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Seeking_help
17th August 2007, 04:00 AM
I understand that its quite common for individuals who have kyphosis to also have lordosis. Can anyone here share their experiences with this? Specifically related to spinal fusion & corrective surgery. Is it just one long operation to correct it? Or is it broken down into two? Or does is the lordosis decreased as the kyphosis is eliminated?

Just curious, thanks!

mark
17th August 2007, 12:05 PM
Hi seeking help

I am sure titch has had these experiences i'm sure once she reads this post she will reply or you could send her a pm

titch
17th August 2007, 11:08 PM
Hiya - I'll try to write something tomorrow, but if I don't, kick me (well, either bump the thread or pm me ;-))

Seeking_help
18th August 2007, 01:08 AM
Originally posted by titch@Aug 17 2007, 10:08 PM
Hiya - I'll try to write something tomorrow, but if I don't, kick me (well, either bump the thread or pm me ;-))
I think I can do that :-)

titch
22nd August 2007, 01:48 PM
Right, finally with some time to type - been very busy the last few days, and every time I thought I had a few minutes to do it, I found I had a bored or wailing baby to deal with instead :P

Anyway, of course all that I can speak of is my own experience, conjecture and anecdote based on several years as a member of various forums, but here goes.

It's actually a very complicated question as a lot depends on the individual circumstances, and what is the primary problem. I think it's fair to say though that generally speaking, of people who have structural kyphosis, the lordosis is compensatory in much the same way that a person with an S curve scoliosis may have a primary thoracic curvature, with the lumbar curvature being compensatory as the spine attempts to balance itself. It is possible to have hyper-lordosis as the primary complaint, or as an additional structural problem along with kyphosis, but I think it's more common for the kyphosis to remain pretty normal when there is an excess of lordosis - the spine can remain balanced mostly just by the shape of the lordotic curvature.

When it comes to surgery, anecdotally I would say that the greater issue with correcting kyphosis is not the correction of the compensatory lordosis, but rather ensuring that the neck is well balanced and the head positioned correctly. Generally speaking as long as at least one mobile segment is left at the bottom of the spine, and preferrably 2 (ie fusion to L5 or L4), there is a certain amount of self-balancing and correction which can occur - as rods are now shaped to maintain lordosis, this is generally more than enough to leave a person comfortable and entirely upright.

The question of how many operations depends even more on the individual and their particular circumstances. In my case for example, where my first surgeon actually reversed my lordosis into a kyphosis at the back of the waist (he was a general ortho, and in 7 years on forums I have never heard of actual reversal happening to anyone else, so it's not something anyone else needs to worry about), he removed 2 discs and fused me anteriorly with a rod as well as posteriorly. What this meant is that where the usual treatment for a kyphosis positioned there and of the size that mine was would likely be to remove discs, place shaped cages anteriorly and then do small Smith-Petersen osteotomies posteriorly, this wasn't possible due to the fusion and rod. So instead, the anterior fusion was broken up, but leaving the rod in situ, and a very large osteotomy that removed a significant amount of the vertebral body was done - all of this was done from a single posterior incision.

Thoracic kyphosis surgery is also similarly based on the individual - they may go anteriorly to replace discs with spacers/cages, which can be shaped to help correct the kyphosis, or they may be able to do the entire surgery from a posterior incision. In the case of posterior surgery, there may not be any need for osteotomies if the curve is longer and smoother, as it could be possible to simply use the rods to provide compressive or distractive force to the rear of the spine, pulling it straighter either by compressing the rear of the spine to straighten it, or opening the front of the spine to lengthen it to a straighter shape. In the case of a shorter, sharper curve, such as a Scheuermann's kyphosis, it is much more likely that osteotomies will be needed, as the sharpness can probably only be combatted and corrected by the removal of wedges from the rear of the spine.

In particularly rare cases, usually of congenital deformity, it may be necessary to do a vertebrectomy, ie complete removal of a vertebra - this is done for some cases of congenital scoliosis also, where a hemivertebra (one that is triangular when viewed from the front, having only developed on one side) is removed completely to allow correction to be achieved. This really is extremely uncommon though, and is very unlikely to apply to any adolescent or adult surgery as the kind of problems requiring it are generally very serious very early.

I'm not actually sure if all of that helps, but hopefully it gives you a bit of an overview at least :-) If you've got any more questions based on it, ask away and I'll do my best to answer or to find the information needed!

titch
22nd August 2007, 01:48 PM
Right, finally with some time to type - been very busy the last few days, and every time I thought I had a few minutes to do it, I found I had a bored or wailing baby to deal with instead :P

Anyway, of course all that I can speak of is my own experience, conjecture and anecdote based on several years as a member of various forums, but here goes.

It's actually a very complicated question as a lot depends on the individual circumstances, and what is the primary problem. I think it's fair to say though that generally speaking, of people who have structural kyphosis, the lordosis is compensatory in much the same way that a person with an S curve scoliosis may have a primary thoracic curvature, with the lumbar curvature being compensatory as the spine attempts to balance itself. It is possible to have hyper-lordosis as the primary complaint, or as an additional structural problem along with kyphosis, but I think it's more common for the kyphosis to remain pretty normal when there is an excess of lordosis - the spine can remain balanced mostly just by the shape of the lordotic curvature.

When it comes to surgery, anecdotally I would say that the greater issue with correcting kyphosis is not the correction of the compensatory lordosis, but rather ensuring that the neck is well balanced and the head positioned correctly. Generally speaking as long as at least one mobile segment is left at the bottom of the spine, and preferrably 2 (ie fusion to L5 or L4), there is a certain amount of self-balancing and correction which can occur - as rods are now shaped to maintain lordosis, this is generally more than enough to leave a person comfortable and entirely upright.

The question of how many operations depends even more on the individual and their particular circumstances. In my case for example, where my first surgeon actually reversed my lordosis into a kyphosis at the back of the waist (he was a general ortho, and in 7 years on forums I have never heard of actual reversal happening to anyone else, so it's not something anyone else needs to worry about), he removed 2 discs and fused me anteriorly with a rod as well as posteriorly. What this meant is that where the usual treatment for a kyphosis positioned there and of the size that mine was would likely be to remove discs, place shaped cages anteriorly and then do small Smith-Petersen osteotomies posteriorly, this wasn't possible due to the fusion and rod. So instead, the anterior fusion was broken up, but leaving the rod in situ, and a very large osteotomy that removed a significant amount of the vertebral body was done - all of this was done from a single posterior incision.

Thoracic kyphosis surgery is also similarly based on the individual - they may go anteriorly to replace discs with spacers/cages, which can be shaped to help correct the kyphosis, or they may be able to do the entire surgery from a posterior incision. In the case of posterior surgery, there may not be any need for osteotomies if the curve is longer and smoother, as it could be possible to simply use the rods to provide compressive or distractive force to the rear of the spine, pulling it straighter either by compressing the rear of the spine to straighten it, or opening the front of the spine to lengthen it to a straighter shape. In the case of a shorter, sharper curve, such as a Scheuermann's kyphosis, it is much more likely that osteotomies will be needed, as the sharpness can probably only be combatted and corrected by the removal of wedges from the rear of the spine.

In particularly rare cases, usually of congenital deformity, it may be necessary to do a vertebrectomy, ie complete removal of a vertebra - this is done for some cases of congenital scoliosis also, where a hemivertebra (one that is triangular when viewed from the front, having only developed on one side) is removed completely to allow correction to be achieved. This really is extremely uncommon though, and is very unlikely to apply to any adolescent or adult surgery as the kind of problems requiring it are generally very serious very early.

I'm not actually sure if all of that helps, but hopefully it gives you a bit of an overview at least :-) If you've got any more questions based on it, ask away and I'll do my best to answer or to find the information needed!

pink_candy_swirl
22nd August 2007, 03:03 PM
All I can say is to do with my own personal experience. I have scoliosis Kyphosis and lordosis. Scoliosis is my main problem. I had an operation mainly to correct my scoliosis but to also correct my kyphosis and lordosis. They went in from the side (I have a thoraco-lumbar, but more lumbar curve). They used a rod and three pins and also one of my ribs which they made some sort of cages with. If anyone could explain my op a little more further to me I'd probably be of more use. But that's all I can say. My op lasted 9 hours.

Seeking_help
22nd August 2007, 03:42 PM
Originally posted by titch@Aug 22 2007, 12:48 PM
Right, finally with some time to type - been very busy the last few days, and every time I thought I had a few minutes to do it, I found I had a bored or wailing baby to deal with instead :P

Anyway, of course all that I can speak of is my own experience, conjecture and anecdote based on several years as a member of various forums, but here goes.

It's actually a very complicated question as a lot depends on the individual circumstances, and what is the primary problem. I think it's fair to say though that generally speaking, of people who have structural kyphosis, the lordosis is compensatory in much the same way that a person with an S curve scoliosis may have a primary thoracic curvature, with the lumbar curvature being compensatory as the spine attempts to balance itself. It is possible to have hyper-lordosis as the primary complaint, or as an additional structural problem along with kyphosis, but I think it's more common for the kyphosis to remain pretty normal when there is an excess of lordosis - the spine can remain balanced mostly just by the shape of the lordotic curvature.

When it comes to surgery, anecdotally I would say that the greater issue with correcting kyphosis is not the correction of the compensatory lordosis, but rather ensuring that the neck is well balanced and the head positioned correctly. Generally speaking as long as at least one mobile segment is left at the bottom of the spine, and preferrably 2 (ie fusion to L5 or L4), there is a certain amount of self-balancing and correction which can occur - as rods are now shaped to maintain lordosis, this is generally more than enough to leave a person comfortable and entirely upright.

The question of how many operations depends even more on the individual and their particular circumstances. In my case for example, where my first surgeon actually reversed my lordosis into a kyphosis at the back of the waist (he was a general ortho, and in 7 years on forums I have never heard of actual reversal happening to anyone else, so it's not something anyone else needs to worry about), he removed 2 discs and fused me anteriorly with a rod as well as posteriorly. What this meant is that where the usual treatment for a kyphosis positioned there and of the size that mine was would likely be to remove discs, place shaped cages anteriorly and then do small Smith-Petersen osteotomies posteriorly, this wasn't possible due to the fusion and rod. So instead, the anterior fusion was broken up, but leaving the rod in situ, and a very large osteotomy that removed a significant amount of the vertebral body was done - all of this was done from a single posterior incision.

Thoracic kyphosis surgery is also similarly based on the individual - they may go anteriorly to replace discs with spacers/cages, which can be shaped to help correct the kyphosis, or they may be able to do the entire surgery from a posterior incision. In the case of posterior surgery, there may not be any need for osteotomies if the curve is longer and smoother, as it could be possible to simply use the rods to provide compressive or distractive force to the rear of the spine, pulling it straighter either by compressing the rear of the spine to straighten it, or opening the front of the spine to lengthen it to a straighter shape. In the case of a shorter, sharper curve, such as a Scheuermann's kyphosis, it is much more likely that osteotomies will be needed, as the sharpness can probably only be combatted and corrected by the removal of wedges from the rear of the spine.

In particularly rare cases, usually of congenital deformity, it may be necessary to do a vertebrectomy, ie complete removal of a vertebra - this is done for some cases of congenital scoliosis also, where a hemivertebra (one that is triangular when viewed from the front, having only developed on one side) is removed completely to allow correction to be achieved. This really is extremely uncommon though, and is very unlikely to apply to any adolescent or adult surgery as the kind of problems requiring it are generally very serious very early.

I'm not actually sure if all of that helps, but hopefully it gives you a bit of an overview at least :-) If you've got any more questions based on it, ask away and I'll do my best to answer or to find the information needed!
Thanks! That was very in depth :D

Some it was over my head but it gives me somthing to talk to the ortho about as I believe I have compensatory lordosis.

At this time, I've only had x-ray's takin on my kyphosis (upper spine) but not my lower spine (lordosis), do you think I should take the x-rays for the lordosis as well and forward it to the ortho? Or is it a minor issue which the ortho would most likely take care of at examination of the kyphosis?