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Marcilo
17th August 2006, 04:33 PM
Other day at grocery store I saw an old lady with big back hump and I knew what it was. I was wondering why did she not get surgery done? Are there any age restrictions to surgery? I mean after certain age they (doctors) say no surgery, deal with it? Just a thought that came to my mind.

Does any one know what age they mark as cut off age?

sins
17th August 2006, 04:48 PM
Hi Marcilo,
I don't think there's a cut off age as such.However the older the patient the weaker the bone quality and the less likelihood of a solid fusion.That matters more for women who have poorer bone density after menopause or are more likely to suffer from severe osteoporosis.
The old lady you saw probably had kyphosis due to osteoporosis (Dowager's hump) and even surgical intervention at such a late stage would carry more risks than benefits. Most doctors would treat the pain and not ever atempt to correct the curve.However on scolioadults site I recall a lady who's 73 year old mom had scoliosis surgery. I suspect surgery after 60 would be very unusual.
Sins

Marcilo
17th August 2006, 09:07 PM
I think what you have said was probably the case. But then what if Kyphosis is due to osteoporosis and person is still young say around 50 or so. Do they first make sure bone density is high and then operate or do other way round by first operating and then trying to achieve fusion along with increase in bone density?

sins
17th August 2006, 11:36 PM
If they suspected Osteoporosis, I think they'd do a dexa scan first to check bone density.At a guess they'd most likely need to ensure that the bone was strong enough to take the screws and withstand the forces of correction.
There are a number of things they can do improve fixation of screws in the spine, use of artificial bone cement for one.
Also they'd do an anterior/posterior fusion to maximise fusion chances.
There's a bone growth stimulator which some adult patients in the US have tried.They wear it like a belt.Not sure if it works well or not.
There's a new product called BMP (Bone morphogenetic protein) which is under trial at the moment and seems promising which aids fusion of bone.
But I think someone in their fifties, who although may have Osteoporosis, would still be candidates for fusion, as they would not suffer from the multiple fractures that the little old ladies in their seventies would.My 81 year old gran has severe kyphosis and was straight until she turned 78 and then her spine just collapsed in a few months.
I think anyone who has osteoporosis or osteopenia should check with their surgeon about the possible problems with fusion.
Hope some of this has made sense, It's very late on this side of the Atlantic.
Sins

zerodegrees
21st August 2006, 05:18 PM
when I was in having my op there was a lady in her late 70's being fused. she had a very prominent scoliosis!

Marcilo
21st August 2006, 07:30 PM
I too was thinking that they would treat osteoporosis first and then go for fusion. Itís hard to understand how they can achieve fusion when bone density is low, but you never know.


Also they'd do an anterior/posterior fusion to maximise fusion chances.

You mean with such a thing there are better chances of fusion, I thought decision on doing either anterior or posterior or for that matter both depended on surgeon


I think anyone who has osteoporosis or osteopenia should check with their surgeon about the possible problems with fusion.

Does nay one know more about such a scenario?


Hope some of this has made sense,
Thanks for your response


when I was in having my op there was a lady in her late 70's being fused. she had a very prominent scoliosis!
Wow, so they do treat old folks with complications

Amazed Jean
21st August 2006, 07:33 PM
Every case is different. The 70 year old woman is to be commended for her braveness. In my case I am only 55 but the doctors are less than anxious to attempt anything but its more a case of lung function. Simply they are not sure they could wake me up again. The untreated curves that I have are twisting lungs etc. My lung function is only about 10% of normal. I have had anesthesia for C section and gallbladder type things and even though I was much younger it was very difficult to wake me. I probably could have gotten someone to look at a surgery when I was in my 30's but even then they were hesitant and almost negative about any success they MIGHT have....add that to we were moving about a bit then and my husband travelled a lot for work so I was raising our daughter on a full time basis. I just didn't keep looking for a scoliosis guy to do something when I was more into being Mom. I might also add that back in the dark ages (when I was young) surgeries on spines often failed later with really unpleasant results. Be happy that you are young and have lots of physical strength to do something now. Be confident in your doctors and go for it. You are only young once!

Marcilo
21st August 2006, 07:38 PM
Is it not normal that all curves affect lung function to some extent, be it Scoliosis or Kyphosis

Amazed Jean
21st August 2006, 10:57 PM
I'm no expert but it seems like most people with any large degree of scoliosis also has some lung compromise. In my case it is very severe. I am on full time oxygen and sleep with a Bipap machine on because I forget to breathe in my sleep. For years I was telling doctors that I awoke with killer headaches and finally someone put it together with my scoliosis and history of pneumonias and sent me to a lung/sleep specialist. Thank goodness that I can sleep much better and have lots fewer headaches. The current trend on other scolisis patients seems to track lung function lots closer. AND when you get a lung function test done have the techs use your armspan rather than your height when determining what would be normal for you. So my scoliosis has scrunched up most of my spine I am short (4"8") the readings with my height weren't so out of range. A scoliosis guy finally said get this lung function test done over using arm span which gives a more accurate reading. Instantly I went from about 25% normal for my height to reality of 10%. In short full time oxygen was ordered. Its not the end of the world but it restricts me a bit.

pips
12th September 2006, 11:01 AM
My surgeon told me he was not keen to operate past 50 because most womens bone density decreases with age. He said it was at it's best at 17 and its all downhill from there!! :woe:

I'm guessing it varies from surgeon to surgeon, but bone density must play a part.

Marcilo
12th September 2006, 09:23 PM
Do they not use bone growth simulators? Does that not help? So what if Bone density is low in case of a patient and age is also low say 25 or 30

titch
13th September 2006, 01:24 PM
Bone growth stimulators are fairly commonly used in the US on older women who have revision surgeries for flatback resulting from Harrington rods. There seem to be several types, and I'm not sure to what extent they actually do help, as it still seems that some surgeons like to use them, and others do not.

There are other developments such as Bone Morphogenetic Protein, compounds which can be used as part of the fusion mix and dramatically increase the chances of successful fusion.

I think that although there is a strong element of preference, and that is especially the case with scoliosis - as it is very unlikely to be an emergency surgery, it is most likely that women will be seen earlier in life and the doctor can then recommend that for example, a borderline case that is only getting worse very slowly should have surgery, say at age 40 rather than wait any longer, nevertheless, I think that if surgery becomes necessary later and with poorer bone density, or in someone younger who has poor bone density, that they will just go ahead and do it.

When I was in QMC after my revision, there was a woman who was 67 and rushed in for emergency fusion surgery after developing cauda equina syndrome. She had poor bone density, but they went ahead and did it because it was necessary. She actually made a fantastic recovery :-)

crkcallie
30th November 2006, 11:21 PM
I don't think there is a cutoff age for surgery for scoliosis if you're going to have it. I'm 21 and I know that with my back as bad as it is, the surgeons would just love to do surgery on me. However, I'm not going to do it.

littlelou1975
29th April 2007, 09:04 PM
In response to the lung function topic raised earlier. I've just turned 33 and like Jean have to go on a bipap machine at night due to having low 'sats'. I had my last spinal op when I was around 13 (a harrington rod). I have very prominent scholiosis (I lean very much to the side, appear to have only one shoulder blade as the other sticks out my chest and have a 'big' hip). I'm sure that medical advances could probably do so much more for me now but my lung function is too poor. People accept me as I am but obviously I'd like to look more 'normal' for myself.

Louise

mark
29th April 2007, 09:34 PM
Hi Louise

Have you been back to your surgeon

We have a memeber who is in her 30s (sorry Michele for giving your age away) who had a very large curve who has just recovered from surgery. Sorry if you've already told us, where abouts in the world are you