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Old 28-12-2013, 09:56 AM
venleh venleh is offline
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Join Date: Dec 2013
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Default Advice on Future Management for the Aged

I have been unable to find any professional facts on how to manage my rapidly deteriorating scoliosis. I will soon turn 68 and live in a regional area. I am being treated by my GP for pain.
I had a solid spinal fusion from T4 to L1 measuring 70 degrees in 1959. In 2000 an X-ray showed a fractional lumbar curve of 40 degrees with some subluxation at L1-2. Also a junctional kyphosis and a relative flat back. This description was taken from the letter of one of your specialists.
Each year, I experience a worsening of pain. Currently I am having nerve spasms on my lower left side just above the buttocks and find I cannot stand for long. The pain levels around the fusion area are at least an 8/10 without medication.
For several years I was taking Tramal for pain relief, but have now started on Buprenorphine. Lyrica is the next drug suggested for the spasms.
So my question is - does this drug regime sound like the norm for patients with my history? And what is the long term expectation for the aged with scoliosis? Is it possible or probable that I will need a wheelchair (currently I use a walking stick)? Would a Physio help my spasms? I accept my condition but do need to understand the future. I am not interested in any surgery. I am so glad I found this website - many thanks.
Old 30-12-2013, 06:28 PM
Dr Scoliosis Dr Scoliosis is offline
Join Date: Apr 2009
Posts: 187
Default Re: Advice on Future Management for the Aged

Dear venleh,

Thank you for your question and helpful information. It sounds as if your symptoms are secondary to an increase in the fractional lumbar curve, with associated arthritic changes. This is not uncommon with the condition known as "flat back". Flat back is where the normal kyphosis of the thoracic spine is not restored after scoliosis surgery - it was a common problem with the first generation of scoliosis spinal implants - that is, Harrington rods. This inability to correct the "sagittal" or side on profile of the spine leads to abnormal loads on the lumbar spine and the discs and joints deteriorate.

Your pain may be due to instability in the lumbar spine - the subluxation mentioned in the letter. Due to arthritis, the disc and joints between the vertebrae wear out and abnormal movement occurs. It would be expected that the situation on x-ray in 2000 would have worsened.

I would strongly suggest seeing the surgeon you saw in the past, or another spinal deformity surgeon. A repeat examination and x-ray would give a good indication of the cause(s) of your symptoms and what has changed in the spine since the last picture.

The surgeon can then give you options of treatment. Surgery would be one of those, but the non-operative course could include medications, physiotherapy and bracing. A specialist will help you discuss these options.

It is likely that untreated, your pain will worsen and significantly limit your mobility. Leg pain and weakness can occur due to compression of the spinal nerve roots by progressive spinal deformity. Bladder and bowel function may also be affected

The medications you are currently on are commonly used for pain of this type, but doses and so on need to be individualised. A pain management program, to find the best combination of drugs and physical therapy, can be very helpful. Again, your GP or spinal surgeon can arrange this.

Your problem is complex and therefore seeing the specialist will provide the best perspective and range of treatments.

Dr Scoliosis
Old 15-02-2014, 12:04 PM
venleh venleh is offline
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Join Date: Dec 2013
Posts: 2
Default Re: Advice on Future Management for the Aged

Hello Dr Scoliosis - it has been several weeks since I first asked for advice and since receiving your most welcome response, there has been an escalation in events.

Firstly, I wasted no time in contacting the Scoliosis Clinic in my capital city via a referral from my doctor. However at the same time I have discovered I have a prolapsed bladder caused by constipation from taking Buprenorphine. You did make mention about future compression of the spinal nerve roots and the affect it may have on my bladder and bowel function. So this is weighing on me at the present time.

I am now on a Cat 2 waiting list at my local hospital to have a vaginal repair and I expect the operation to be done in the next few weeks. Naturally, I have been very concerned about the procedure in light of the ignorance that exists about my type of scoliosis, regarding pain control, etc. Also the recovery time could be lengthy,

Due to this I asked my GP to send an email to the City clinic to see if they can see me before my operation, and I am pleased to say that I received the letter yesterday. My appointment is in 2 weeks.

I don't know what will transpire at my appointment but I do hope I can get a clear understanding of what lies ahead. I am not expecting a miracle but I would like a strategy for the future.

Another factor is that in my mind this information is vital for the medical team at my local hospital, because as I have found over the years, no one appears to really understand my condition.

If you have any further thoughts about how to manage the next few weeks, or advice about the Clinic visit, I would be most grateful.

Thank you
Helen (Venleh)
Old 17-02-2014, 05:24 PM
Dr Scoliosis Dr Scoliosis is offline
Join Date: Apr 2009
Posts: 187
Default Re: Advice on Future Management for the Aged

Dear Venleh,

It is good to hear that you have been able to get an appointment so quickly. I would give no further specific advice, except to recommend that you take along all the x-rays and other investigations you have of your spine.

This will help the doctors assess the degree of progression over the years.

Dr Scoliosis

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