ADR and Scoliosis?

Hi Everyone.
Has anybody had an ADR that also has scoliosis?
In the clinical trials from what Ive read, scoliosis was part of the exclusion criteria for a Charite disc. I'll be having a 1 level fusion L3/4 and Disc relacement at L4/5. I'm concerned that with the spinal rotation from my 35 degree thoracolumber scoliosis that my new disc will be compromised. Also I'm scared that I'll still have unresolved pain related to the scoliosis after surgery. Anyone else had this problem?
Thanks Cathy

Hi Cathy,
I have had ADR x2 a year ago.I have worked very hard to regain my fittnes with hydro therapy every day.My pain has continued since surgery and increased to the point now that I,m on morphine patches. Xrays 2 weeks ago showed that I now have a marked scoliosis of the lumber spine taking the top plate with it. My top disc replacment looks like pac man. My nuro surgen said they no longer do ADR on people with scoliosis for this reason. I did not have scoliosis before surgery and it appears that my bottom plate has moved forward and this may be what has cauesed all of this.
Thanks, Jacqui

[Harrison]

Cathy, this has not come up that often in discussion, perhaps because of what Jacqui explained (sorry Jacqui).

On a related note, I was doing some research on thoracic kyphosis, and found a scoliosis site that may interest you. The article I found is about "flatback."

...Balance is achieved in the human spine by three curves in the sagittal (side-view) plane. The normal cervical and lumbar spine is lordotic or concave posterior. The thoracic spine is convex posterior or kyphotic. The S-shaped configuration of the spine in the sagittal plane provides a shock-absorbing or spring like function which reduces stress on the vertebral column when weight loaded....

[Kim]

Hey Cathy
I have 11 degree scoliosis and was told that I was borderline as far as getting ADR done. Dr Blumethal told me at that time I was still a candidate but he would not accept anyone with over 11 degrees. He liked it to be 10 degrees or less to be optimum. I dont know if that is helpful or not but thought I would post my experience.
Kim

Hmmm... interesting replies.
I will query my surgeon when I see him next month but He's so experienced I will trust what he recommends. He did say though it would be a more difficult case but could be done.

Hi

I had a Harrington rod correction for scoliosis when I was 11 (now 33) and I had a ADR 2 years ago at L4/L5. Unfortunately though the disc is not performing well because of my curves and I have flatback anyway therefore will be having a spinal realignment later this year.

I have been told my atificial disc cannot be removed for this but will be fused in solid. I am having my origianl fusion (from T3-L2) extended all the way down and a osteotomy in the lumbar region to try to restore natural alignment.

[Alastair]

Hi YB,
yes this is the usual scenario where a disc is performing badly, they won't remove it, but probably put pedicle screws in to stop it moving again. And it will be made to fuse probably by introducing some bone across the gap.

I'm sure your surgeon is now using the advanced Harrington Rod technology, I'm sorry the ADR has not worked out, but obviously you've got a huge spine problem right from an early age and this surgeon is a man who's been using a lot of brainpower to help you. I hope it all works out and please do come back and tell us how you get on -- -- -- do you have a date for your surgery?
Best,
Alastair

I am having the surgery in October.

[Harrison]

Also check out the "Back to Basics: Current Thinking" page for some perspectives on corrective surgery -- including both fusion and ADR:

"...Balance is absolutely critical in spine surgery. The delineation between good and excellent surgery may depend on how well the surgeon balances the spine during the reconstruction.

A spine which is decompensated or tilted forward, will require increased energy utilization by the various muscles which support the head, the neck, and the rest of the spine. A spine which is out of alignment and pitched forward will require various back, buttock, and leg muscles to "right the spine" during activities such as sitting and walking. This increased energy requirement may cause the muscles to become easily fatigued which may in fact cause pain. Reconstruction surgery which reduces the normal curvature of the spine of the lumbar spine (flatback syndrome) may in fact leave a patient more vulnerable for symptoms than prior to reconstruction..."

And here's the kicker that really has me thinking about all of us patients:

...Although various techniques may seem "state-of-the-art" or "minimally invasive" any technique which does not attempt to recreate normal spinal balance may have long lasting negative or adverse results on the patient's spine "health..."

http://www.espine.com/basic_thinking.html

[Cindee]

Yes I have scoliosis of the lumbar spine, and I have a 2 level replacement. Pro Disc by Delamarter almost 2 years ago. I just saw him 1 week ago, and he has some concerns with the way they are rotating, but since I am in a trail...there is no way to predict what will happen. I am pain free, and do not feel limited in any way, at this point. I am going to try to attach my pictures so maybe you can see what I am talking about.