freshman and it is about 10 years later (not sure) then she might be progressing at about 3 degrees a year. Of course that is VERY speculative!

[Pooka1]

Okay I re-read the original article and I think I understand the timeline.

She did NOT say the surgeon told her she needed sugery when she was first diagnosed with a 32 degree curve. I think the surgeon suggested surgery when it progressed into surgery territory a few years later.

That makes the most sense of what has been posted about this.

[flerc]

I think it would be compatible with what I have heard in Tv.

[flerc]

The big question now is: What's going to happen when she quits active ballet?
If she ever stops her vigorously active ballet exercises she will quite likely experience what most of us do ... a worsening of her scoliosis and the pain and disfigurement that goes with it.

Maybe or not. I think she has not a big curve and for 'most of us', I suppose you are referring to people on this forum, but I know people who are fine even having really a big curve and they don't write in any forum. Maybe anyway she will need to do some physical but not necessary hard activity all her life, who knows? but which is your point? Do you think that her father was wrong refusing what her surgeon recommended her?

[LindaRacine]

I don't think it's ever really wrong to avoid surgery, as long as the curve(s) aren't in a high danger area (>40 degrees and skeletally immature, >80 degrees and skeletally mature, rapid progression, etc.). Every case has to be judged on its individual merits. We often see semi-professional athletes and dancers who are in what is widely considered to be a surgical range. The majority of our surgeons will recommend surgery, but at least one conservative surgeon usually tells the athletes to try to avoid surgery by getting involved in a good program like yoga or Pilates for scoliosis. If the person is outside of said "danger area", there's relatively little risk to waiting. And, while some athletes and dancers do just fine if they can get away with a limited thoracic fusion, there's no guarantee that they'll be able to continue competing. This particular group of people are probably more likely to be successful with a long-term exercise program, as they're already used to that way of life. If I were in their shoes, I would almost certainly choose to wait.

With that said, I also don't think it's wrong for someone to go ahead with the surgery if that's what they want.

I think all we can do is give everyone as much information as possible so they can make an informed decision that's right for them. Unfortunately, I think that so many of the charlatans that are discussed here are clouding the issues. I seriously doubt that any chiropractor is going to keep someone whose natural history is going to give them a large curve, from having that large curve. I do think it may be possible for a good exercise program to potentially help someone avoid surgery. That's just an educated guess. There's absolutely no proof that any alternative program can help someone avoid surgery in the long term.

--Linda

[Pooka1]

I don't think it's ever really wrong to avoid surgery, as long as the curve(s) aren't in a high danger area (>40 degrees and skeletally immature, >80 degrees and skeletally mature, rapid progression, etc.). Every case has to be judged on its individual merits.

It's an interesting question about is it ever wrong to avoid surgery. I think Linda has set out some examples where the consensus of medical opinion would be that it is probably better to have surgery than not. Certainly there is a overwhelming consensus to fuse the "typical" large thoracic curves in adolescents when there is growth remaining. That is the clear standard of care as far as I can tell.

Beyond that, I think the answers are different for an adult making the decision for themselves or a parent making a decision for their child.

For me as a parent, besides the consensus on fusing large progressing T curves in growing adolescents, I think it is wrong to avoid surgery for a child if they are likely to need a fusion or longer fusion into the lumbar if you wait. There is at least one testimonial on this site about a surgeon operating on a kid below the surgical threshold for the purpose of saving more of the lumbar. That's the surgeon I would seek out.

For a parent or a patient, I think it is always right to delay lumbar fusion and TL fusion that is expected to be extended to through the lumbar unless there is the potential for permanent nerve damage. I think it is right to delay fusion even if the later fusion will extend further into the thorax for waiting.

For a patient like Paige Fraser, I think it is correct to delay surgery to have a dance career but she should be completely debriefed on whether or not that will require a longer fusion into the lumbar at a later time or not. It might be a rational choice to trade a career in dance now for losing your lumbar later. It is her decision and there is no right or wrong answer. And she should be absolutely clear on the outcome if she ignores radiculopathy if she develops it. Some things have time windows and lay people have no clue about that.

[flerc]

Is not possible to be sure if she would need surgery (not necessarily fusion) or not regardless if it would be long or not. Some old people with big curves never needed surgery and younger people with not big curves are worse. Surgeons and nobody may ensure her nothing. Some lay people have no clue about that.

[flerc]

And of course the decision should be taken not only because her career but her life! What if now she have not pain and after surgery she begin with pain that never she felt? What if she feel rigidity, if she wants to have again the body that she had?