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Thread: Flatback or something else?

  1. #1
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    Default Flatback or something else?

    Hi

    Apologies in advance for the long post but my symptoms are making me depressed

    I am 41 years old and had Harrington rod surgery in 1984 when I was 11 after spending 4 years wearing a Milwaukee brace. I was fused from T2 (or T3) to L2...everything was ok for a long time apart from loss of flexibility but went on to have 2 children with no problems.

    I had a costoplasty when I was 25 which involved breaking and resetting 10 ribs and I managed ok for about 4 years. Things started to get worse pain wise after this time and I went on to have facet joint injections, an artificial lumbar disc replacement below my original fusion which serves no purpose now as I later had to have my fusion extended where the artificial disc is down to L4 (apparently it would have been too dangerous to remove the disc!). I changed consultants after the ADR and my new consultant (Mr Webb) was surprised my ADR consulatnt thought I would be suitable candidate for ADR so I'm not happy about that!

    My problems now are that my muscles are so fatigued from constantly trying to maintain an upright position all day long. I have been to the GP complaining of hip pain, knee pain and back pain, my lung function has declined too, but I always come away feeling like they think I am a hypochondriac. I have been on prescription painkillers for years (Codydramol) but I now take more than I should just so I can work fulltime etc. I also go swimming twice a week which is actually not that comfortable for me, I visit a chiropractor monthly too so I do try to help myself.

    My question is should I insist on being referred to a spinal consultant or is this something I have to put up with? It's really getting me down and I dont want to give in. Does anyone else have similar symptoms or advice please? Thanks if you have read this essay

  2. #2
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    Default Re: Flatback or something else?

    If you tend to lean forward, especially when you try to straighten your knees, then it's very likely you have symptoms of flatback. The diagrams below show the different alignments of the spine in differing conditions:



    A forward-leaning posture causes terrible pain and discomfort, especially in the neck and shoulders - I suffered with it for a long while before getting re-referred to my surgeon for revision surgery.

    If you think this relates to your problems then I would definitely advise seeking an appointment with a specialist who deals in complex adult surgery.

    Hope this helps
    Me, a Mod? Nah ... I'll always be a rocker

  3. #3
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    Default Re: Flatback or something else?

    Thank you for your reply - I am still able to stand upright but it's getting to be so much effort these days. I feel like my posture is lke number 3 diagram as I have no curve in the lumbar region. I just worry that it may progress to a point where I have to give up work and not be able to do anything. Can you (or anybody else) recommend any consultants in the UK. As mentioned in my previous post my last surgery was with Mr Webb who was in semi-retirement then (7 years ago) so I guess he will be fully retired by now..........

  4. #4
    tonibunny's Avatar
    tonibunny is offline T Sr: Admin, Big Sister and Da Police!
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    Default Re: Flatback or something else?

    Hi there,

    I'm sorry you're having these worries. I do believe that Mr Webb has retired, but there is another surgeon at Queens Medical Centre in Nottingham who looks promising for cases such as yours....

    Bronek Boszczyk, Consultant Spinal Surgeon

    Don't worry! Hopefully we will be able to help you to find the help you need

    Toni x
    37 years old, diagnosed with infantile idiopathic scoliosis at 6 months old with curves of 62(T) and 40(L) degrees. Casting and Milwaukee braces until surgery at 10 - ant release/pos fusion T1-T12, halo traction. Post op cast and then TLSO. Further surgery at 18 (ant release/pos fusion extended to L3 to include lumbar curve, costoplasty) and 25 (another costoplasty). Fusion extended to L4 at 33 (XLIF with 4 pedicle screws and two short rods). Pre-op curves: 76(T) and 70(L). Post-op curves: 45(T) and 35(L). Diagnosed with Ehlers-Danlos Syndrome aged 34; scoliosis almost certainly due to this rather than being idiopathic.

  5. #5
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    Default Re: Flatback or something else?

    Thank you, I will see if my GP will refer me....

  6. #6
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    Default Re: Flatback or something else?

    We have some great surgeons in the north

    Mr Cole at Sheffield
    Mr Gibson and Mr Fender at Newcastle

    Mr Fender is my surgeon and he is great

    Hope that helps a little

    Mark
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  7. #7
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    Default Re: Flatback or something else?

    thank you mark, i decided to email the one tonibunny recommended directly first and he has followed up my email within an hour which is promising so i will see if anything comes of this

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    Default Re: Flatback or something else?

    Hi Spinals, I have similar problems to what you describe, and it certainly sounds as though your flattened lumbar spine could be to blame. I'm 49, had T3-L4 Harrington rod surgery in 1985, had a number of good years, two children, then hit 40 and everything changed. The pain became relentless and walking and standing up straight became difficult, and I too started to get awful muscle fatigue and hip and knee pain. I had my rod taken out six years ago, have had numerous spinal injections, and then was due to have revision surgery just a few weeks ago. On the morning of the surgery my surgeon decided to just work on my lower lumbar spine, where he knew I had a compressed nerve root at L5-S1. He decompressed that and fused that level, then used rods to prop up my wonky bottom vertebrae - a distraction rod on the leaning side meant he could crank it into position and this in turn propped up my whole fused spine. I was in hospital two weeks but I'm doing really well now and my posture seems so much better.

    He said the longer I can go without messing around with my old fusion (which is an S shape as I had a double curve that wasn't really corrected by my Harrington rod) and bolting everything to my pelvis the better, as there's no where else to go then if the pain isn't eased. I was shocked at first at the change of plan and disappointed it wasn't all going to be sorted, but everything he said made sense. I know I'm just putting off the inevitable but there ARE things that can be done to ease the pain from our old fusions, without necessarily having to have the whole lot revised (although he said that time will undoubtedly come), so it's definitely worth getting a referral. Hope you get your appointment through soon and get some advice on the best way for you to go with this at the moment. Take care.

    Jan

  9. #9
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    Default Re: Flatback or something else?

    Thank you Jan, its reassuring to know I am not alone! Did you feel any benefit when your rod was removed?

  10. #10
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    Default Re: Flatback or something else?

    I did initially, but it wasn't long before it became apparent that the rod wasn't the only cause of the pain. What the surgeon who took my rod out did say, was that it would have done it's job after 23 years and that removing it meant they could get very clear MRI's to see exactly what was going on. The MRI's I had prior to the rod removal were useless due to the distortion from the metalwork.

    Jan

  11. #11
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    Default Re: Flatback or something else?

    Ah right, I didn't think of that as I worry that the MRI scans cannot get good enough pictures with the rod in and therefore something could me missed......

    By the way, I'm pleased to hear your latest op has meant you are more comfortable.

    Claire

  12. #12
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    Default Re: Flatback or something else?

    Thanks Claire, I know I'm just buying some time but I'm happy to do that for now.

    I remember when my surgeon said he would remove my rod - he said it as if he'd said he'd burst a blister for me! I was sat there with my mouth open wondering how on earth he'd remove it :O. As it was, it was very straightforward - the old Harrington's were only attached top and bottom, unlike the modern instrumentations, so removal was quite simple - and all MRI's since then have been very clear!

    Jan

  13. #13
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    Default Re: Flatback or something else?

    my rod has been in there for 30 years since i was 11....i have always thought it would be deeply embedded since i was growing for about 3 years after......

  14. #14
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    tonibunny is offline T Sr: Admin, Big Sister and Da Police!
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    Default Re: Flatback or something else?

    Harringtons are generally much easier to remove than more modern hardware is, because as you say they are only attached at the ends, but removal very much depends on the individual patient. In some cases removal is very easy, but in others it can be very difficult due to the rod becoming encased in bone (again, as you say). Your surgeon will weigh up the risks of removing the rod vs the benefits of having it out.

    I had my original Harrington (placed in 1986, when I was 10) removed and replaced with a longer one in 1994, to extend my fusion to include my lumbar curve. After just eight years that original Harrington was very deeply embedded and they had to break the bone away and actually cut the rod into three pieces in order to get it out. That was a very difficult removal, but my surgeon felt it was necessary.

    A few years back I needed to have my fusion extended down one level (due to disc degeneration at the bottom of the fusion) and I requested that my surgeon remove my Harrington whilst he was in there, if he could - simply because I'd prefer not to have it. However, when he took a look at it during the surgery he saw that this rod was also very deeply encased in bone; he didn't attempt to remove it because there was no real clinical need to do so, and the risks outweighed the benefits. Fair enough!
    37 years old, diagnosed with infantile idiopathic scoliosis at 6 months old with curves of 62(T) and 40(L) degrees. Casting and Milwaukee braces until surgery at 10 - ant release/pos fusion T1-T12, halo traction. Post op cast and then TLSO. Further surgery at 18 (ant release/pos fusion extended to L3 to include lumbar curve, costoplasty) and 25 (another costoplasty). Fusion extended to L4 at 33 (XLIF with 4 pedicle screws and two short rods). Pre-op curves: 76(T) and 70(L). Post-op curves: 45(T) and 35(L). Diagnosed with Ehlers-Danlos Syndrome aged 34; scoliosis almost certainly due to this rather than being idiopathic.

  15. #15
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    Default Re: Flatback or something else?

    I would be apprehensive about having my rod removed as I only imagine it is buried deep somewhere! Lol!

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