Wednesday, April 30, 2014

Posterior spinal fusion for scoliosis or spine surgery ?

Notes :- I had Posterior Spinal Fusion for Scoliosis on 17/2/2014. I underwent this treatment at UMSC  (University Malaya Specialist Center). My surgery was lead by Prof Kwan Mun Keong. University Malaya Specialist Centre (UMSC) is the private wing of Pusat Perubatan University Malaya (PPUM).

This blog was initially meant to share my birding field trips reports. Ever since I started to use Facebook I  have not post anything since then.  At current I am in my recovery period from my spinal fusion for scoliosis.   Once I start to update this blog with nature photographs and field trips reports that means my spine has fussed up and my restriction has being uplift.

I hope my sharing on scoliosis and me will serve as an encouragement to those who have spinal deformities like me. For those who  have Scoliosis, spinal disc herniation, spinal disc degeneration, spondylosis, kyphoysis, do not be afraid/avoid when the  spine doctor recommend the solution is surgery. There is hope for you in today modern medical technology.  Please do not endure the pain in silence.

Should I (or my child) have spine surgery for scoliosis?
After hearing your spine doctor said  “…OK I recommend the option is surgery due to the curve is over 45 degree and it is severe…no brace can help in this situation….no drugs/medicine to cure… ” If the patient is you yourself or it is mean for your child, I can sense that eerie statement send a shiver down to your spine.  Your knees are wobbling now.  101 questions suddenly runs in your brain now.  Sure?  Huh,… Isssh ..Is there any special tailor-made exercise for scoliosis or alternative treatments to avoid surgery? … yoga for scoliosis? … special gym tailor made program?  What happen it end up a fail surgery…. Oh no…on wheelchair? Bed ridden?  Then whole life will crumple down overnight. 

If the patient is your child, you have a quick glance at your child who has just past her/his birthday who is still in a small frame size.   You feel like crying, have a lot of why, how come questions but need to swallow down the tears as you continue to listen what the spine doctor says.  “….curve increase in a fast rate as your child is still in the growing stage… affect the child  lungs/heart function  as well as bowels function when the curve touch….. surgery risk are  nerves injury, infection, fever…internal organs failure due to a sudden stretch … bleeding … blot clots…spine implant hardware failure ….etc..etc..

Now some of patients might have the thoughts is this doctor is all about meeting the KPI (key performance indicator) of how many spine surgeries need to be done in a year?  Hmmm wonder how many extra $$$ this spine doctor will get in each surgery?  Is surgery necessary?  Is this doctor words are worthy and trustworthy?  Most patient will do spine doctor shopping to have 2nd, 3rd …or even 4th or 5th opinions.

My real life experience being a scoliosis sufferer
I am being diagnosed as a scoliosis sufferer ever since I was 12 yrs old.  Mum was then informed that ultimately she need to send me to the hospital for further diagnosis and very likely it will then lead to spine surgery.  Mum came back to discuss with dad.  After so many decades, I still recall Dad the statement he made…no matter what the final decision is No ..NO. over my death bodies.. our daughter will get paralyse…. She will have no future…we cannot afford of having our daughter bed-ridden.  Being a child who is unable to decide for oneself, scoliosis and me tag along as I grow from a child till adulthood. I still recall in my early working life daily I commute by bus to my workplace.  Usually at the bus stop I would bump into a lady who is more curvy than me.  Her curves start from cervical (neck).  Her head is slanted to the left side glue together with her shoulder.  You can’t notice that she has a neck. Whenever she want to see what is on her right, she need to turn her whole body. Her torso is also compress with a very huge obvious rib hump.   There is one day I noticed she has a neck.  She can use her neck to turn left and right.  I asked her what she has done, she advice me to seek consultation from her orthopaedic at GHKL.   That time I was 24yrs old, quietly without my parent knowledge I went to GHKL. I still recall dutifully paid my RM1 join in the long queue of sick and sorrowful face group of people as though tomorrow never turns up. Walk into the orthopaedic room when my named is being called, he test my reflexes using a rubber hammer to tap my elbows and knees cap. He ordered me to do the Adam’s forward bend test.  Then ordered me to go to another counter to pay RM5 for spine X-Ray.  Once they hand me some big pieces of black and white film, I will then need to walk back to his room again.   I still recall those days in order to take this X-Ray, the patient need to wear the hospital gown with the back fully exposed.

He looked at my spine X-Ray and he said hmmm roughly your curve is 45 degree now. Do you have pain on your heels when you touch the ground? …as of date spine surgery is really dangerous… need to be in body cast for 6 months…cannot bath.. I predict over the years due to gravity pull over body balance your C curve will turn to S curve…. don’t know when with a normal slip/fall you will be paralyze.. in this world there is no drugs/medicine to cure this…since you don’t have heels pain .. then you need to come at 2 times a week at 4 pm to learn physiotherapy…at that hospital block… in the mean time walk in your journey of life heads up girl.  Don’t let the deformities to over take and drown you.

Since he pronounced no cure…over the years off and on I source alternatives treatments. Some treatments required to press my muscle here and there, press my rib cage,  press at certain vertebrate, twist my body here and there.  I end up more painful than before.  Few occasions I end up having a tremendous level of back-ache after the alternative treatment.  I will chart my level of pain as level 12 in the standard pain chart of 10 being the max.  I am in so much pain.  Ooossh as I reflect back my ignorant and stupidity could have landed me up in big trouble.  Beside gone through this physical torture, over the years my rib cage hump become more and more prominent.  I could not find a piece of dress that could fit me well even during the days when my waistline is only 24 inches.  Some people commented I don’t know how to wear my skirt properly?  Why can’t I walk and stand properly? 

I ended up with some days I have forgotten how to smile.  I am very cautious how people look at me physically.  I wear more clothes to hide my deformities even in our Malaysia hot and humid weather.  I still recall for about 2 years I was so depress I hardly utter any words and there is no smile on my face.  Some nights my brain keeps churning miserable, uncertain of the future thoughts that makes me more sober and miserable and I ended up in tears.   My torso shrunk over the years.  I suffer mild breathless and right pelvic bone pain and soreness. My right leg is starting to have sign of weakness before the recent spinal fusion surgery I take up when my C curve reading was 64 degree. 

Anyway my long years of scoliosis experience miserable life due to my ignorant not only enable me to have a safe spine surgery with modern medical technology, it has unintentionally turn me to be a living testimony that spine surgery is not eerier but safe.  My limbs and brains function are not affected.  FYI I walked to the bathroom, take shower and wash my hair on my own after all the surgical IV tubes detached from my body.  

------- This photo was taken in Mar 2010.  Based on the estimation of curve increase 1 degree each year.  This is how I look in standing position when my C curve was 60 degree then.

------- This is my standing posture now after spinal fusion for scoliosis surgery performed on 17/2/2014 

Choose quality life
Please do not let yourself or your child to end up the same life experience as mine.  Quality life and healthy life need to be restored ASAP.  Don’t be surprise your small build child of 13 yrs old falls into the prime age group category for this type of surgery. If the spine surgeon pronounced surgery then have a great thought about it. The good news is in today modern medical technology spinal fusion for Adolescent Idiopathic Scoliosis is only < 1% fatal risk for a healthy patient.   For adult in additional to that < 1% fatal risk will also expose to 10% other forms of risk.  When I discovered fatal risk  < 1% YES!!  I have being waiting for it such a long time.  The 10% risk factors, the level of pain, the cost, anesthesia and painkillers allergy and recovery period restriction eg weight, no body bending, no running, no body twisting...etc..etc.  I will worry for them later.

To undergo this surgery the patient must in good medical condition, not pregnant and having an acceptable bone density level.

Do not get paranoid hearing news of failure spinal fusion for scoliosis.  Daily there are around 27,000 cases of scoliosis each year are serious enough to require surgery. Spinal fusion is the most frequently performed surgical procedure to correct severe scoliosis  *** ****
Percentage of spinal fusion surgery successful is tremendously many more times higher than the failure. It is just somehow human nature like to magnified failures.
The continuous research over many decades has allowed advancement of medical technology and equipments.  It has made spine surgery less risky today compare to two decades ago. ****  ****
Moreover these orthopaedic implants need to pass through a long stringent series of Industrial and Medical ISO world standard. The spinal hardware implants are improvised from time to time.  As well as the list of Industrial and Medical ISO standard, more and more world standard added as it progress. 

The objectives for this surgery are :-
  • To prevent the curve keep getting worse and then lead to lung, heart and bowel problems. 
  • Restore body balance by straighten the spine as much as possible in a safe manner.
  • The other tag along benefit is cosmesis – smaller rib hump.

How to select good spine surgeon
Cost should not be priority factor as there are many more criteria that supersede it. Since this is a major surgery it need more consideration factors for you to choose the surgeon. Below are some of the questions that you use:-
  1.  Is this hospital has up to date modern medical equipment? Fully equip?
  2. Is this hospital has all the personnel medical team in one single location eg a team of spine surgeons, anaesthetist, neurologist  This question is for you to access the surgery is done by internal/external doctors.
  3. How many patients did the surgeon performed the same sort of surgery?  How many patients in a year? Month?  Week?  This question is to access how much experience the surgeon and the team has. This will also able to access how skillful the surgeon and the team.
  4. In the normal standard scoliosis case like this how long does the surgery takes in terms of hours?  This question is to access how many hours you or your child is going to lie on the operating table.  The longer the surgery will have greater exposure to infection, facial swells, longer recovery and others unforeseen.  
  5. What is the industry success rate for this type of surgery?  Ask the surgeon what is the surgeon personal level of success rate?   This is to access the surgeon skill set.
  6. Any 2nd surgery within the admission period that the surgeon did before?  The reasons for the redo work?  If 2nd surgery is required within the admission period that means you can judge yourself how confidence and skillful is this surgeon.

Your Homework
  • Search in the web what sort of achievement/recognition this surgeon have/obtained?
  • How long in terms of years this surgeon being in this field?
  • From your clinical appointment how do you judge the surgeon level of confidence/knowledge.
  • Did the surgeon hand you the list of patients that has undergone the same kind of surgery that is proposed for you/child? Look at the list  when was the surgery done. Any phone numbers that you can contact them?  notes **** do not purposely ask for the list.  This will allow you to access how many patients successfully operated by this surgeon.  Normally the past patients had given the consent that they are use as the reference. You can put a doubt on the surgeon work if this list was not hand over to you.

Others items to consider
  1. Is this hospital  located in another state?  If so then where is the possible nearest recovery site for at least 2 weeks?  This is essential as usually in the initial stage of recovery the patient is in so much discomfort therefore travel long journey is a torture even though permitted for car ride. In additional to that patient need to go back to the hospital for bandage removal normally that is usually within 14 days from the day of surgery. If you do not have any possible near recovery site, please check with the hospital do they have such facilities?  What is the rate per day? What is the rate for food and laundry?
  2. Is the propose surgery cost affordable?  Does the patient have medical policy? Find out in much more details what does the medical policy cover? Do you have staff medical benefits? What is the limit? EPF withdrawal? Credit card limit?  Personal loans? Delay on spending on the items wish to have eg new car/house/furniture, renovation, jewelry, holiday and etc..etc Have gone through the whole list of possibilities yet the bill is still cannot afford then make a clinical appointment to discuss with the surgeon.  A good surgeon who understand repair spinal deformities is restoring lives as well will help you to explore the surgery cost to fit your pocket.
  3. Plan and schedule with the surgeon the possible date to undergo this surgery. 

Your other doubts
  1. Is the hardware safe for our body?  At present the hardware is titanium. It is non-toxic and not rejected by human body. It is light, strong and non-corrosive. FYI I am installed with 16 screws and 2 rods, additional weight to my body is less than 1 kg.
  2. Need to take out the hardware after the spine is fussed up? NOT required.  People with spine implant need to be more stringent in back care for their daily life eg proper posture in lifting heavy things and no crouching (proper sitting posture).
  3. How long is the imposed restriction on weight, no body bending, twisting, jumping, running?  Temporary until the spine is fussed up. The surgeon are keeping tab on your spine progress on 14 days, 2nd months , 6th months, 12  months post ops clinical appointment.  The surgeon will let you know when. 
  4. Is it possible for a person who has undergo Spinal Fusion for scoliosis to go through pregnancy? Yes you may if you wish to, however please wait for your spine to fussed up.  Inform your gynecologist that you had gone through spinal fusion for scoliosis.
  5. Can scoliosis spine surgery lead to fatal? Yes less than 0.1 percent based on the database data at the hospital where I undergone the surgery.  In my opinion 0.1 percent is equivalent to nil or too negligible a figure to consider. Fatal possibilities occurred in our normal daily activities are any time greater than 0.1 percent.  Example once we are on the road we are exposed to fatal risk and total permanent disability due to accident no matter how careful and how good is our driving skills.
  6. Would I prone to lighting strike with the metal implant? Titanium is fairly hard, non-magnetic and poor conductor or heat and electricity.
This is most likely some of the questions people ask. If you have others doubts, feel free to drop your comments.  I will try to explore with you to get the answer.

Notes:- credit for images taken from