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Old 26th February 2010, 06:55 PM
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Default Does surgery correct the rotation of the spine? YES, IT DOES

Hi everyone,

There are some websites out there claiming to provide information about scoliosis and spinal fusion surgery, but they are providing outdated and incorrect info. I thought I'd write this just to reassure people who may have stumbled across such sites.

I've often seen it claimed that "surgery will not correct the rotation of the spine": this is incorrect. Years ago, the old Harrington Rod (which has been obsolete for many years) was not able to derotate the spine because it only attached to each end of the curve. However, today's pedicle screw systems attach to each separate vertebrae, and each one is gently derotated before being fused in place. Usually this will be enough to pull the ribs back into place and reduce the rib hump significantly, but if a large ribcage deformity remains then the surgeon may do a costoplasty procedure to correct it.

It has also been claimed that surgery will correct the spinal curvatures "by 50% at most". This is again inaccurate; it may have been the norm 20 or 30 years ago, but whilst today's surgeons tend to err on the side of caution with regards to the amount of correction they say they will be able to achieve, most people today find that their scoliosis is greatly reduced - very often to near enough normal degrees.

If you are considering surgery, it's a good idea to talk to your surgeon about the techniques that they use and the typical corrections that they achieve, and talk to others who have had surgery RECENTLY (rather than years ago - techniques have moved on!). Don't rely on websites which take their information from old, outdated sources, and be especially wary of unscrupulous alternative practitioners who publish scare stories and use data from decades ago to try to frighten people off surgery.

BTW I'm not vehemently pro-surgery, I'm just very keen on people having access to accurate information. Surgery is not always the best course of action for everyone.

Toni xx
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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.
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Old 26th February 2010, 07:24 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Ya there really needs to be more recent info out there.

After having surgery about a year ago I can say that my curve definitely improved by way more than 50% and rotation of the spine, which was almost a bigger concern to my surgeon, improved greatly too.

Thanks for putting that out there Toni!
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Old 26th February 2010, 08:44 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

I think it's very worrying that there is still such a lot of misinformation out there This was a great post Toni and will be very helpful to people searching for the truth
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Old 28th February 2010, 12:06 AM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Thank you for the information ... my 'specialist' seems to feel that surgery would be a very last resort for me but so far i have had no treatment whatso ever! I believe it is because my spine is perfectly balanced in the curves but this does not mean i would stay this way if i didnt have too ... altho i realise there can be complications
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Old 2nd March 2010, 01:46 AM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Mr Harrison said my rotation is completely gone. It can happen!
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Fusion and costoplasty took place November 3rd '09 T3-L1. Reduced top curve from 42 to 13. Bottom curve from 35 to 1.5. Rotation now non-existent and the rib correction is fantastic.
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Old 2nd March 2010, 04:11 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Thanks for that Toni i am sure that it will put a lot of peoples minds at reast. Don't worry about the being pro surgery, we all know that you give out a balanced opinion when it comes to the advice you give

take care

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Old 15th March 2010, 01:14 PM
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Thumbs up Re: Does surgery correct the rotation of the spine? YES, IT DOES

My 16 year old son had anterior release, spinal fusion with rods and screws and rib costoplasty at Stanmore August 2009. He is fused from T2 to L3. His thorocolumbular curve was reduced to 16 per cent from 75 percent. His rib hump has gone. Mr Molloy and his team did a fantastic job.
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Old 15th March 2010, 02:05 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Thanks for that Toni,
I have been worried about my rotation and what might happen to my rib hump so that has answered one of my questions.
I will also discuss this with my surgeon on the 18th.
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Old 31st March 2010, 07:44 AM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Thanks for the infomation. Correcting rotation, does that mean correcting lordosis too? My daughter has thoracic lordosis which the doctor seemed more concerned about at our last visit. Also just to clarify, is rotation measured in percentages and not degrees? Thanks
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Old 31st March 2010, 12:41 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Hi Angela Rotation describes how much the spine twists round, whereas thoracic lordosis is related to the spine lacking its normal backwards curve that keeps the body balanced.

Rotation is usually measured in degrees, using a device called a Scoliometer. The scale goes from 0 degrees (no rotation at all) to 30 degrees (severe rotation). There may be other devices out there that measure by percentages though, I'm not sure. Sorry I can't be more helpful
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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.
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Old 3rd April 2010, 08:00 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

OK,thanks. I'm sorry, I know you are not medical experts but can anyone tell me if my daughter's thoracic lordosis and lack of lumber lordosis the same as flatback and is it caused by her scoliosis or are they 2 separate conditions.
Does anyone else have the same 2 problems? If she needs surgery do you think both problems would be treated?
Thanks again, and happy easter everyone!
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Old 3rd April 2010, 08:15 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Flatback is a term usually reserved in scoliosis for people who have had their natural sagittal plane (ie as viewed from the side) curves flattened by surgery, however this is perhaps more correctly termed iatrogenic flatback.

There is considerable variance in these natural curvatures, with some people having only modest curves, so some of it is likely due to that. However, a true thoracic lordosis is fairly rare, and is likely to be due to her particular curve pattern. If surgery does turn out to be required though, these are things which can be corrected
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Diagnosed at 15 with 50 curve, but probably juvenile IS. Fused in kyphosis (by non-specialised ortho) with a/p surgery T10-L2 @ 21, posterior only revision surgery to correct kyphosis @ 29. Now 38 with further revision surgery and extension of fusion to sacrum required to correct residual kyphosis, restore lordosis and address spinal stenosis.
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Old 3rd April 2010, 08:17 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Hi Angela,

I think you need to clarify with your surgeon whether your daughter has true thoracic lordosis (which is a rare condition) or whether she actually just has a lack of the normal curve in her upper back, or thoracic hypokyphosis (which is common in Adolescent Scoliosis).

A lack of the normal forwards-backwards curves of the spine could cause a "flat back" appearance. However, this isn't the same as "Flatback Syndrome", which is a term that specifically refers to a range of problems that can happen in people who had fusions years ago with the old Harrington Rod.

One of the most important aims of surgery is to make sure that the spine is in sagittal balance; this means that the head is balanced properly over the sacrum. Your daughter's surgery should adjust the flattened curves in her back so that this is achieved.

Toni xx
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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.
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  #14  
Old 3rd April 2010, 08:23 PM
Angela Angela is offline
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

Thanks Titch. I've been trying to imagine her spine 3 dimensionally, that why I got it confused with rotation.
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Old 3rd April 2010, 08:38 PM
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Default Re: Does surgery correct the rotation of the spine? YES, IT DOES

There does seem to be quite a lot of confusion in the terminology as well - we see this a lot, with doctors using terms quite loosely. A prime example is the number of people who end up thinking that they have Harrington rods, when in fact these have not been used for nearly 20 years now, but as it is a term which has some presence in the collective consciousness, we assume this is why it is incorrectly used by some medical practicioners when telling patients what surgery they will be having (possibly also in many cases it comes from a conversation along the lines of "Have you heard of Harrington rods? Well, we'll be using something similar but more modern").

Anyway, my point is that having spent a lot of time on iatrogenic flatback related forums, due to having something very similar myself as a result of surgery, what I have seen is that there are quite a lot of doctors who will describe a patient with flatback as having a (thoraco)lumbar kyphosis. What they actually mean is that as there should be 30+ degrees of lordosis, a significant reduction from this is effectively "kyphosed", even though a clinical kyphosis may not exist, if you see what I mean? A true thoracolumbar or lumbar kyphosis is rare, and usually due to congenital issues, although as in my case it can be surgically induced. Due to the kyphosis there, I developed a genuine thoracic lordosis - even when lying down it could be seen slightly on MRI. What I am thinking though, is that it could well be that as toni has suggested, your daughter has reduction in the normal kyphosis - it should be 20+ degrees in most cases, so if her back is close to flat, then they may simply mean it is lordosed, ie reduced, rather than there being an overt lordosis. Another possibility is that she has one long, shallow lordosis which extends over more levels than it normally would - usually most of the lordosis is over the lumbar levels, and there is then a straight part of the back from say T12 up to somewhere between T8 and T6 before the spine begins to gently curve forward again. It could be that your daughter has a very modest kyphosis, and that the apex of it has moved up somewhat, so that her lordosis extends upward into the thoracic spine - this would be a genuine lordosis in the thoracic region, but again something quite different.

Hope that makes some sort of sense, and I'm sorry that it doesn't actually qualify for you what is meant - hopefully when you get to see someone new, they will be able to explain what is intended by the use of the term. The 3 dimensional nature of the problem does make it difficult to understand what exactly is doing what, even when you don't have issues of loosely used terminology!
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Diagnosed at 15 with 50 curve, but probably juvenile IS. Fused in kyphosis (by non-specialised ortho) with a/p surgery T10-L2 @ 21, posterior only revision surgery to correct kyphosis @ 29. Now 38 with further revision surgery and extension of fusion to sacrum required to correct residual kyphosis, restore lordosis and address spinal stenosis.
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