
Originally Posted by
curlygirl
I am 65 years old and had fusion in 1976 with Harrington rod, was corrected from 49 degree lumbar curve to 23, but it later went to 37, where it stabilized for many years. It’s been gradually getting worse, and rod has been broken for a long time. I went for x-ray last week and it got 6 degrees worse in past year and is now back at 49. It’s very deforming looking but I don’t have any pain or functional problems. However, I’m concerned about future progression. My x-ray last week was with Dr. Dennis Crandall’s practice here in Phoenix, but unfortunately there is a very young NP who is a gatekeeper, and you can’t see a doctor unless she thinks you are a surgical candidate. Wanting to see an actual doctor, I went to see the other good scoliosis specialist here, Bill Stevens. He thought I would be a good case for a medical ethics class – do you operate on someone like me? But ultimately, he looked at my bone density, and it is at about the lowest he would accept and that my time frame for any intervention is this year before bone density gets any worse. I’ve been on Forteo and am currently on Prolia and have used other osteoporosis meds in the past, and do everything I can to help bone density. He suggested that because of age/bone density, he could do a fusion that would keep me from getting worse – in other words, not remove old hardware or do osteomoties, just stabilize me. It would be anterior/posterior a couple of days apart and fuse to S1 or S2.I’m not sure which. Curve level would stay the same but he said he could better “balance” me – I didn’t quite get what that means and if that would result in a visual improvement. Does this sound like a good approach? Should I seek another opinion, and if so, where? I’m in Phoenix but willing to travel for the best outcome. I kind of like this conservative approach but any surgery does worry me at my age. Dr. Stevens said I’d be walking a mile a day a month post-op. Sorry so long, would greatly appreciate your thoughts. Bonus points if anyone has had personal experience with Dr. Stevens!
Hi...
I've never seen Dr. Stevens professionally, but know him from the time he was a fellow at UCSF. I think he's giving you good info. It sounds like he's saying he can keep your curve from progressing, but that it won't change how you look.
If I were in your situation, I would not have surgery. I think I would watch for a couple of years, to see if your curve continues to progress. Even if it does progress, there's not necessarily a reason to have surgery. Here are the reasons why I would choose to avoid surgery in the short term:
*You currently have no pain. There's a very realistic possibility that the surgery will cause long-term pain, and even if you progress, you may never have pain if you don't have surgery.
*You have poor bone quality.
*Curve progression might be completely benign. Even if your curve increases, it's unlikely to cause any issues with things like heart, lungs, or abdominal organs.
*Fusion to the sacrum may severely limit your flexibility. This doesn't happen to everyone, but in my own case, it's the thing I hate the most about having had my fusion extended to the sacrum.
*Surgery at 75 isn't much more risky than it is at 65.
I'd be happy to talk with you more in depth if you feel the need. Best of luck with your decision.
Regards,
Linda
Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation