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Old 13-08-2010, 01:11 PM
Patricia Patricia is offline
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Join Date: Jun 2010
Posts: 25
Default What does Decompensation mean

Hi Dr S,

Our surgeon wrote in a letter to our GP that there was some decompensation below a previous T5/L1 fusion. What exactly does that mean?

Does pain from scoliosis purely come from being unbalanced? We, child, parents and surgeon alike are hoping that her extension surgery to L3 will alleviate her back pain to some degree, but no guarantees obviously can be given. But..... if her spine is straightened and muscles no longer under strain, wouldn't this help alleviate the pain?

Also.... after surgery why is it that surgeons don't send you off to rehabilitation. Surely some physio with recomendations on building up back muscles after what they have just been through would be beneficial. I was quite surprised first time around why this was seen as not needed?

Thank you in advance

Trish
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Old 25-08-2010, 07:55 PM
Dr Scoliosis Dr Scoliosis is offline
 
Join Date: Apr 2009
Posts: 187
Default Re: What does Decompensation mean

Thank you for your enquiry and I apologise for the late reply.

Decompensation means that the centre of gravity in the torso has moved to one or other side. Thus the head is not centred over the pelvis. This puts a significant asymmetrical strain on the intervertebral discs and this is particularly important in the lumbar region. An analogy is when the wheels on a car are not aligned correctly. What happens is that the tyres tend to wear out more quickly because of increased loading on one side. In all spinal surgery one of the principal aims is to get the spine back into normal balance with symmetrical loading of the remaining intervertebral discs.

There is no evidence that pain results from decompensation. However, in the long term, as I have mentioned above, asymmetric loading will lead to early wear and tear changes on one side with the consequence being a variable degree of pain.

Long experience shows there is no need for what is popularly considered to be "rehabilitation" for teenagers after scoliosis surgery. The healing of the fusion is a slow process and is similar in its nature to the healing of a fracture. Surgeons talk of the fusion being mature and that takes at least six months. Until the fusion is mature then the fused spine is not able to absorb stresses and strains in a safe fashion. Every patient is different and after the surgery you should seek guidance from the surgeon. In an otherwise uncomplicated case, a gradual return to non-contact, low-impact, non-collision sport is usually permissible at or about nine months to one year post operation.

There are no hard and fast rules which are universally applied after spinal surgery for scoliosis and each surgeon has a set routine which makes it easier for his staff to answer queries from parents. For example, the surgeon who is dictating this response allowed the otherwise uncomplicated spinal fusion for scoliosis to start gentle swimming at six months post surgery but the patients were not allowed to dive until one year post surgery.

When surgery for scoliosis is carried out in adult life, as is not infrequently the case, again, individual surgeons have a regime which they find to work most satisfactorily for them.

In general terms there is a little more freedom nowadays with the more rigid and effective forms of internal fixation which allows the adolescent to go without a plaster. It is not that long ago, before Harrington instrumentation was introduced, that after surgery the patients went to bed in a plaster from their neck to their knees for one year.

We trust these remarks are helpful.
 

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