View Full Version : Your valued opinion please

23-09-2010, 03:35 PM
Hi Dr S,

Help! Ahhhh!!! As I've mentioned on the forum here, our 15 year old is due for revision surgery on the 30th November. She was fused T5 - L1 at age 13, Risser 0 and now has some crankshafting and rotation occuring again through her Thoracic and now a curvature occuring in her lumbar. A tilted L2 vertebrae!

Our 15 year old has been suffering from depression regarding the upcoming surgery, having already been through this once. Her back pain that she was having has now diminished somewhat due to her sports season concluding! She now is refusing to have this surgery stating "I will have it when I finish year 12"

Whilst it's ultimately her decision, I'm worried on a number of accounts, firstly that she's against this surgery for all the wrong reasons, ie, interferring with summer holiday plans, being very self conscious of her privacy, the scary thought of "I know EXACTLY what I'm in for this time"

Since she has now completed her growing and is now at Risser 5 - do you think that delaying this surgery for another few years will alter the outcome? By that I mean, our surgeon has said it's a relatively easy surgery to do now, being so young. I'm worried that waiting 2 more years for this, her curve will worsen and the surgeon have to go lower than L3. It's not really a curve, we were told that it's a "tilt" of the L2 vertebrae and that it was unrelated to the crankshafting happening in the thoracic.

By all accounts the crankshafting shouldn't get worse since she's stopped growing. The back pain should be kept at bay IF she avoids strenuous contact sports. I know it's difficult for you to give opinions without seeing x-rays etc but I thought it worth posting this for your opinion.

Thanking you in advance

Dr Scoliosis
24-09-2010, 04:07 PM
Thank you for your further enquiry.

You are correct that it is not possible to give "opinions without seeing x-rays etc" and indeed it would be unprofessional to do so. The object of Dr Scoliosis' role in the forum is to give advice or comment on general principles only. This can sometimes allay anxieties and improve understanding.

I note your daughter is now 15 years old and is refusing to have the surgery. If she was 6 years old you would make the decision for her. In due course it is she who will make a decision about placing you in a Sunshine Home. However, if she is at the stage where she is refusing to undergo the surgery then you have very little room in which to manoeuvre.

You have been told that she is a Risser 5 which simply means that vertebral growth will have ceased. That is not the same thing as skeletal maturity and it is a rough guideline most commonly used at a point when a curve which is being managed by brace-wearing can move to part-time bracing under close supervision. Many curves will still progress to a variable degree after Risser 5 has been attained and this is the fusion of the iliac apophyses (see our website on the role of the radiologist (http://www.scoliosis-australia.org/scoliosis/radiologist_role.html) for an explanation of the Risser sign).

If a patient is thought to have acute appendicitis, that is an emergency and the appendix must come out as soon as it can possibly be arranged and almost invariably that day. Scoliosis surgery is never an emergency. In general terms scoliosis surgery is a truly elective procedure, that is, the surgery is carried out at a time which is convenient to both the patient and the surgeon. The Dr Scoliosis on duty frequently schedules a very large part of his clinical load over the Christmas holidays which gives the patients time to recover well before returning to school. Hence, and you should confirm this with your surgeon, it will probably not affect the long-term outcome to any significant degree if the surgery is held over until your daughter has finished schooling. There may be another reason for early intervention and this you should clarify.

We trust this advice is helpful.

06-10-2010, 01:39 PM
Thanks Dr S,

After thinking things through, Leash has decided to proceed. I'm scared! How many revision surgeries on young adolescents do you think are performed in Australia on average??? In the states they have special revision surgeons. How is this addressed here in Australia with such a small population? I didn't even want to ask our surgeon how many of these he had performed previously - I didn't want to hear if the answer was zero! Dumb question but here goes.... when the bone is fused, would it attach itself to or around the instrumentation?? If so, is this just chipped away when removing rods? Leash will have her previous rods removed and new ones inserted to extend down into the lumbar.

I hate asking questions like this of surgeons to "explain the process", I've asked so many of ours over the years, I'm sure he's considering inviting me to sit in on one to get me off his back!!!! But it's just to alleviate the fear monster that's attacking my brain.


Dr Scoliosis
07-10-2010, 01:02 PM
Thank you for your enquiry. From what you told me earlier on your daughter is not undergoing revision surgery in the strictest sense of that word. From the information, the fusion is being extended to L2 because the spine has decompensated above. I trust the explanation on decompensation was clear to you. Extending the fusion one level is not a major procedure and is quite frequently done. I do not have any precise figures and I doubt if there are any really good indications in the literature.

When a fusion is extended one level it is usually possible to attach the required instrumentation to the rods which are already in place. Sometimes it may be necessary to remove the rods and replace them with longer ones. Even this is not a major procedure.

A revision surgery is a horse of a different colour. This often entails dividing the fusion mass, repairing areas of failed fusion and other technical steps. I am not aware of any surgeon in Australia who limits his/her practice to strictly revision surgery. When such procedures are indicated most spinal surgeons carry these out themselves. In some areas of orthopaedic surgery, particularly hip and knee replacements, there are surgeons in the United Kingdom who do limit their practice to revision arthoplasty.

The Dr Scoliosis on duty recalls that in his time in practice it was usual that the need to extend a fusion by one and sometimes even two levels arose about once a year, though accurate data were not kept. However, you can be reassured that this is not a major surgical procedure.

07-10-2010, 01:27 PM
Wow! I just let out a BIG sigh of relief!! Thank you Dr S for that explanation, that has really reassured me!!!!! Sometimes the internet can be a dangerous thing for us parents as we over read and get ourselves tied up in nots!!

Thanks for all your wonderful help on this forum