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  1. #1
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    Other Surgeries to Fix Scoliotic Problems

    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?
    Last edited by Tina_R; 09-09-2020 at 08:43 PM.

  2. #2
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    Quote Originally Posted by Tina_R View Post
    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.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  3. #3
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    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
    Decompression surgery L4/L5
    April 3, 2015
    Twin Cities Spine Center - Dr. Joseph Perra
    Fused from T11 - Sacrum anterior/posterior
    June 24, 2016 - 55 years old at surgery
    Twin Cities Spine Center - Dr. Joseph Perra
    Before Surgery: 42 degrees lumbar, 28 degrees thoracic
    After Surgery: 10 degrees lumbar, ?? Thoracic
    2 inches taller

  4. #4
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    Quote Originally Posted by KathyInIowa View Post
    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
    Isn't it terrible when surgeries interfere with big events in your life.
    Was your scoliosis entirely adult onset? You didn't have a trace of it before, or you just didn't realize it?
    I think I had mine all my life but the curve increased very slowly if at all for a long time. It got bad when I approached 50, probably worsened by general deterioration of the skeleton from age. Then the curvature increased noticeably. Then I felt symptoms.
    Last edited by Tina_R; 10-13-2020 at 11:00 AM.

  5. #5
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    Quote Originally Posted by Tina_R View Post
    Isn't it terrible when surgeries interfere with big events in your life.
    Was your scoliosis entirely adult onset? You didn't have a trace of it before, or you just didn't realize it?
    I think I had mine all my life but the curve increased very slowly if at all for a long time. It got bad when I approached 50, probably worsened by general deterioration of the skeleton from age. Then the curvature increased noticeably. Then I felt symptoms.
    My case is similar to yours - I probably had a slight case when I was younger and it went undetected. I had "low back pain" for most of my adult life - starting in my early 20s but pretty tolerable. I just dealt with it. It did get worse as I got older, but it was all muscular pain that I could handle. There was nothing noticeable about my spine being slightly crooked. At some point around my early 40s, my rib hump appeared but I didn't know what it was. I went to a local orthoped and he said that was the "classic scoliosis hump - how long have you had that?" I had noticed about 4 months prior to that appointment. He did scoliosis xrays and my curve was around 24 degrees. He said that in adults it usually doesn't change much. But mine did, - my curve was getting about 2 degrees worse per year. By age 52 I was having all sorts of issues but was still fairly active so they weren't really treating me. By age 54 I was when it got really bad and I had surgery at age 55.

    By the time of my surgery, my curve was around 32 degrees - so not really all THAT bad - but it was pain the drove me to surgery. I had everything on the list: rotted discs, the one half decent disc had ruptured, stenosis, nerve impingement....

    I had a great outcome, all things considered. I still have residual "pains" that we all probably have - but they are very tolerable - nothing near what they were before surgery.

    My surgery was at TCSC - so I felt that I was in good hands. I am going up next week for my 4-year follow up x-rays. Hopefully I will hear that my nothing has shifted and it all still looks good!!

    Kathy
    Decompression surgery L4/L5
    April 3, 2015
    Twin Cities Spine Center - Dr. Joseph Perra
    Fused from T11 - Sacrum anterior/posterior
    June 24, 2016 - 55 years old at surgery
    Twin Cities Spine Center - Dr. Joseph Perra
    Before Surgery: 42 degrees lumbar, 28 degrees thoracic
    After Surgery: 10 degrees lumbar, ?? Thoracic
    2 inches taller

  6. #6
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    Kathy, I remember when you were done, but I had to go back and look at your x-rays in your first post. You had a mild S curve, but you had a decent sized spondylolisthesis (slippage) in your lower lumbar which looks quite painful....wow! I would guess that your surgeon didn't offer any alternative's for this....

    I had a good spondy at mid back around T8 orT9 from a hard ski crash when I was around age 30. After a few Chiropractic adjustments and some time, it didn't show up on x-rays anymore, and was never seen again on x-ray. I have read that thoracic disc herniations usually happen from traumas. I must have really hit my ribs hard on that one. I skied on edge all the time and didn't crash much, but when I did, they were doozies and usually broke something. Either equipment or body.

    Discovering your rib hump in your early 40's sure is late. (From the congenital, early onset, and idiopathic patient point of view)

    Here is some material on Degenerative Scoliosis. This is a good review.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192887/

    ================================================== ==============================

    Kathy, I think there is a scoliosis surgical museum or Dr Moe exhibit at TCSC or somewhere in Minneapolis. Can you ask when you get there? Old scoliosis casts, Stryker frames, Metal braces, racks, screws, x-ray machinery, surgical tools, etc. That sort of thing.
    I would be extremely interested in visiting...

    I just discovered the Museum of Surgical Science Chicago....I didn't know this was there.
    https://imss.org/plan-your-visit/#cost
    https://imss.org/pain/


    Glad you are doing well...

    Ed
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  7. #7
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    Quote Originally Posted by KathyInIowa View Post
    My case is similar to yours - I probably had a slight case when I was younger and it went undetected. I had "low back pain" for most of my adult life - starting in my early 20s but pretty tolerable. I just dealt with it. It did get worse as I got older, but it was all muscular pain that I could handle. There was nothing noticeable about my spine being slightly crooked. At some point around my early 40s, my rib hump appeared but I didn't know what it was. I went to a local orthoped and he said that was the "classic scoliosis hump - how long have you had that?" I had noticed about 4 months prior to that appointment. He did scoliosis xrays and my curve was around 24 degrees. He said that in adults it usually doesn't change much. But mine did, - my curve was getting about 2 degrees worse per year. By age 52 I was having all sorts of issues but was still fairly active so they weren't really treating me. By age 54 I was when it got really bad and I had surgery at age 55.

    By the time of my surgery, my curve was around 32 degrees - so not really all THAT bad - but it was pain the drove me to surgery. I had everything on the list: rotted discs, the one half decent disc had ruptured, stenosis, nerve impingement....

    I had a great outcome, all things considered. I still have residual "pains" that we all probably have - but they are very tolerable - nothing near what they were before surgery.

    My surgery was at TCSC - so I felt that I was in good hands. I am going up next week for my 4-year follow up x-rays. Hopefully I will hear that my nothing has shifted and it all still looks good!!

    Kathy
    Kathy, I was 10 years older than you when I had my surgery and I probably should have gotten it done sooner, by your age.
    I thought they never straightened curves as small as 32 degrees but waited until they got larger. Or is pain the determining factor, maybe it's teens that wait until their curve gets larger? I forget what Linda said.
    Last edited by Tina_R; 10-17-2020 at 11:08 PM.

  8. #8
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    Quote Originally Posted by LindaRacine View Post
    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?

  9. #9
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    Quote Originally Posted by Tina_R View Post
    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.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  10. #10
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    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.
    Last edited by Tina_R; 10-01-2020 at 06:47 PM.

  11. #11
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    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.
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  12. #12
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    Quote Originally Posted by Tina_R View Post
    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
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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