Other Surgeries to Fix Scoliotic Problems

[Tina_R]

Is it possible to treat the symptoms of scoliosis with other surgeries besides fusion surgery?

I know that no other surgery straightens spinal curves. But maybe you don't care about being straight. You have a problem that the curvature caused and you want the problem taken care of with surgery that isn't as invasive and body-altering as fusion.

Me, for instance. My lumbar curve caused muscle strain and a pinched nerve that affected my walking. Alleviating the strain on the muscles probably requires straightening the curve. But fixing the pinched nerve might be possible with another kind of orthopedic surgery, a "release" surgery that carves out the area of bone that is impinging on the nerve.

Anyone have any experience with or information about something like this or reaction to it?

[LindaRacine]

Is it possible to treat the symptoms of scoliosis with other surgeries besides fusion surgery?

I know that no other surgery straightens spinal curves. But maybe you don't care about being straight. You have a problem that the curvature caused and you want the problem taken care of with surgery that isn't as invasive and body-altering as fusion.

Me, for instance. My lumbar curve caused muscle strain and a pinched nerve that affected my walking. Alleviating the strain on the muscles probably requires straightening the curve. But fixing the pinched nerve might be possible with another kind of orthopedic surgery, a "release" surgery that carves out the area of bone that is impinging on the nerve.

Anyone have any experience with or information about something like this or reaction to it?

Depending on one's age, some much older patients have gotten relief from smaller surgeries. Unfortunately, doing smaller surgeries on middle aged adults, often (if not always) leads to destabilizing curves, causing even worse structural issues.

[KathyInIowa]

My adult onset scoliosis was mostly my lumbar - I am fused T11-Sacrum. 4 of my lumbar discs were basically dried up and gone - but I still had a little bit of my L4/L5 disc. I ended up rupturing that and so I had the nerve pain all the way to my foot. After awhile, I couldn't stand for more than 2 minutes without horrible pain and same for walking - I could barely go 1 block without pain.

At the time, I had 2 daughters engaged and I wasn't willing to have my fusion surgeries before their weddings in case I had a "bad outcome." 4 months prior to the 1st wedding, I had a discectomy to relieve the sciatica pain. It did help somewhat. (of course I still had tons of back pain from bone on bone and all sort of other issues but at least I could walk).

In the 11 months before the next wedding, I could tell I was getting worse. I believe the discectomy destabilized my spine and made me worse. At the time, my surgeon said "This is a bandaid surgery. If you choose this option, I guarantee you I will be seeing you again." But, he understood my predicament and was OK with my choice.

So, you can probably have a smaller surgery and relieve some pain, but in my experience it did make my spine "crumble" faster....

Kathy

[Tina_R]

Depending on one's age, some much older patients have gotten relief from smaller surgeries. Unfortunately, doing smaller surgeries on middle aged adults, often (if not always) leads to destabilizing curves, causing even worse structural issues.

But haven't you said that the size of the curve doesn't matter in adults?

[LindaRacine]

But haven't you said that the size of the curve doesn't matter in adults?

That is correct. Not all surgeons use the same procedures. Doing smaller surgeries to fuse just the degenerative segments in patients with degenerative scoliosis is usually done by more conservative surgeons. The majority of surgeons seem to treat these patients just like other scoliosis patients, and choose to fuse their entire curve(s). At UCSF, Dr. Berven is well known for doing more conservative procedures when he thinks there's a good possibility that he can get a patient out of pain without doing a bigger surgery. In those patients, there is always a risk that they will have further degeneration that might require additional surgery, but at least by the time I retired, the vast majority of these patients had not required additional surgery.

[Tina_R]

I've read and appreciate your answers, but I'm bothered that fusion is commonly depended upon as a cure-all. Patient has scoliosis, therefore scoliosis is causing all patient's problems. Fusion straightens spine, a straightened spine should relieve all problems.

It doesn't always work that way. I don't think a fusion always cures all the related pain and other problems. Those can remain after the fusion. This is what I am left with.

I have been unable to walk well and have been telling my surgeon for months (and getting nowhere). I had a problem even before the fusion surgery but it felt slightly different. It isn't clear to me whether the original problem was never fixed by the fusion or whether the fusion surgery introduced a new problem. Or both.

Finally I saw a neurologist who administered an EMG test. The findings: I have nerve compression in my lumbar which is weakening several leg muscles and is the reason I can't walk well. I just discovered a hollow area in the muscles of one thigh. The neurologist with his trained eye says that that whole leg is slightly smaller -- I have atrophied muscles.

I'm not sure this is fixable now. It's been this way for too long.

I think I should have had a more specific surgery that would have targeted my pinched nerve originally.

THEN it could have been followed by a fusion once it was shown that the first surgery fixed the nerve.

Instead I got a fusion that didn't solve that problem.

The next step is a lumbar MRI for the neurologist. With my hardware it's difficult to read MRIs, the metal obscures a lot of the imaging. I'm not confident they'll be able to find the source of the problem with the imagery.

[jackieg412]

You could ask if a myelogram could help show the problem. It is also possible to use the myelogram to diagnose a condition called arachnoiditis. It can cause some of the problems you have spoken about.

[LindaRacine]

I've read and appreciate your answers, but I'm bothered that fusion is commonly depended upon as a cure-all. Patient has scoliosis, therefore scoliosis is causing all patient's problems. Fusion straightens spine, a straightened spine should relieve all problems.

It doesn't always work that way. I don't think a fusion always cures all the related pain and other problems. Those can remain after the fusion. This is what I am left with.

I have been unable to walk well and have been telling my surgeon for months (and getting nowhere). I had a problem even before the fusion surgery but it felt slightly different. It isn't clear to me whether the original problem was never fixed by the fusion or whether the fusion surgery introduced a new problem. Or both.

Finally I saw a neurologist who administered an EMG test. The findings: I have nerve compression in my lumbar which is weakening several leg muscles and is the reason I can't walk well. I just discovered a hollow area in the muscles of one thigh. The neurologist with his trained eye says that that whole leg is slightly smaller -- I have atrophied muscles.

I'm not sure this is fixable now. It's been this way for too long.

I think I should have had a more specific surgery that would have targeted my pinched nerve originally.

THEN it could have been followed by a fusion once it was shown that the first surgery fixed the nerve.

Instead I got a fusion that didn't solve that problem.

The next step is a lumbar MRI for the neurologist. With my hardware it's difficult to read MRIs, the metal obscures a lot of the imaging. I'm not confident they'll be able to find the source of the problem with the imagery.

Tina...

It's not always possible to know the cause of a patient's pain. Because of the curvature of the spine, it's not always obvious that there's nerve root impingement (that is, I think the curvature can hide problems). Did your surgeon order a CT myelogram prior to your surgery? I think that's often done, especially when patients are known to have leg pain.

At this point, it's possible, as you say, that the damage is permanent. But, it also might not be. It is possible to do a decompression, even after a fusion, although I'm unclear about whether it's always possible. I agree with Jackie, that a myelogram would potentially be diagnostic at this point.

--Linda

[Tina_R]

The next step is an MRI with dye injected, I think. Is that a myelogram? I have had CT scans with something that warms the body, but I don't remember if it was in connection with either of my fusion surgeries.

[Pooka1]

The next step is an MRI with dye injected, I think. Is that a myelogram? I have had CT scans with something that warms the body, but I don't remember if it was in connection with either of my fusion surgeries.

(your mailbox is full.)

[jackieg412]

If the dye is injected into your spinal cord area it would be similar. But all the myelograms that I have had it is the dye and then CT scan.

[LindaRacine]

The next step is an MRI with dye injected, I think. Is that a myelogram? I have had CT scans with something that warms the body, but I don't remember if it was in connection with either of my fusion surgeries.

If your pain area is at or near an instrumented fusion level, I don't think an MRI will be of any use. I'm not, however, a doctor.

--Linda

[Tina_R]

If the dye is injected into your spinal cord area it would be similar. But all the myelograms that I have had it is the dye and then CT scan.

I'll let you know what they do after I have it done. Still waiting for it to be scheduled. I thought I heard "MRI" and "injection".

[Tina_R]

If your pain area is at or near an instrumented fusion level, I don't think an MRI will be of any use. I'm not, however, a doctor.

--Linda

Almost all my levels are fused. Somehow the neurologist thinks another lumbar MRI will be useful. The EMG test told him the probable vertebrae where the nerve is being pinched. I guess he's hoping an MRI will confirm his hunch.

Funny how you and Titaniumed talk about pain a lot. I never mentioned pain. That's not my issue and never has been. Being unable to control my legs is my issue. It makes me think my experience is very different from both of yours, and from most other people's.

I do have post-surgical pain of all sorts, and widespread numbness. I'm more concerned with what the pain might signify rather than alleviating the pain itself. And I'm concerned with function. My legs not functioning is a big deal. It's alarming if it's getting worse, which I think it is. Not being able to drive and then maybe being in a wheelchair is something I want to avoid.

There's no one pinpoint area of pain on my spine where you can say that coordinates with the nerve pinching that is affecting my leg(s).

[jackieg412]

Linda said everything I know about MRI's not being helpful because of the hardware. However, when I was in a major accident with a broken neck I had a CT scan that proved that . But because of the pain I was having throughout my torso the neurosurgeon knew there could be more. So he had an MRI scan also, one even with the hardware it showed 2 large blood clots in the epidural space spanning both the cervical and the thoracic.
Don't be afraid to question the test. You have a right to know what he is looking for and the right to question the reason behind the type of orddr.