A question about rotation

[flerc]

I was told that after completion of growth, the vertebrae are structured with a deformity which is not (necessarily) wedging, but something like a rotation in the horizontal plane, as I think the 4th drawing indicate http://www. sastre-roca.com/fedmethod.html
If it so inexorably in all cases of large curves, the rotation could not be corrected because a structural issue (not muscles) and as far as I understand even the surgery could do not nothing . After surgery, did you notice that the rotation improved as significantly as the curve or much less?
Thanks in advance

[Pooka1]

As I understand it, one of the advances associated with pedicle screws is the ability to de-rotate spines.

One of my kids was extremely rotated. This was corrected at least 90% and the residual rotation is not noticeable unless you know what to look for. She looks normal to the untrained eye.

The other kid was not rotated much and came out with absolutely no rotation even if you know what to look for.

They had the same Cobb going in... 58* and 57*. They are now at ~5* and ~0*.

They look normal again.

[Mojo's Mom]

If you're not too squeamish to watch a surgery video, just go here:

http://www.orlive.com/akronchildrens...ctive_redirect

and you can actually see the de-rotation process in action. It's fascinating, although a little horrifying when you realize this is what will be done to you, when you have your surgery.

[junosand]

thanks for the tip!

thanks for the tip on the surgical video from Akron

here is another one (again for the non-squeamish) from Dr Lenke in St Louis:

http://www.spinal-deformity-surgeon.com/stories.html

if anyone knows of other good ones, PLEASE POST; i find it very helpful to understand exactly what will be done for me

[flerc]

Sharon, what an incredible correction! I think it was possible because they are so young. If it is true what I have heard, that kind of correction in rotation should not to be possible in adults, because vertebra deformation. As far as I know, surgery do not alter the vertebra shape. Mojo's Mom, I hope I'll not need to see this video to understand how could it be possible, but if it is the only way, I should to see it. Thanks!

[Mojo's Mom]

Never noticed the video footage on Lenke's website, wow. Hammers, chisels, drills and screwdrivers, it's amazing. I particularly liked, at the beginning of the footage, as he's opening the incision, "'She's still moving a little bit, can we have a little more anesthetic?"

[flerc]

I don't understand

The ribs according to the rotated vertabras form a hump. If that vertebras are de-rotated, it should not form a hump in the other side?

[Pooka1]

The ribs according to the rotated vertabras form a hump. If that vertebras are de-rotated, it should not form a hump in the other side?

As far as I can tell, they are just bringing the ribs back into normal alignment. If they overshoot then there will be a hump on the other side. I doubt they ever overshoot.

The hardware returns the spine to a normal configuration in every plane if it is flexible enough and if the surgeon has a good eye as far as I know.

[flerc]

Mmm..

vertebras and ribs do not formed a rigid structure so they should to move together?.. thanks Sharon, but it seems that my imagination is so limited..

[Ballet Mom]

For those wanting more videos, here's a very quick, but interesting video. Surgery performed by Dr. Peter O. Newton at Rady Children's Hospital in San Diego.

http://www.youtube.com/watch?v=TbQaT7z54E4

[junosand]

to "Mojo's Mom"

let me explain his comment: "'She's still moving a little bit, can we have a little more anesthetic?"

this does NOT mean she was almost awake or feeling anything; anesthesia vs consciousness is not black & white; there is every degree of anesthesia which is monitored closely during an operation with many numbers (heart rate, blood pressure, oxygen, carbon dioxide, etc etc) which help guide the anesthesiologist; occasionally, all the numbers are fine, yet the surgeon can detect a very slight reaction to something he does and alerts the anesthesiologist so he can 'tweak' them a little "deeper" as we say. Often this will be in response to using the "Bovie," an electrocautery unit which cauterizes (seals) the ends of small blood vessels and is used throughout the case, beginning right after the opening incision

i wouldn't want anyone to think that patients can awake during surgery and actually feel pain; apparently this is a common fear of non-medical people facing surgery but if it ever happens (and i never heard or saw it ever in my 35 yrs in ORs) it would be the most extreme of rareties

[LindaRacine]

Hi junosand...

I think the best way to understand what is done is to view an animation. You can find one here:

http://www.understandspinesurgery.com/

Click on View 3D Animations
Click on Spine Procedures
Select Thoracic - Derotation with Instrumentation

Regards,
Linda

[Ballet Mom]

Great link Linda! Thanks for posting.

[Mojo's Mom]

let me explain his comment: "'She's still moving a little bit, can we have a little more anesthetic?"

this does NOT mean she was almost awake or feeling anything

I know all this, Junosand, but couldn't help my eyebrows raising in a sort of dark amusement when I heard Dr. Lenke say that on the video. My father always maintained, however, that he was slightly conscious when they sawed open his chest to do his heart valve replacement in 1967, but who knows?

Naturally she's not feeling anything in a conscious sense, or any sense she will recall upon waking, but her body is most definitely feeling something!

[flerc]

a question to adults with a great correction of a great hump

After surgery do you note a hump in the other side?