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  • Posterior only vs. A/P?

    Did any of you have a choice in the type of surgery you had, i.e. posterior only or anterior/posterior? I have had both options recommended to me, and I'm wondering about the pros & cons of each. Thoughts?
    age 48
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
    Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
    Not "confused" anymore, but don't know how to change my username.

  • #2
    Well I had a posterior approach thankfully. Anterior approaches as you know are done through the front but are more complicated because they have to go through all of the stuff infront of your spine (insides). I know my doctor told me there would have to be another doctor there to do an anterior appraoch that monitors other things.
    Maliha

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    • #3
      I had both A/P. There was a reason for this (anterior), but my mind has gone totally blank at the moment. (I keep falling asleep at the computer). I will ask my surgeon on Tuesday, along with goodness knows how many other questions! He did tell me that my recovery would take a little longer than if i had posterior only. My incision at the front looks the same as a caesarian incision. I had the surgery explained to me as to how and why, but figured that he (the surgeon) knew best what to do and therefore placed my complete trust in him. He did a good job!
      Vali
      44 years young! now 45
      Surgery - June 1st, 2009
      Dr David Hall - Adelaide Spine Clinic
      St. Andrews Hospital, Adelaide, South Australia
      Pre-op curve - 58 degree lumbar
      Post -op - 5 degrees
      T11 - S1 Posterior
      L4/5 - L5/S1 Anterior Fusion

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      • #4
        my surgeon said if my cuvre got to 60 or 70 dergees he whould do it from the front and back i was only 7 degrees from that evether way
        Kara
        25
        Brace 4-15-05-5-25-06
        Posterior Spinal Fusion 3-10-10
        T4-L2
        Before 50T
        After 20T

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        • #5
          My surgeon recommended A/P in my case because it would make for a much stronger fusion. He knew I wanted to be able to go back to rollerskating and be very active. Each case is different though. Maybe you need a third opinion to break the tie., or at least ask the Docs why they recommend or not the Anterior in your case.
          Sally
          Diagnosed with severe lumbar scoliosis at age 65.
          Posterior Fusion L2-S1 on 12/4/2007. age 67
          Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
          Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
          New England Baptist Hospital, Boston, MA
          Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

          "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

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          • #6
            I had my 12 month checkup today. I questioned him about why the anterior as i knew there was a reason for this. He said that the anterior was done for more stability. The two screws posterior would not have been adequate as the L4/5-L5/S1 discs had to be removed and replaced with cages. He said that in my case those two levels needed more stability, therefore A/P was needed.
            Vali
            44 years young! now 45
            Surgery - June 1st, 2009
            Dr David Hall - Adelaide Spine Clinic
            St. Andrews Hospital, Adelaide, South Australia
            Pre-op curve - 58 degree lumbar
            Post -op - 5 degrees
            T11 - S1 Posterior
            L4/5 - L5/S1 Anterior Fusion

            Comment


            • #7
              My surgeon originally recommended anterior and posterior, two big surgeries spaced a week apart. The anterior would have been a thoracoabdominal surgery with an incision beginning at the side and down the front. This is what two other Chicago surgeons recommended for me as well. My surgeon later changed his mind to only posterior. While I probably would have gotten a better cosmetic result with both approaches, in hindsight I believe my surgeon made the right decision for me. This surgery was very hard on me and I honestly don’t think I could have tolerated two big surgeries. I was initially concerned that lack of anterior might put me at higher risk for pseudoarthrosis, but thankfully that was not the case.

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              • #8
                I was also originally scheduled for both A/P and my surgeon decided a month or two prior (I don't remember now) that he could achieve what he wanted with just posterior. Sounded good to me!
                71 and plugging along... but having some problems
                2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
                5/4/07 posterior fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
                Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

                Corrected to 15°
                CMT (type 2) DX in 2014, progressing
                10/2018 x-rays - spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

                Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

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                • #9
                  Thanks everyone, for responding.

                  Vali, appreciate you asking your doc about this. I heard something about cages at my last appt., too. I will ask about it at the next visit.

                  Thanks again,
                  Evelyn
                  age 48
                  80* thoracolumbar; 40* thoracic
                  Reduced to ~16* thoracolumbar; ~0* thoracic
                  Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
                  Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
                  Not "confused" anymore, but don't know how to change my username.

                  Comment


                  • #10
                    I was a/p and my surgeon echoed what others have said in that a/p is typically done for a stronger fusion as apparently you can't remove the L4/L5/S1 discs without going through the front. If I understand correctly my surgeon wanted L4-L5-S1 fused in front and back to make sure my spine had a very solid foundation. If he just went from the back those vertibrae would only be fused in the back of the spine like the rest of my vertibrae.

                    Rich
                    Pre-Surgery Lumbar 65 degrees
                    A/P Fusion T10-Pelvis by Dr. Christopher Good
                    Virginia Spine Institute, Reston, VA 3/17/10, 3/18/10
                    Post-Surgery Lumbar 19 degrees, and 2" in height

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                    • #11
                      I had an anterior approach...my scar goes from under my right shoulder blade and then continues down and across my side... and ends right above my right hip bone. They used my rib for the fusion and this seemed the best approach. My doctor had a team with him and also a general surgeon who he always works with. The general surgeon did the opening and closing...moving all the delicate things around as he said. After the fusion, he came back and put everything back into place and sewed me up...he also threw in a hernia repair!!
                      Kathy, 43
                      Diagnosed as a teen
                      Boston brace 2 years
                      63 degree lumbar curve
                      Surgery August 26, 2009
                      Anterior approach fused T12-L4
                      now 28 degrees

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                      • #12
                        Originally posted by kt2009 View Post
                        he also threw in a hernia repair!!
                        Hmmm. I'd been thinking about asking for a tummy tuck...
                        Not all diagnosed (still having tests and consults) but so far:
                        Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                        main curve L Cobb 60, compensating T curve ~ 30
                        Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                        Comment


                        • #13
                          One of the docs I saw had recommended an anterior release done minimally invasively followed by posterior instrumentation - they remove disk(s). He said it would increase flexibility and could be done during the same surgery, but would increase surgery time. The other docs I saw did not think it was necessary and not enough potential addtional correction would warrant the additional risks of an added procedure. Hopefully when I see Dr. Boachie in June he'll still feel posterior only is the way to go. I figure less is more for surgery, if poss., but they're the experts and of course a good result is the goal.

                          Deb
                          Debra
                          Age 45
                          Pre - surgery Thoracic 69, Lumbar 48
                          Post-surgery Thoracic 37, Lumbar 39 (unfused)
                          Fused T4-T12
                          Milwaukee braced, 11 years old to 15 yo
                          Surgery Sept. 1st, 2010 Dr. Boachie

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                          • #14
                            the discs can be removed from the side..and are...that is where my discs will be "cleaned out" and "spacers" (also called "cages") will be put in...IF/WHEN i have the surgery...

                            jess

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                            • #15
                              I had three surgical recommendations, in retrospect unclear about how all would be accomplished.

                              At least one was for A/P separated by days (up to a week, I think)

                              Another wants to do me all posterior pending the judgment of his partner. Both would be working on me at the same time (hope the two sides of the tunnel meet in the middle of the mountain! ) Now I need to see his co-surgeon.

                              Reading the report from a third, it appears he DOES want to do both posterior with an anterior release but cut from the side (I hadn't gotten that from our appt) - both would be done on the same day. (How could they turn me over to do both at once?)

                              He'd be starting at much lower levels than either surgeon above. That would mean the surgery would take less time, even though it would all be at once and only one surgeon (I do NOT want my surgeon getting all tuckered out! No kidding) . I think it's pretty clear i need A/P - the question is how it's to be approached. That's because my lumbar area is such a mess.

                              I have an appt to see another surgeon at the end of June. He tends to operate with the two parts separated by 4-6 weeks! Hard to imagine how I'd tolerate that! His belief is that it's easier on the body to allow for intermediate healing. So that's what I'm expecting to hear about me.

                              When you speak of having a choice, you must mean in which surgeon you choose, right? Don't think many surgeons actually leave it up to the pt.!
                              Last edited by Back-out; 06-02-2010, 10:29 PM.
                              Not all diagnosed (still having tests and consults) but so far:
                              Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
                              main curve L Cobb 60, compensating T curve ~ 30
                              Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

                              Comment

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