Degenerate Scoliosis

Late complications of adult idiopathic scoliosis primary fusions to L4 and above: the effect of age and distal fusion level

UNLABELLED: STUDY DESIGN A retrospective analysis of primary cases of adult idiopathic scoliosis treated with long instrumented fusions from the thoracic spine proximally to segments that range from T11 to L4 distally. OBJECTIVE: To analyze whether patients requiring revision surgery had lower postoperative SRS-24 scores; age >or=40 years correlated with higher rates of revision surgery; disc degeneration below the fusion occurred more commonly with a more distal lowest instrumented vertebra or older patient age (>or=40 years); and whether smokers had higher rates of major complications or revision surgery. SUMMARY OF BACKGROUND DATA: Few reports describe complications related to primary long fusions using modern 2+ rods, hook/pedicle screw instrumentation methods in the treatment of adult idiopathic scoliosis. METHODS: Sixty-seven patients were analyzed with an average age of 38.8 years (range 21-61 years). The average clinical follow-up was 7.8 years (range 2-16 years): 42 patients had >5 years follow-up, including 23 patients with >10 years follow-up. Patients were categorized by age (< or >or=40 years) and level of the lowest instrumented vertebra (T11-L2 vs. L3-L4). Upright radiographs and postoperative SRS-24 questionnaires from the latest follow-up date were analyzed. RESULTS: Patients requiring revision surgery had lower total score (average 72.0) than those that did not (total score = 94.2; P = 0.01). More specifically, patients with pseudarthrosis had lower total scores (average 74.7) than those without (average total score = 93.5; P = 0.02). When analyzing age, there were similar rates of pseudarthrosis, but higher rates of transition syndrome (2) and sagittal/coronal imbalance (1 each) in patients >or=40 years. Subsequent distal disc degeneration did not correlate significantly with more distal lowest instrumented vertebra or older patient age. Smokers did not have higher rates of major complications or revision surgery than nonsmokers. CONCLUSIONS: Patients with adult idiopathic scoliosis and long fusions had similar pseudarthrosis rates, but higher rates of transition syndrome when lowest instrumented vertebra was L3-L4 relative to levels T11-L2. When categorized by age, complication rates were similar in each group. Patients with pseudarthroses or other diagnoses requiring revision surgery had lower SRS-24 total scores than those without (P = 0.02 and P = 0.01, respectively)

Keywords : Adult,adverse effects,Age Factors,analysis,complications,epidemiology,etiology,Female,Humans,instrumentation,Lumbar Vertebrae,Male,methods,Middle Aged,Patients,Postoperative Complications,Pseudarthrosis,Reoperation,Retrospective Studies,Scoliosis,Smoking,Spinal Fractures,Spinal Fusion,Spinal Osteophytosis,Spine,Spondylarthritis,surgery,Syndrome,Thoracic Vertebrae,Treatment Outcome,Universities,Washington,, Complications,Adult,Idiopathic,Scoliosis, how to massage lower back pain

Date of Publication : 2004 Feb 1

Authors : Rinella A;Bridwell K;Kim Y;Rudzki J;Edwards C;Roh M;Lenke L;Berra A;

Organisation : Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/14752356

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2022-06-10

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2022-06-08

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2022-06-06

Sciatica My mother was in absolute agony for more than 3 months due to sciatica. It just came out of nowhere and took her out of action. From working full time she went straight to being bed bound and unable to carry out simplest of actions.The pain was 9/10 and she was bed bound for those three months. Multiple trips to A&E and GP and they wouldn't class it as an emergency therefore they wouldn't do anything about it other than upgrading the painkillers which did next to nothing for my mother. I couldn't bear to watch my mother sleeping on A&E bench in pain for 7 hours, just to be told by doctors that she wouldn't be kept in. I remember her joining her hands and begging the doctors to stop the pain which broke my heart. I then started doing research on google and London spine unit came up with Dr Mo AKMAL's profile and review. First meeting with Dr AKMAL was via ZOOM as my mother was bed bound. Dr AKMAL spoke to me and my mom and told us that this is nothing to worry about and that the pain would be 100% gone.Dr AKMAL assured us to visit the hospital so he could physically inspect my mother and give us the best solution. One trip to the london spine unit and Dr AKMAL advised us that the best solution would be to carry out Minimally invasive disectomy. Dr AKMAL advised that due to my mother being bed bound for a while, steroid injection might not give the result that my mother wishes. Dr AKMAL was very confident and showed us some videos from other patients who had gone through the same ordeal. The biggest thing i noticed between before and after was the smile on the patients face. Dr AKMAL was constantly assuring my mother throughout the meeting that he would take care of her pain and gave her 100% confidence that the result would be delivered.He promised her that she would be walking pain free the same day after the operation. Before the operation Dr GURUNG was consulted multiple times and he also was very helpful. Right after the surgery, as Dr AKMAL promised, my mother was walking and the biggest thing was that the pain was gone. My mother had forgotten to smile for three months and there i saw her smiling again. Dr AKMAL and Dr GURUNG gave us brilliant aftercare and informed us that just give them a ring if there was any issue. Its been several weeks now and my mother is heading towards complete recovery without any issues. The pain is completely gone and anyone who is reading this going through the same horrible sciatica pain you must come and see Dr AKMAL. Thank you Dr AKMAL and your whole team for helping my mom achieve this pain free life.

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2022-05-18

Extraordinary Care My 81 year old mother who has retired in Ghana was suffering from severe lower back pain so a local surgeon put her through discectomy with hardware (spine screws). The procedure was essentially botched, with one screw breaching her spinal canal resulting in extreme pain; unable to walk, pins and needles and numbness in the left leg. The hardware subsequently had become infected and loosened as a result. Her life after this surgery was the worse she has ever experienced in all her life. She had no doubt that she was eventually to die from the infection and pain. Fortunately, through diligent search, we found Mr Akmal and his team at The UK Spine Centre. She had a zoom consultation and with a ready MRI and CT scan, Mr Akmal knew exactly how to have her back to fitness and a better quality of life. She travelled to England on 26 March 2022 and had the surgery on 11 April 2022. It was a day-case. It lasted no more than 1 hour 30 minutes. She was on my feet within 2 hours pain free - still pain free 5 weeks on! To her this is simply a miracle ! She is grateful to Jehovah God for Mr Akmal and his team - thoroughly professional bunch at the top of their game. No one deserves to suffer the pain she experienced for two years. She seriously recommends Mr Akmal and his team for anything SPINE!

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2022-05-18

Bilateral discectomy and dynamic stabilisation for complete foot drop From the first phone call, the team at London Spine have been amazing. I had severe symptoms following an L4/L5 disc injury from playing sports and had complete foot drop. Mr Akmal and his team treated the situation incredibly sensitively, as I had risk of permanent damage. The whole process was so quick, from initial consultation to operation was about 96 hours. On the day of the operation, the nurses couldn’t have been more helpful, attentive and calming. The surgery was flawless, with absolutely zero pain from the operation following. I am now 8 weeks from a bi-lateral discectomy and dynamic stabilisation procedure and have regained full use of my leg and toes, with a complete range of motion also. Mr Akmal’s aftercare has been first class, with regular calls from his team in the 2 weeks following the surgery, to the final consultation and discharge. Thanks so much for giving me my life back

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2022-04-22

I had a massive bulging disk on my back… I had a massive bulging disk on my back compressing my nerve for three years. It caused me excruciating pain and almost left me disabled. I was on both crutches and completely homebound due to the severity of pain and mobility limitations. I had my lumber surgery two weeks ago and walked out of hospital within a few hours pain free on my right leg that was almost paralysing prior to surgery. The disk was shaved off releasing the nerve completely. Two days after surgery I had excruciating pain on my head that is unexplained as I had CT scan and MRI which were all fine. Dr Akmal has suggested it could be from the anaesthetic. I am extremely grateful to Dr Akmal and his very welcoming and cari g team. I would highly recommend his clinic as I have had excellent recovery.

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2022-04-02

Thank you Mr Aklam After having a poor and very slow experiance in glasgow . I contacted Mr mo Amlam . Who is a true gentleman, great listener and paitent . We transfered my scans and treatments from glasgow to harley street . Mr Aklams p.a arranged a quick zoom to start our contact .I then went down for a meeting and examination and what should have been a spec scan .only to be told of a UK shortage . So 4 weeks later the scan took place in wellington hospital . Before I traveled back to glasgow. 5 days later I got a call to book me in to 19 harley street for a l3 and l4 debridement and stabilisation. The opp took place on 24th March. 2hours I was out walking 4 hours later . My pain in back groin and foot was all gone .thanks to Mr aklam . Top of his craft but more importantly pouts his patients first .he really wants to help you get better. Thank you so much Mr Robert harvey

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2022-03-22

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2022-03-17

Great service and painless procedure Great service and painless procedure. Definitely alleviated the pain

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