Guest guest Posted July 1, 2004 Report Share Posted July 1, 2004 ... While I can't give you references for papers that specifically state that most people with iatrogenic flatback had fusions below L2, I've definitely heard both Drs. Hu and Bradford mention that level in their talks. And, most of the papers I have on flatback that mention specific details on the lowest instrumented vertebrae, start at L3 or L4. (That is, none of the cohort had a lowest instrumented vertebrae above L3.) Here are some internet references that talk about the problem being mostly in the lower lumbar area: FROM DR. LAGRONE'S WEBSITE: Clearly, the most important causative factor responsible for flat-back syndrome is loss of lumbar lordosis. Distraction instrumentation extending into the lower lumbar spine or sacrum has been identified as the most frequent cause of loss of lordosis. FROM DR. ONDRA'S PAPER ON FLATBACK: In 1988, Kostuik and associates[39] reported on combined single-stage anterior and posterior osteotomies in 54 patients to treat iatrogenic flat-back syndrome. In this group of patients, the original fusion was to the sacrum in 44 patients, to L-5 in eight patients, and to L-4 in two patients. No patient in whom fusion stopped at or above L-3 developed flat-back deformity. The same year, La Grone and associates[42] reviewed the Minneapolis experience. They reported on 66 extension osteotomies performed in 55 patients to treat iatrogenic loss of lumbar lordosis. Failure to restore sagittal plane balance led to a higher rate of pseudarthrosis and recurrent deformity. In 1983 Cochran and associates[17] reported on 100 patients treated with Harrington rod fusion for idiopathic scoliosis with a minimum 5-year follow up. They found that in patients who had undergone fusion distal to L-3 their lumbar lordosis was not maintained, many developed retrolisthesis and all had significant low-back pain. Since then several authors have discussed different techniques to correct flat-back syndrome surgically. And, from the same paper: Distraction instrumentation allowed greater correction to be obtained and maintained in the frontal plane. Initially little consideration was given to the effect of distraction instrumentation on the sagittal plane. When placing posterior distraction instrumentation that is not contoured for lordosis there is a tendency to flatten the lumbar lordosis or even to cause frank kyphosis. The magnitude of loss of lordosis increases the farther distally the instrumentation is placed. Aaro and Ohlen[1] studied 96 patients in whom Harrington distraction instrumentation had been placed. They used nonradiographic methods (kyphometer inclinometer) and demonstrated a progressive loss of lumbar lordosis as the level of instrumentation extended distally. They recommended avoiding fusion below L-3 unless clinically indicated. Patients in whom instrumentation was placed down to T-12 had lumbar lordosis of -38°, whereas patients in whom instrumentation was placed to L-5 had lumbar lordosis of only -16°. In 1990, Swank, et al.,[66] reviewed 43 patients in whom radiographs had been obtained before and after placement of Harrington instrumentation in the lumbar spine for scoliosis. Lordosis decreased progressively at lower levels of fusion. The increase in lordosis below the fusion did not compensate for the overall loss of lordosis in the fused portion of the spine. As always, that doesn't mean you didn't have flatback. It just means that you're not the norm. -- -- In , " poetryperson " <poetryperson@s...> wrote: > Hi, , > I couldn't agree more about not scaring people, . I hope most of the information I do provide is reasonably accurate and helpful without being alarmist. It would be wonderful if I could get hold of the studies or statistics that support the lack of problems following most fusions terminating at L2 or higher. Do you have any citation for this which I could incorporate in my own files? I am not doubting you -- I just did not realize that anyone had gathered sufficient epidemiological data on the Harrington rod population to support this statement. So many patients have inevitably been " lost to follow-up " -- maybe because they are problem free, but who knows for sure? > > Thanks, > . > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2004 Report Share Posted July 1, 2004 Oh, , I was referring to a posting which discussed HARMS and whether or not it is a concern above (or below?) different levels. I discerned that my T6-L5 was right on the border of concern for flatback. That was the conversation. Do you remember? I think you were chatting with . If you can't " pull it back out " please do not worry too much. Thanks, anyway, for responding! You are very dependable! Sincerely, Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2004 Report Share Posted July 1, 2004 Carole... What what means? --Lind > , can you extrapolate for a novice to tell me what it all means to > T6-L5? > Carole > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2004 Report Share Posted July 1, 2004 Carole... If you had fusion that resulted in loss of lordosis (which can certainly happen to L5), than you could have flatback. L5 isn't borderline. The discussion was essentially about L3 and above, and we're talking about the lowest fused vertebrae. -- > Oh, , I was referring to a posting which discussed HARMS and whether or > not it is a concern above (or below?) different levels. I discerned that my > T6-L5 was right on the border of concern for flatback. That was the > conversation. Do you remember? I think you were chatting with . If you > can't " pull it back out " please do not worry too much. > > Thanks, anyway, for responding! You are very dependable! > > Sincerely, > > Carole > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2004 Report Share Posted July 1, 2004 What is lordosis? Joyce Re: Helping out a friend Carole... If you had fusion that resulted in loss of lordosis (which can certainly happen to L5), than you could have flatback. L5 isn't borderline. The discussion was essentially about L3 and above, and we're talking about the lowest fused vertebrae. -- > Oh, , I was referring to a posting which discussed HARMS and whether or > not it is a concern above (or below?) different levels. I discerned that my > T6-L5 was right on the border of concern for flatback. That was the > conversation. Do you remember? I think you were chatting with . If you > can't " pull it back out " please do not worry too much. > > Thanks, anyway, for responding! You are very dependable! > > Sincerely, > > Carole > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2004 Report Share Posted July 2, 2004 , Thank you! Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2004 Report Share Posted July 2, 2004 Hi Joyce... Lordosis is the natural curve at the bottom of a normal spine, when viewed from the side. You can see diagrams and find a glossary on the SRS website at: http://www.srs.org/patients/ Regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2004 Report Share Posted July 2, 2004 Joyce, I'll put it backwards. Lordosis is the lack of which gives one " flatback " . It is actually that little bend inward at the base of a normal spine, and which bend those of us with flatback do not have. Hanging in there? You are great! Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2004 Report Share Posted July 2, 2004 Thanks for the web site . The glossary was very helpful. Joyce Re: Helping out a friend Hi Joyce... Lordosis is the natural curve at the bottom of a normal spine, when viewed from the side. You can see diagrams and find a glossary on the SRS website at: http://www.srs.org/patients/ Regards, Support for scoliosis-surgery veterans with Harrington Rod Malalignment Syndrome. Not medical advice. Group does not control ads or endorse any advertised products. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2004 Report Share Posted July 2, 2004 Thank you for the info Carole. I am learning a lot form this group. Joyce Re: Helping out a friend Joyce, I'll put it backwards. Lordosis is the lack of which gives one " flatback " . It is actually that little bend inward at the base of a normal spine, and which bend those of us with flatback do not have. Hanging in there? You are great! Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 4, 2004 Report Share Posted July 4, 2004 Not a bad policy, I guess, but some people, like myself, have very little to no back pain, but pain nearly everywhere else from messed-up body mechanics, as well as greatly reduced tolerance for walking, sitting, etc., and a visibly tilted-forward posture. I think I would be more candid, given the wide range of symptoms this deformity can create. Re: Helping out a friend Kathi... When I meet people with Harrington rods who are pain free, I usually just tell them that they should seek the advice of a scoliosis specialist if they should start having any back pain. Since most people with Harrington rods that don't extend past L2 don't have problems, I don't think there's any sense in scaring them. Just my opinion. :-) -- Support for scoliosis-surgery veterans with Harrington Rod Malalignment Syndrome. Not medical advice. Group does not control ads or endorse any advertised products. Quote Link to comment Share on other sites More sharing options...
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