Considering surgery at age 69.

[Linda Foshee]

Hi, My name is Linda Foshee. I have thoracolumbar scoliosis. The lumbar is 50 degrees and the thoracic is in the upper 40 range. I have degenerative disc disease, osteopenia I believe a -1 but not sure and several other age related issues in the spine. The reason I am considering surgery is due to spinal stenosis. I have radiating pain in my leg, numbness, pins and needles, etc. I developed balance problems and trip frequently. Only one fall so far. The surgery will be from T-5 to the pelvis. Anterior and posterior. Health is pretty good. I am afraid to have the surgery but also not having surgery. If I fall and fracture my spine or hip, which is likely, I would need to live in a skilled nursing facility. I started PT almost two years ago and am committed to following the exercises. I walk almost daily. The pain comes and goes but is increasing in intensity. I’m not active, as in being out in the community, but I am involved with my grandkids and don’t want to lose the ability to play. I met with Dr Ames at UCSF (zoom). Plans to have surgery are moving forward. I’ve been reading a lot about scoliosis and spinal stenosis. I am aware of the risks. If you have any suggestions about having surgery or not please let me know. Thank you

[titaniumed]

Welcome to the forum Linda....

UCSF is an incredible place.....Linda Racine, our moderator used to work at UCSF in spine, and has organized several scoliosis patient meetings in the past which were fantastic....I met with several of the surgeons there, but not Dr Ames since it was many years ago. Chances are very high that he will tag team with one of the other scoliosis surgeons....I guess you should ask at some point who it will be. They will also use a vascular or general surgeon for ALIF. There will be a bunch of top specialists for your procedure, some of the best in the world. Heck, the Hippocrates statue on Parnassus Ave will probably help also! You might have noticed he is a bit on the quiet side.... (Scoliosis forum humor)

With adults over age 40, pain usually makes our decisions. If I didn't have a lot of pain, I wouldn't have had surgery and really didn't have a choice. The sciatica leg pain was excruciating (flames and horse kicks) and all alternatives just didn't last as long. It was a LONG battle living with scoliosis and I ran out of time.

Nobody can tell you to have surgery....It's our own personal decision. There were a few things that flipped on that green light with my decision. First, hearing my surgeon state that it will help. They don't do these surgeries unless they think it will improve the situation. Second, was hearing from a full fusion patient to do it. You have to hear it once. Third, was watching the Discovery Channel Juma Genda graphic video with Dr Boachie, 2006 (Incredibly difficult case) and thinking if Juma can make it, so can I. I can do this. I watched it several times the year before my surgeries. Thank you Dr Boachie! (and Juma)

We can have central stenosis or narrowing from the spinal cord, usually from disc herniations. We can also have foraminal stenosis from the exiting nerve roots left and right on each level. ALIF discectomies are very effective on disc removal, and the spacers or cages used separate out vertebrae and create room for these nerves. When I was in ICU standing up by my bed, I knew all these particular neuropathic sciatica pains were solved. It was one of the immediate results from scoliosis surgery, but the recovery took 2 years. I was 90% recovered at 1 year. Staged full fusion A/P's are big surgeries. It was a 2 day flip. They did an L1-Pelvis ALIF.

I had no choice, it had to happen, and it worked. I was guaranteed 100% complications, but told my surgeon I was going to hang in there. I had powerful powers of recuperation. High anxiety happened and then a few days before, that dropped off because you know you have no choice. When my vascular surgeon asked me if I was nervous in the stage area, my response was "Am I supposed to be?" I installed the faith....and had it after during my recovery.

Its not an easy decision. I was a Luque wire candidate in 1975 and waited for technology which has progressed leaps and bounds over the last 50 years....

Ed

[jackieg412]

Hi and welcome to the forum. You will find great information here. No one can really help you making the decision for surgery. Maybe a family member. Find a surgeon you can speak openly with and discuss the medical point of view.
At an older age there is always something but make sure to discuss that. Just know that if you are active in your life now that you want to continue that for as long as possible.
Once you trust your decision, the rest moves forward.
Stay as healthy as you can and read information that you find. There is a lot of information on spine surgery and recovery.

[Linda Foshee]

jackieg412
Thank you for reaching out. I didn’t know how informative this forum would be so am very happy that I joined. I will continue to stay informed and will add this to my list of searches. Thank you for Your recommendations, they are very helpful. I saw from your list of surgeries that you have been through a lot. I hope you are doing well. Thanks again, Linda

[Linda Foshee]

titaniumed

Thank you for your reply. I appreciate the information about UCSF. It helped calm some anxiety that I had regarding the surgery. Regarding the doctors, I thought Dr Ames, an orthopedic surgeon and a vascular surgeon would perform the surgery but that was a guess. What other doctors will be involved? Do you know what their role would be? What does tag mean in surgery?
I watched the video. It was hard to watch but I did learn from it. It is quite amazing.
Thank you for including your photos. The photos answered questions that I had.
Again, thank you. I need to keep this short as I have some difficulty processing what I want to say.
Linda Foshee

[LindaRacine]

titaniumed

Thank you for your reply. I appreciate the information about UCSF. It helped calm some anxiety that I had regarding the surgery. Regarding the doctors, I thought Dr Ames, an orthopedic surgeon and a vascular surgeon would perform the surgery but that was a guess. What other doctors will be involved? Do you know what their role would be? What does tag mean in surgery?
I watched the video. It was hard to watch but I did learn from it. It is quite amazing.
Thank you for including your photos. The photos answered questions that I had.
Again, thank you. I need to keep this short as I have some difficulty processing what I want to say.
Linda Foshee

Hi Linda...

Dr. Ames almost always operates with Dr. Vedat Deviren when he does complex spine surgeries. Dr. Deviren is an Orthopaedic Surgeon, so you'll likely have the benefit of both techniques. I don't think they do a lot of ALIFs (I can't recall, but I think they mostly do TLIFs when operating on the front of the spine is necessary), so I think the thought that you'd have a vascular surgeon in on your surgery is questionable. When Dr. Ames and Dr. Deviren work together, they traditionally each do one side of the surgery. As you'll see from the links below, having two attendees working at the same time, greatly reduces surgical time and blood loss.

https://spinecenter.ucsf.edu/surgica...-spine-surgery
https://www.eurekalert.org/news-releases/535743

--Linda

[Linda Foshee]

Linda, Thank you for the information. I wonder if the doctor would use the ALIF for the stenosis which is in the lower lumbar area. I thought I heard him say that term but I could be wrong. My hearing isn’t the greatest. I checked the videos that you sent. I did see that video but didn’t know if the surgeons were still working together as a team. Having both, orthopedic surgeon and neurosurgeon, is great for the patient. I will read up on TLIF, Thanks again, Linda

[Linda Foshee]

Linda, I was just thinking about the surgery. I believe Dr Ames said it would be a two day surgery. The front one day for two hours and the back the second day for three hours. Which one sounds like this? Thanks again, Linda

[titaniumed]

titaniumed

Thank you for your reply. I appreciate the information about UCSF. It helped calm some anxiety that I had regarding the surgery. Regarding the doctors, I thought Dr Ames, an orthopedic surgeon and a vascular surgeon would perform the surgery but that was a guess. What other doctors will be involved? Do you know what their role would be? What does tag mean in surgery?
I watched the video. It was hard to watch but I did learn from it. It is quite amazing.
Thank you for including your photos. The photos answered questions that I had.
Again, thank you. I need to keep this short as I have some difficulty processing what I want to say.
Linda Foshee

Since you state a 2 hour ALIF, it sounds like this will be on the L5-S1 level. It's the lowest level. They can also fuse the level above that (L4-L5) in the same opening which is about a 2-3 inch horizontal or vertical off to the side. I don't know if a vascular surgeon is required for these levels. I don't think so since the aorta and vena cava are not involved on those levels.

My front incision runs all the way up to my sternum and is about 18" long. Surprisingly, I did not have much pain from the front incision and it all healed up nicely.....Most of my pain came from the large pelvic anchors which ached for exactly 3 months. (And lower GI issues from paralytic ileus) Sometimes this happens on abdominal surgeries. They have meds for this and they do resolve. It's one of the complications that can happen.

Tag teaming is when people work together.

It all sounds ok and you are at a great place with great surgeons.

You do realize that there will be pain involved. I would address this. Also, there is a high chance that you will have to do a rehab facility after the hospital for about a month. Have you ever done any surgeries under General Anesthesia?

These procedures are very expensive and co-pays need to be addressed before. Co-pays have changed, and not for the better. Might be time to increase your supplemental policy.

Recovery takes time and patience.....Some of the photos I have are a pretty good case scenario for full fusion. After my surgeries, I never thought I would be able to reach my feet ever again, but that all changed in 2 years. It's still not a super easy thing getting to my feet, let's just say that pedicures will be needed. I can tie my shoes on the floor, but not all can do this. We use open slip on shoes in recovery.

I did not pre donate my blood and I went off the blood bank. You will need transfusions....I needed more about a week later in the hospital and after 2 units, that was a breath of fresh air. I don't know what was up with my blood chemistry but it worked like a charm.

Ed

[LindaRacine]

Linda, I was just thinking about the surgery. I believe Dr Ames said it would be a two day surgery. The front one day for two hours and the back the second day for three hours. Which one sounds like this? Thanks again, Linda

Yes, if it's two stage, then it's probable that they will be doing at least one from the front of the spine. It could be ALIF, but it could also be XLIF, DLIF, or who knows what they've come up with since I retired.

[Linda Foshee]

Linda, I verified the surgery details with Chrystal, the PA. The surgery will be a ALIF from L4-S1 with a vascular surgeon. The second day will be the T5-pelvis fusion. I know that this is not as bad as many others have gone through but I am terrified. So glad I found the forum. Linda

[Linda Foshee]

I was reading about doctors recommending surgeries that are not needed. How do you know when a surgery is actually needed? For me the stenosis pain, tripping and falls is what I want resolved not necessarily the scoliosis. I assume the scoliosis needs to be addressed once the stenosis is corrected? Also the mind body connection is interesting however can the mind cause the weakness and balance problems from nerve pressure? The last thing I want to do is have surgery when it is not needed. So much to learn. Thanks for any help you can offer. Linda

[LindaRacine]

I was reading about doctors recommending surgeries that are not needed. How do you know when a surgery is actually needed? For me the stenosis pain, tripping and falls is what I want resolved not necessarily the scoliosis. I assume the scoliosis needs to be addressed once the stenosis is corrected? Also the mind body connection is interesting however can the mind cause the weakness and balance problems from nerve pressure? The last thing I want to do is have surgery when it is not needed. So much to learn. Thanks for any help you can offer. Linda

Scoliosis surgery is almost always optional. Many people choose to live with the pain, disability, and deformity. I think most older patients who choose to have surgery, do so because of the pain.

Your tripping and falling probably aren't a direct result of your scoliosis, and correcting your curves may or may not help with your balance. While my curves are fairly well balanced since surgery, I still have relatively serious balance issues. There's a lot of research on the subject of balance and scoliosis. Check some of it out HERE.

In patients without scoliosis, stenosis can sometimes be addressed with a simple decompression surgery. Decompression without fusion in patients with scoliosis is rarely successful. Lastly, stenosis can be addressed with shorter fusion techniques in some patients. Here's a study from UCSF that addresses the issue: https://pubmed.ncbi.nlm.nih.gov/30717041/

--Linda

[titaniumed]

tripping and falls is what I want resolved

Linda, have you had a physical examination? Have you met with your surgeon in person? If not, you should go in.

Here is a video...Low back exam.
https://stanfordmedicine25.stanford..../BackExam.html

There are a whole host of physical tests that doctors do in person. They can tell a lot about you, but only in person. And not just scoliosis related issues. I have been amazed in the past.

How often are you tripping and falling?

Ed

[Linda Foshee]

I had more scans. MRI of the cervical spine, first one. I am not an expert but the findings don’t look great, however, the cord is not damaged. There is contact with the cord in several areas from disc bulges and osteophytic ridges. Other areas have severe neural foraminal stenosis. Also have a reversed lordosis of the cervical spine. I haven’t heard from the spine team if there is a decision about what was found. I also had a CT of the lumbar, thoracic and cervical spine. Nothing new from three months ago on the lumbar. Thoracic has problems as expected. Linda, do you know what the process is in regards to processing or approving a patient for surgery? Length of time or extra tests? Thank you, Linda