Your Observations on Adult Scoliosis Repair Outcomes

[josterberg]

Hello All, 62 yoWM, w/ significant scoliosis and kyphosis. Unable to walk 100 yards w/o great difficulty. Previous PLIF @ L4-5 L5-S1 in 1998, result =CFBSS. Scoliosis/kyphosis not present before PLIF. Onset of s/k was slow, accellerated it seems post femur fracture in 2009. Forteo tx since May 2014, DEAX SCAN revealed significant osteoporosis in December 2013. L/S sciatic nerve impingement, several dessicated thoracic discs w/ short pedicles. Similar OA disc degen in neck, trouble swallowing large pills, s/k begnining to cause minor lung compression by rib on R/S. If suitable BMD increase can be achieved w/ Forteo, this would obviously be an extremely complex, prolonged surgery. Patient's QOL score is 2/10, chronic pain treated with high dose opiates ( approx 4 grams morphine sulphate per 24 hours) and NSAIDS. Opiate intake being tapered, down from 6-7 grams per 24 hrs).
CONCERNS: Obviously risk vs. reward, but almost importantly the ability to supply sufficient analgesia post procedure. If patient reduces morphine to <2 grams per day, opiate tolerance may prove a tremendous obstacle. Patient is otherwise in good physical health. MH wise, patient is extremely motivated, denies depression/suicide ideology, given the circumstances appears to be coping well, states he "refuses to live in a wheel chair". Post op motivation and adherence to rehab most likely will not be an issue. Any of your observations/ experiences with similar patients > procedure would be greatly appreciated. Thanks To All

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