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View Full Version : 6-week post-op doctor visit



boomergal
08-23-2011, 03:55 PM
First of all, I want to thank everyone for their responses to my post-op forum posting last month after I got home.

I had my first post-op visit with Dr. Boachie August 21st and it was a bit of a surprise. I have developed kyphosis below the fusion (T2-T12), and am getting more
surgery Sept. 21st to fuse L1-L4. I have actually lost height since the surgery (they didn't tell me how much--I wish I'd asked). The kyphosis has developed because
of my soft bones. I was diagnosed with osteopenia eight years ago and have taken osteoporosis medications (Actonel, Boniva, Atelvia) for over five years.

The x-rays taken right after surgery looked good. The x-rays done last week looked dramatically different because of the post-distal kyphosis ( I believe that is the
right term). I think I look more round- shouldered since the surgery, too. I hope that doesn't mean I am getting kyphosis above the fusion, too. I didn't ask about
that. (I'm always lecturing my mother about how shehas to ask her doctor more questions but I tend to do the same thing.) I am going to have an osteotomy and a
cage. Is it usual to get a written report on your surgery soon afterwards? I think there was a thread about this topic recently but I can't find it. Also, is it usual to
get a written report on exactly what is planned for upcoming surgery? I think Melissa said her doctor sent her a detailed report about his plans.

At the end of the visit, I at least remembered to ask what my correction was. My thoracic curve went from 60 to 26, and the lumbar curve went from 52 to 33 (it's
unfused). At my pre- op visit Dr. B. said that on my bending x-rays the lumbar curve corrected to 16 degrees. That is why he wanted to take a chance on doing a
selective fusion and preserving lumbar mobility. He had told me ahead of time I might need the fusion extended--I just wasn't expecting it so soon. By the way,
Dr. Neuwirth, the first doctor I saw, recommended a fusion from T5-T12. (My pre-op curvature numbers that were formerly in my signature were based on the
x-rays I had last December with Dr. Neuwirth.) I guess the selective fusion would have worked if it weren't for my Gumby-like bones.

I have to write an e-mail to Dr. Boachie with all my questions. Do you think it is crazy to ask if I could be fused to the sacrum? I know that would be a very long
fusion but so many of you fused to the sacrum seem to be doing so well.

I am very afraid of ending up like my 80-year-old mother, who was told she had very mild scoliosis when she was in college. (It was never measured and wasn't at
all apparent.) Even though she had osteoporosis, she was very active and pain-free until she was 78. She took a variety of osteoporosis medications for many years, which reduced her diagnosis to osteopenia. From age 78 to 80 she became more and more bent over, and ended up with a spontaneous sacral fracture a year
ago. The KUMC Spine Center in Kansas City diagnosed her with lumbar scoliosis of 48 degrees, lateral listhesis 3-4, degenerative disc disease of L2345, stenosis,
and collapse of S-1. She is in constant pain and has trouble walking and sitting up to eat without leaning over to the side. I don't feel the KUMC was very helpful.
When I went there in 1974 Dr. Marc Asher was my doctor, who was a well-known scoliosis specialist, but I don't know if there is anyone expert there now. She has
other health problems and would never want to have surgery, and it seems doubtful any doctor would recommend it. She has been on Forteo for a year now.
Anyway, my point is maybe I would rather get all the fusion done before it is too late for surgery.

If you are fused to L-4 is it inevitable that eventually you will need to be fused further down?

Thank you so much. I don't know what I would do without this forum.

Mary
Age 54
Surgery with Dr. Boachie 7/5/11, Fused T2-T12
Pre-surgery T60, L52
Post-surgery T26, L33
Next surgery scheduled 9/21/11

LindaRacine
08-23-2011, 04:18 PM
Hi Mary...

Yes, I think it may be a bit nuts to ask to be fused to the sacrum. :) If Dr. Boachie felt you needed that fusion, I'm sure he'd recommend it. If you can avoid fusing the lowest segments, you definitely should. I don't think the fact that a bunch of us who are fused to the sacrum and who have had good outcomes, has anything to do with being fused to the sacrum. There's probably a reasonable likelihood that you'll end up needing fusion to the sacrum, but if you can avoid it for awhile, and potentially avoid it forever, I think it's worth the risk of potentially needing another surgery in the future.

I think it is common to ask for a copy of the surgical dictation, and it's good to have a copy for your records. You can also ask for a copy of the visit dictation, although I think you may find that there can be significant differences between the visit dictation and the final surgical plan.

Best of luck with the surgery.

Regards,
Linda

peachrush7
08-23-2011, 05:16 PM
There's probably a reasonable likelihood that you'll end up needing fusion to the sacrum, but if you can avoid it for awhile, and potentially avoid it forever, I think it's worth the risk of potentially needing another surgery in the future.


I couldn't agree more with Linda! At first my surgeon thought because of my rotation, he would need to fuse me to my pelvis...so I went into surgery prepared to be fused all the way down. When I came out of surgery, he was very excited to tell me that he hadn't needed to fuse me that far after all. My spine was so "limber" he was able to get my double major curve down from 52 degrees to less than 15.

I may need to have the whole shebang at some point...but I trust that he felt it was better to leave those bottom discs free for as long as possible. And, he feels there is a great chance I may never need it at all. Even if I get 20-30 years without it, I'm fine with that.

You are in great hands, and I would just trust what your surgeon thinks is best at this point.

Blessings!

jeneemohler
08-23-2011, 08:17 PM
I am one of those who has had a wonderful outcome with my pelvic fixation. BUT-I still recommend avoiding it if at all possible. As well as I have done, I would be even BETTER if I didn't have it. But it was necessary in my case, so I have no regrets, personally. Your doc is one of the best around-trust him. And ask questions so that you feel comfortable with the decision. Good Luck!

debbei
08-25-2011, 06:47 AM
I'm so sorry that you need to have more surgery so soon! But whoever said above, you're in the best hands, so I'd go with whatever he recommends.

How is your pain level since your surgery? Are you having different pain in the lumbar area now?

((Hugs))

mabeckoff
08-25-2011, 10:09 AM
I am sorry that you need to have surgery again so soon but welcome to my club. As you have a very knowledgeable doctor, you need to go with what he says to do.

Good luck

Melissa

golfnut
08-25-2011, 11:45 AM
Mary,
I am sorry you have to have another surgery, but it sounds like it's necessary. Dr. Boachie has an excellent reputation so you know he will do what he believes is best. Like Jenee', I am fused to the sacrum and doing fine, but I would respect Dr. Boachie's opinion. It wouldn't hurt to ask what he thinks of fusing to the sacrum to avoid a surgery at a later date, but Linda didn't recommend asking.

Susie*Bee
08-25-2011, 06:46 PM
I am one where we (my surgeon and I) discussed fusing all the way or not to play it safe and my surgeon left the decision up to me. He told me I had about an 80% chance of not needing further surgery, but of course there was that 20% if we stopped at L4, but he thought it would be worth the risk for the added flexibility. I am a little over 4 years post-op and so far, so good. I just had my exam and my new doctor, Christopher DeWald, says L5 and S1 look just fine. (My original surgeon is now working only at Shriner's Children's Hospital...)

boomergal
08-25-2011, 09:49 PM
Thanks so much for your responses. I suspected it was sort of a crazy idea to want to be fused to the sacrum, but was curious what people thought about the idea. I do trust Dr. Boachie to do
whatís best and Iím eager to get this next stage done with. I probably wonít bother asking about being fused lower.

I know Iím getting ahead of myself, but is there anything in particular that a person fused partially in the lumbar area can do (or shouldnít do) to preserve the remaining lumbar vertebrae
(especially someone with weak bones)?

Linda: Thanks for your input. I was hoping Iíd get your opinion. Rebecca, Debbe and Susie: Thanks for your perspectives, too, as people fused partially in the lumbar area. Jenee and Karen: Your recoveries from fusion to the sacrum are really something, and fun to read about. Melissa: I think your strength and stamina are amazing. You have been through so much but Iím sure things
will be getting better and better for you.

Debbe, you asked about my pain level. The fused upper part of my back isnít causing me any problems but three weeks ago I started getting more and more pain in the lower unfused part of my back. Also, I can feel the bottom end of the rod sticking out more and more, which makes it hard to lie on my back or sit in a chair or car seat. I hope this will not get progressively worse and more painful in the next few weeks. This is a new concern for me. Iíve been holding up well emotionally but had my first little meltdown two days ago.

P.S. I wrote my last post on an iPad and I thought it came out all right when copied and pasted to the forum site but it still looks like some sort of weird haiku on the iPad. Hope this one is better in terms of spacing.

Mary, Age 54
Surgery with Dr. Boachie 7/5/11, Fused T2-T12
Pre-surgery T60, L52
Post-surgery T26, L33
Next surgery scheduled 9/21/11

titaniumed
08-25-2011, 11:05 PM
Mary

Iím so sorry about this. Its hard to believe that this happened so quickly.

Many surgeons spare levels under constructs. This seems to be the norm unless there is any doubt with the integrity of the lowest levels. Since the lowest levels articulate approx 20 degrees, each level is valuable.

The fact that you do have an osteoporosis issue, and many of us fused all the way down are doing well, I can understand why you ask your question....

The one thing about Dr Boachie is that his hands on experience, # of scoliosis surgeries has to be one of the highest and it makes it difficult to question his decision. I guess its your right to ask him once to see what his response is....I had no doubt on my lower levels since my spine was pretty shot, but I tried to get my surgeon to fuse a little lower up high (T4) and his answer was no. There was really no discussion since I do have some neck issues with some degeneration. I think about it often, and I guess Iím prepared just in case my neck has to be done. Anyway, sometimes we have to roll with the punches, but we always get up...

Ed

boomergal
08-29-2011, 10:21 PM
Ed, Thanks so much for your words of encouragement. You are another of those fused-to-the-sacrum people who do amazingly well. Maybe in my somewhat oxycodone-addled mind I thought I
could turn into a skiing, scuba-diving, golfing, roller-skating dynamo if I were fused to the sacrum. (I am not a very athletic person although I do love badminton and really miss going to the
gym.) Actually, I just want to avoid another surgery, if possible. I hope your neck problems stay stable or improve.

P.S. Just saw your YouTube skiing video. That is really impressive (and scary -- all those trees!)

Mary, Age, 54
Surgery, Dr. Boachie 7/5/11 fused T2-T12
Pre-surgery T60, L52
Post-surgery T26, L33
Next surgery scheduled 9/21/11