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…...it 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  *** http://www.medtronic.com ****
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. ****http://www.theborneopost.com/2011/11/20/spine-surgery-now-faster-and-safer/#ixzz2z75NKmfL  ****
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. 

Benefits
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.  http://en.wikipedia.org/wiki/Titanium
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 http://www.mdjunction.com 

32 comments:

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Wong Chor Mun said...

thank you.

Wong Chor Mun said...

yeah... I am about to pass through 3 mth post ops. At current I am recover very well. I have gone back to work on 5/5/2014.
If anyone of you wish to drop any enquirers, feel free to do so. I can pick up from my email

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Wong Chor Mun said...

Images not loading correctly or you see no images most probably is due to your are surfing the internet through proxy server. Your organisation the internet admin could have set some policy rules.

Anonymous said...

What is the price of spinal fusion which you carried out at UM Specialist Centre?

Wong Chor Mun said...

Thank you for drop down a comment.
The price is very much depends on how many screws, how long the rod that need to be install. If I am not mistaken a titanium screw cost RM1,500.

If you wish to know further kindly drop me an email at wcmsusan@gmail.com

铭的平凡故事 said...

This is good to share.
My gf also suffered from scoliosis before. Similar to u, she has undergone surgery lead by Prof Kwan in UM.

Wong Chor Mun said...

铭的平凡故事's blog owner, thank you for leave behind your comment. Glad to know that your gf has seek medical help for scoliosis.

In simple analogy a beautiful nice bungalow - a person frame, where it's beam is our spine, the furniture and fittings is our internal organ. Scoliosis is like the nice bungalow's beams of unknown reason curve and slanted. In the initial stage the furniture and fittings inside the house can bear with little curve and slanted.. however eventually the beams curve/slanted more.. The bungalow structure gone out of shape..The furniture and fittings will damage eventually as the beams continue to slant/curve more.
Spinal fusion is like salvage the beams of the bungalow before it crush and damage the furniture and fittings inside.

Yen Goh said...

Hi so happy that you made a right choose. I am a scoliosis patient operated by the late Prof Subra about 32 years ago. I am 48 yrs old now. Those day after the operation I was bedridden for about 3 weeks before i can stood up and walked. Stayed in the UH for about 2 months. After discharged from the hospital, I had to wear the Plaster (from neck to hip) for 6 months. I met Prof Kwan today, he shared me your situation...

Yen Goh said...

Hi so happy that you made a right choose. I am a scoliosis patient operated by the late Prof Subra about 32 years ago. I am 48 yrs old now. Those day after the operation I was bedridden for about 3 weeks before i can stood up and walked. Stayed in the UH for about 2 months. After discharged from the hospital, I had to wear the Plaster (from neck to hip) for 6 months. I met Prof Kwan today, he shared me your situation...

Wong Chor Mun said...

Hi Yen,
Thanks for dropping down a comment. Yar Prof Kwan told me about spine surgery for scoliosis in the olden days.. Well I may have wasted a lot of my youth living a miserable live with this scoliosis. When I ponder back oooosh... it was not a bad idea that my parent are ignorant ... It is indeed in everything in my life everything that happen is in GOD's timing..

Dorothy Gonzalez said...

Hi! Good to hear your surgery is successful. Actually my best friend’s mom has the same situation with you, but not that curved as yours. I think next week is her operation. My friend told me that placidway.com connects her mom to one of the top surgeon in town. I hope the outcome of the operation would be success as yours. Take care and god bless. Oh by the way how long did you recover in the operation?

Wong Chor Mun said...

Thanks Dorothy for drop down your comments.
I admit to the hospital on Monday, surgery in the evening. On Thursday my surgeon want to discharge me. I request to stay in another day. So all in all I am having 5 days 4 nights in the hospital.
I am now passing my 3rd mth after ops.. my recovery period is at least 9 - 12 mths.. My surgeon keep remind me please do things carefully .. your weight restriction is not more than 3kg.. I have 16 screws and 2 rod ..fussed from T3 to L2. My restriction will be lifted after my spine is fussed up..

Mimi Leong said...

Hi Miss Wong. Thank you so much for your sharing. It's really helpful. Am going to have spine surgery on August by Prof Kwan. Kind of stressful whenever I though about the pain. But I believe God is going to do something amazing in my life. Take good care. You are so brave and so strong.

Mimi Leong said...

Hi Miss Wong. Thank you so much for your sharing. It's really helpful. Am going to have spine surgery on August by Prof Kwan. Kind of stressful whenever I though about the pain. But I believe God is going to do something amazing in my life. Take good care. You are so brave and so strong.

Wong Chor Mun said...

Mimi,
Thanks for dropping down your comment. You would be automatically be brave and strong when these are the only option you have.
I believe that you would have a good correction of spine too. Just relax.. you will be ok

Susan John said...

Hi Wong, this is great and good to know that you made the right choice and doing well after surgery. Take care

Wong Chor Mun said...

I truly glad I did. BTW not only I gained 3.5cm by going through the ops. I also have a number of health condition resolve..
eg
I used to have 'trapped gas".. hands touch on my stomach area gives you the sensation of boiling water.. This has being resolved...
I also glad that I exist in this modern medical spine technology era.

Mustafa Ismaiel said...

Hi dear. Thanks for ur great sharing. Can u tell more about prof kwan and umsc. Is he a trustworth surgeon to do such surgery? Is the umsc is good place enough to have the treatment there? Thanx

Mustafa Ismaiel said...

Hi dear. Thanks for ur great sharing. Can u tell more about prof kwan and umsc. Is he a trustworth surgeon to do such surgery? Is the umsc is good place enough to have the treatment there? Thanx

Wong Chor Mun said...

Hi Mustafa, Thank you for leaving your comments. This is the url of my spine doctor profile. http://www.umsc.my/umsc_doctor/kwan-mun-keong/
BTW are you looking for spine doctor/surgeon?

Mustafa Ismaiel said...

Hi wong, thank u for ur reply.
Actually i know prof. Kwan and visited him several times. However, i want to know about ur opinion about him, and whether he is a trustworthy surgeon to make a spine surgery? Your experience is very important to me. Thanx

Wong Chor Mun said...

Hi Mustafa,

Rest assured that Prof Kwan is a very good and passionate on his work. I believe this statement will be repeated to your ears if you ask all his patient.
BTW I bump into this blog
http://wynndarrien0428.blogspot.com/2014/06/the-sadness-moment-that-happen-in-2012.html
With this sharing this can assured you that Prof Kwan is very careful and details when diagnosing his patients.

Jo Lee said...

Dear Chor Mun,
Have you worn a brace before? Prof Kwan told me I need to wear a TLOS brace for three years.
Thank you for your inspiring blog.

Wong Chor Mun said...

Hi Jo Lee
Thank you for drop down your comments.
I am in the category scoliosis untreated during my prime growing age (12- 15yrs). I have no experience on TLOS Brace.
I presume you are in your prime growing age and your curve is not severe therefore Brace is being administer..
Please be diligent in wearing the brace.. hopefully you can control the curve and surgery is not required.

Anonymous said...

hi chor mun,
thanks for your info and sharing, may i know, how much you spend for the operation?

Wong Chor Mun said...

You wish to gauge how much is the cost of your ops? The cost is very much depends on how much implant the patient need.
Each titanium cost around RM1.5K - RM1.8K.
should you wish to know in much details please drop me an email..

zubair abd hai said...

Hi..i dont know wether this thread is still active or not..i hv been advised by colleages to seek dr kwan consultation as currently im suffering disk bulges at L4/5 L5/S1. Currentlu im having physio treatment at glenagles KL under supervision of dato dr zul..it is good to have 2nd opinion and i dont know who should i look for..some say umsc is full with modern equipment.

Wong Chor Mun said...

Hello Encik Zubair..
Thanks for taking the effort to drop a few lines.
From what you describe to me that you are having degenerative disc problem.
You may have daily chronic pain extend from your buttock down to you ankle.
It is indeed a good idea to seek 2nd opinion pertaining to your problem.
UMSC is the private wing of PPUM. The doctors works at both end the only difference is the management.

Yes indeed PPUM/UMSC hospital is one of those few hospitals in Malaysia that handle a lot of spinal issue...
My spine doctor beside handle spinal deformities (scoliosis) he and his team also do have a lot of patient with degenerative disc problem..

Karis said...

Hi Ms. Wong,

Can you share the details of pre-ops preparations and fees needed to get your spine done?
Im having severe scoliosis too and plan to have it done with Prof Kwan.
Here is my email vinyks@yahoo.com

Thanks a lot

Khai Liang Yew said...

Hi Ms Wong,
Hopefully your post still active.

Do you mind to share the details of pre-ops preparations and total fees needed?
My mum is having scoliosis issue as well and we plan to send her to Prof Kwan for surgery.
Perhaps you can share it to my email klyew87@gmail.com

Thank you.