[Donald Corenman, MD, DC]

#10241

You do have a non-union of the attempted fusion at L5-S1 but that is only part of the problem. You have a large scoliosis of your lumbar spine and I will assume a large scoliosis of your thoracic spine. You must go back to the beginning.

For what reason did you have surgery in the first place? What were your symptoms? What did the attempted surgery do for your symptoms?

I assume you have been following this spinal curve for some time. It is important to know the progression of these curves over time. What was the degree of the curve ten years ago? Five years ago? Two years ago? Have you had serial X-rays including standing 14×36 films (full spine standing films) to document the advancement of these curves?

Is your surgeon familiar with scoliosis surgery? Does he know about balanced curves and principles of scoliosis surgery?

Your lumbar curve straightened and fixed without attention to an upper curve in the thoracic spine could leave you with an unbalanced spine. A global impression of the curves has to be undertaken to give you the correct spinal alignment.

I cannot comment on your specific bowel and bladder disorder but in general, it is very rare for spinal problems to be the source of bowel and bladder dysfunction. See the section on cauda equina syndrome to understand this disorder. Spine pain can cause temporary incontinence in some patients. This is also covered in the cauda equina section.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[nikserer]

#10242

Thank you dr. for your helpful explanation. You can see in my last image of x-rays both curves in standing position. When they first notice my scoliosis I was 14 years old and had curve about 37 degrees.
Now I am 44 years old and it is about 55 degrees.
Yes, my neurosurgeon is familiar with scoliosis surgery and he done it many times and also in more complicated cases. I was also confused when he said that he will fuse me only in problematic L5/S1 segment. He said: “we shall see if this is rhe main problem of your pain, and if pain persists we must fuse scoliosis“. But also, didn’t you mention in your article about surgical menagment of degenerative scoliosis next: “If surgery for a curvature of the spine is necessary, surgical treatment may only need to involve the localized individual painful problem such as a herniated disc or a degenerative spondylolysthesis with stenosis”
I was from the first step opinion that my whole scoliosis with spondy must be fused, and that also said first orthopedic surgeon when I went to him. But when I come to hospital for surgery, they said he quit job in hospital and is not working. Other orthopedic surgeons said that “it is not in my interest to have scoliosis surgery now“.
After that I gone to neurosurgeon who is only one in Serbia who perform this kind of surgeries.
We shall see what will he decide after I do CT and MRI. He ordered only LS part of spine to be examined. I have now only two questions:
1.What do you think dr., should I insist on fusing the whole scoliosis spine, and can it be performed only posterior with anterior mobilization?
2. If first lumbar fusion to T10 is done, can it be later (if needed) extended to T3/T4? How will this mine current fusion be extended?
I also think that fusing me only to T10 will give bigger problems to thoracic part later.
Thanks a lot for understanding
NIkola
P.S. I also found one nice article/study about treating adult scoliosis via Posterior only approach:
internaf.org/ataxia/adult_scoliosis.html

[Donald Corenman, MD, DC]

#10249

You are correct in that some individuals with scoliosis have a specific pain generator and sometimes, a “small surgery” (a one level fusion or even a decompression) can remedy the problem. In your case however, there are other factors involved.

You have a known curve that has increased over the last 30 years by about 20 degrees. The curve advance most likely means that this will continue to advance as gravity and disc wear marches on. The greater the curve, the harder it is to correct and the poorer the correction occurs (as the curve stiffens).

If the two curves are balanced at 55 degrees each, what worries me is that your surgeon is thinking about correcting only the lower curve (“If first lumbar fusion to T10 is done, can it be later (if needed) extended to T3/T4”).

Think about two opposite “C” curves balanced one upon the other. The upper “C” curve perfectly balances on the lower curve. If you straighten the lower curve, the upper curve will be out of balance and will push you over to the side.

Now of course, if this surgeon does no lower curve correction and simply fuses the lower curve in situ (no curve correction, just fusion to stop progression), then you will be balanced. The upper curve may still progress but this can be watched over time with X-rays.

The pseudoarthrosis at L5-S1 will have to be fixed no matter what other surgeries you consider.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[nikserer]

#10250

Thank you dr.Corenman for helpful explanation of my problem. I will for sure mention my neurosurgeon your suggestions and I think it will not offend him. At last, it is my spine.
I have trust in his expertise, but I also think that orthopedic spine surgeons (like you) have better insight in whole spine problematic than neurosurgeons.
For sure in my next check I will insist in fusing all scoliosis (as he also mention in some checks to T3 or T4 )as best and long-term solution for me. I know that it is though surgery and recovery, but it is best solution for me because I already had 8 surgeries on head.
He ordered for next check new CT and MRI of lumbosacral segment. I will also ask him by phone should I also do MRI of thoracic spine too because of possibility of extended fusion.
You mention “in situ” fusion, and he also mention in last visit that “it is hard to correct scoliosis now“. I know that it is not possible to correct it 100%, but I think it can be corrected to some 20 degrees. I am saying this because I saw many samples like mine on net(and with bigger curves). Am I right?
I must also mention that your web site is very good and I found much helpful information’s about my problematic.
I will update you about my situation and decision of my surgeon after I done CT and MRI and come from next check.
For sure I would come to your clinic for exam, but unfortunately distance between us is too much.
I must ask you: how much (approx.) is cost of such surgery like mine for foreign patients in USA?

Thanks you a lot for your support and understanding.
Nikols S. – MechE.

[Donald Corenman, MD, DC]

#10252

How much correction you gain with surgery has to do with the pre-operative stiffness of the curve and the strength of the bone. This can be determined by the pre-op bending films and a T score from a bone densitometry. You probably do not need a bone density test being a young male.

I do not know if you need an MRI of the lumbar spine but you will need at least a CT scan of your L5-S1 level due to the probable failure of the fusion. Thoracic MRIs normally may not be needed for a scoliosis surgery unless there is a suspected congenital deformity, a compressive lesion or spinal exam findings that make the spinal canal suspect.

I cannot tell you the cost of these surgeries. You can call my scheduling nurse and she may be able to give you some costs.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[nikserer]

#10254

Thanks again dr. for taking time to answer to my questions.
I have done MRI in 15.05.2012(before L5/S1 fusion surgery) and there were not some significant lesions in thoracic segment, but only curvature of 35 degrees angle (but when I am standing x-rays shows about 50 to 55 degrees?). There was seen only in Th8-9 IV and Th9-10 segment some reduction of dural space diameter to 13 mm.
The conclusion in few words was:
“MRI thoracic spine: Dextroconvex Scoliosis of thoracic spine with kept position of vertebrae.
MRI LS spine: disc herniation on L5-S1 level with Spondylolisthesis corps L5 grad. I-II.”
I have sometimes symptoms like little pain in level of right blade, and sometimes radiating to front. But that is usually when I do little exercises for back muscles. That is nothing comparing to lower back pain and weakness in left leg. I am currently using Neurontin and Amytriptiline for that pain and it helps a little (most for sleep).
I am going tomorrow to neurologist for check and to schedule CT and MRI.
Thanks again for your time, and I can’t regret because we are not closer so I can go to you for exam.
Best regards
Nikola

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