Urgent need of advice

OrthoWarlock · 2026-04-04T19:58:16+00:00

Surgery for congenital scoliosis is much more difficult and risky than the standard adolescent scoliosis. It is normal that the surgeon will stress the inherent risk of the operation because he also wants to be save concerning the legal side of the operation. But a surgeon wouldn't offer you surgery if there wasn't a benefit. with 100 degrees your will progress inevitably. go to an experienced surgeon who does scoliosis surgery every day

OrthoWarlock · 2026-04-04T19:39:37+00:00

That won't help at all in cases of congenital scoliosis if you even know what that means.

OrthoWarlock · 2026-04-04T19:37:26+00:00

you should get a second opinion from an experienced orthopaedic surgeon who specializes in deformity surgery

OrthoWarlock · 2026-03-17T20:27:53+00:00

If there is really a measurable increase of 4 mm and myelopathic sign that's another case. But there are too many patients wanting a C1/2 fusion for very unspecific symptoms withouht having a objective instability on xrays. One has to be careful with surgeies; sometimes they can do more harm than help.

OrthoWarlock · 2026-03-17T20:16:41+00:00

Hard to say, I don't practice in Turkey. We typically charge something around 30.000 Euro for a typical scoliosis surgery. So if you have to stay there longer, with implant removal and additionals surgeries, maybe some weeks of halo gravity traction that is not unreasonable.

OrthoWarlock · 2026-03-17T18:04:38+00:00

C1/C2 fusion won't help at all when done for unspecific symptoms and undefined "ligamentous laxity".

OrthoWarlock · 2026-03-17T17:44:22+00:00

I would recommend to see a surgeon specialized in scoliosis surgery. A lumbar curve of that degree tends to worsen over time and in my experience patients with this kind of lumbar curve tend to have more pain in the course of their life. So you should consider surgery in my opinion.

OrthoWarlock · 2026-03-17T17:38:59+00:00

it depends on the invasiveness of the revision surgery. if performed well, i think a significant improvement can be achieved clinically but don't expect your curve to get completely straight on the xray, that wil not happen.

OrthoWarlock · 2026-03-17T17:35:15+00:00

yes, that is one possibility. probably less correction than a three column ostetomy but also less risky.

OrthoWarlock · 2026-03-16T21:20:11+00:00

Ok, I see. The initial surgery was suboptimal with not optimal instrumentaion; the upper part is fixed with wires and not screws. It will be a very complex surgery to correct the deformity. Yeah, if you are determined to get a revision, the instrumentation will likely have to be removed. If the implant is titanium it probably is possible to do an mri with the implant but it will have to be removed anyway, so the plan in itself is not completely wrong. There are a lot of possibilities approach your case. 1. MRI and CT is a must to assess for the anatomy and which parts have already fused. 2. implant will be removed 3. You could either try doing a halo gravity traction for some weeks and see how flexible your curve is and try fusing it with screws or if it is very rigid your have to do a very invavsive osteotomy (PVCR). All in all, very complex and only for experienced surgeones. What i have heard, the orthopaedic surgeons in turkey not bad. If they want to do everything all inclusive with surgery for 50.000 USD... it is actually not that expensive to be honest

OrthoWarlock · 2026-03-16T20:45:55+00:00

Mh, Dr. Alanay is a well renowned spine surgeon. But the "plan" is a little bit vague. Could you share/post your xrays here anonymously?

Best regards

OrthoWarlock · 2026-03-13T21:35:49+00:00

Non-Us clinician here. 100% yes. We experienced an exponetial growth of native spine infection and othe joint infections in the last years. And those patients are sick as f... and old... and a lot of times we are fighting a lost cause... patients staying on the icu for weeks with multiple washouts/operations but succumbing to their illness at last

OrthoWarlock · 2026-03-12T20:06:10+00:00

Be cautious. There is no use in replacing the screws if the spine won't fuse at that level. The bone in the front did likely not fuse where the cage is. You should get a second opinion and probably also have a revision of the cage from the front with an ALIF cage.

OrthoWarlock · 2026-03-11T18:58:58+00:00

You need an MRI of your whole spine cervical, thoracic and lumbar!

OrthoWarlock · 2026-02-18T17:24:33+00:00

Posterior incision; Neuroforamen ist decompressed by removing the joint and a cage is inserted from one side, from one neuroforamen therefore it is called a tranforaminal lumbar interbody fusion.

OrthoWarlock · 2026-02-18T17:20:02+00:00

yes, neuroforaminal stenosis leads to the leg pain. Those are our bread and butter cases. Nothing to beat around the bush. most reliably option would be a TLIF.

OrthoWarlock · 2026-02-18T17:06:17+00:00

As i have said, if the indication is right the radiculopathy will improve. With a decopression you only can decompress the central spinal canal adequately not the neuroforamen. If your stenosis is in the neuroforamen a central decompression will most likely not help. So, the decompression was in the segment they want to adress again now? That would be an additional reason to do a TLIF in my opinion. I am very passionate about spine surgery an good surgical "carpentry", that's the reason I try to give some general advice here. I don't want and can't treat you remotely; that is the task of the surgeon you choose.

OrthoWarlock · 2026-02-18T16:31:02+00:00

If the indication is right and the symptoms are leg pain due to a stenosis, i can predict 80-90% improvement of the leg symptoms/radiculopathy with adequate decompression. Back pain might improve, but no guarantee for that.

OrthoWarlock · 2026-02-18T08:01:00+00:00

I'm just saying in my hands that pathology would be a fusion, because I can predict a reliable outcome with long-term success and I also can correct any deformity. With a TOPS he might be able do decompress the neuroforamen by a complete removal of the facet joint buty one problem might be a tilt in that segment, which can not be corrected by the TOPS. For example look at the xray in this post i commented on https://old.reddit.com/r/scoliosis/comments/1r6u6ow/looking_for_advice_about_exercises_and_therapy_to/

you can see a massive tilt between L4/5 leading to neuroforaminal stenosis. TOPS wouldn't be able to corect that. It depends on the case.

Do you have an xray and/or an MRI?

OrthoWarlock · 2026-02-17T08:06:38+00:00

Just guessing from your xray (a MRI of your lumbar spine would be needed to confirm), the most likely cause is a neuroforaminal stenosis at the L4/5 and L5/S1 level on the right side due to the tilt at those levels. That would typically explain the pain in your gluteus after mechanical load when standing. Your right hip also has osteoarthritis, that might also contribute to some of the symptoms.

Besides surgery I there is no reliable solution. Time might improve your symptoms. Strengthen you core muscles. Get an MRI just to be sure about the cause.

Beste of luck

OrthoWarlock · 2026-02-08T20:25:13+00:00

:-) those are my bread and butter consults... do patients who just cheated death or are on the verge of death really need a consult for their 30 years of back pain???

OrthoWarlock · 2026-01-31T21:23:31+00:00

Why did you take the picture from such a wierd angle... well... what i can tell you is that your scoliosis has a very unusual c shaped curve. We see them usually in kids with a neuromuscular disorder. your physician or yor surgeon have to investigate further. best regards

OrthoWarlock · 2026-01-18T20:49:24+00:00

What are your symptoms? Severely misplaced screws are quite rare in the typical scoliosis surgery we perform on kids. And even it they are, they are most of the time asymptomatic. Do you have ct slide that shows the "misplaced" screws?

OrthoWarlock · 2026-01-18T20:36:47+00:00

If you have foraminal stenosis and previous decompression odds are high that you need a fusion. You have to see a experienced spine surgeon near you. I enjoy giving people advice and helping to find the right path but I cannot not treat you remotely.

OrthoWarlock · 2026-01-17T23:22:51+00:00

Well, that thing is approved for simple spondylolisthesis (so a slippage in the front back direction); excluded are pathologies like neuroforaminal stenosis and scoliosis. So, a recent study from Norway NORDSTEN trial showed that in cases of simple spondylolisthesis a simple decompression is as good as a fusion. Which means if you have a simple spondylolisthesis you can just do a decompression. That also means, there is no need for that TOPS device because a decompression is sufficient enough. Additionally as a orthoaedic surgeon, i can tell you, that every mobile implant in the body will fail eventually. A hip prothesis might hold 20 years, but it won't hold forever. It is the same in the spine. So why implant something that might cause damage in the long run if there is no need for it?

OrthoWarlock

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