PDA

View Full Version : Was your surgery..2 part, or just one



kootenaygal
06-15-2012, 03:05 AM
Kootenaygal here. I've finally had my consult with my surgeon. I have scoliosis & Kyphosis...91 degree curve. I have seen other posts, when the patient has had 2 parts to their surgery. My surgeon said, my surgery would be done, once. The rods & screws would extend from my T-2 > L-3, with a osteotomy, & possibly a lumbar cage, no brace. Without this surgery, I will continue to collapse...end up in a wheel chair, & then of course, eventually problems with my vital organs. So I was just wondering, if anyone else has had two parts to their surgery, with a wait time between the surgery's .
But sadly, there is a wait list...but he said, he's going to try to push it forward.
I certainly hope so...praying. My ribs are sitting on my hips...so painful. I've even had 1 rib, go under the crest of my hip..3 months ago. Ambulance > Laughing Gas > ER...just from turning the wrong way suddenly. I have never felt such horrendous pain. I have to be so careful!

I hope to see some replies when you have some time. Thanking you in advance!
Kootenaygal

JenniferG
06-15-2012, 05:07 AM
Hi Kootenagal, my surgery was done in one go. My curve wasn't as big as yours, it was 68 at time of surgery. Best of luck. Let us know how it all goes.
Jen

LindaRacine
06-15-2012, 02:27 PM
There are lots of reasons why some patients have front and back surgeries, and some have just back. A small percentage of people just have front surgeries. If someone has front and back surgery, there are also lots of reasons why someone might have both surgeries on the same day, or have the surgeries staged, with as little as one day apart to as much as a year apart. My advice would be to not get hung up on what other patients have had.

debbei
06-15-2012, 09:09 PM
My surgery was just one part, 9 hrs. Good luck to you, I hope you don't have too long a wait. The wait is the worst part--even worse than the recovery.

mdtaffet
06-17-2012, 12:22 AM
Hello,

My surgeon always schedules two days for surgery, and then really hopes he doesn't need the second one. All surgeries he does start on Monday morning. Then if he needs a second day, it will be the Friday of that same week.

My surgery was done in one day. He told me that some of the reasons for having to go into two days include losing too much blood, and other similar situations that bring risk for the patient. I don't remember the other specific examples of risks that would dictate using the second day.

I hope you find relief soon. My curve was primarily lumbar, and my spine was also collapsing, but the curve wasn't as big. The last number I heard was something like 42 degrees. But I also had an issue when standing up off of the toilet where my spine would catch on something and then pop off -- with the pop off being both heard and felt. His nurse told me that it was probably my rib catching on my hip. It was not at all comfortable.

Good luck,
-- Mary

susancook
06-17-2012, 04:06 AM
Another reason for a 2 day surgery is because you have a bigger risk of complications if you are under anesthesia for a very long time, so if there is a lot to do, then your surgeon may need 2 days. Like Linda said, you can't compare people because there are no 2 people on the blog with the same age, same exact curve, same medical history, same doctor...etc. Even when you compare 2 very similar people done a couple of years apart, the medical science of what is done and the techniques change. Susan

mbeckett
06-17-2012, 04:33 AM
Hi Kootenaygal, I was wondering if you ever had your surgery? I just had 2 part surgery this past May 2012. Originally the surgeon thought he could do it all at one time but then he decided against that. A good thing too because the first surgery took 5 hours but the second surgery was 11 hours. He stopped the first surgery short because he said I lost more blood than he anticipated but he was able to set everything up and get all the screws in place.

My surgery produced good results reducing my thoracic curve from 72 degrees to 25 degrees. I don't know the current degrees of my lumbar curve, previously it was about 45 degrees. I'm about 3 inches taller and stand much straighter than I ever have. I'm looking forward to the day when everything in my body settles down and I can resume my normal activities. Right now I'm still dependent on my adult daughter helping me out as I'm only 4 weeks post-op but all things considered I'm doing quite well.

Hope to hear back from you to learn about your progress.

Irina
06-17-2012, 02:46 PM
This might be a dumb question Ė but how are the surgeons able to operate 8 Ė 11 hours nonstop? Donít they need a lunch break, use a restroom etc? How does it work?

mabeckoff
06-17-2012, 05:09 PM
This might be a dumb question Ė but how are the surgeons able to operate 8 Ė 11 hours nonstop? Donít they need a lunch break, use a restroom etc? How does it work?

My surgery last July was 15 hours long and no Dr Bederman did not take a break. If he left the operating room, then he would have to be come sterile before he could go back into the OR. At his age , 38 years old, he has the ability to do long surgeries. He asked me if I wanted 1 or 2 surgeries and I wanted one surgery so he said OK

susancook
06-17-2012, 05:28 PM
This might be a dumb question Ė but how are the surgeons able to operate 8 Ė 11 hours nonstop? Donít they need a lunch break, use a restroom etc? How does it work?

They have a team of "residents" and "fellows" and surgical assistants that work together in the surgery. My doctor said that he does the main part of the surgery, like setting most of the main hardware with the assistance of the fellow MD [they are doctors that want to be spine specialists], sometimes an orthopedic resident MD, and the surgical assists. The other MDs may do less important parts without your doctor present, but like I said they work like a trained team. Your doctor would never leave if he did not have complete trust in the skill of the doctors that are continuing while he takes a break. Most doctors operate with a team that works together over a period of time, so they are very experienced working together. One part that my doctor deligates to probably the fellow is the closing of the surgery, the stitching up when he does leave the room.

Irina: Do not feel that there is a dumb question to ask here. We all have the same worries. Just thought of something that might be helpful for you. Take a friend to your appointments, come with a written list of questions, have your friend take notes, ask for a picture of your spine [that way you can show it to your friends and family who may not be supportive of your surgery, that usually convinces them], ask for written material, take lots of slow deep breaths....and know that you are not alone, that you have lots of friends here that are supportive.

Irina
06-17-2012, 05:52 PM
My surgery last July was 15 hours long and no Dr Bederman did not take a break. If he left the operating room, then he would have to be come sterile before he could go back into the OR. At his age , 38 years old, he has the ability to do long surgeries. He asked me if I wanted 1 or 2 surgeries and I wanted one surgery so he said OK

Again, I may sound like a little kid, but how is it possible for Dr. Bederman do not use a restroom for 15 hours? Did he wear a diaper? I am just really curious.

LindaRacine
06-17-2012, 08:14 PM
There are usually some natural breaks during long surgeries. For example, if a plain xray needs to be taken, the surgeon will have enough time to scrub out and back in. There can also be a relatively long break if both front and back surgeries are being done in one stage. Some surgeons only do one side of the implants and let a fellow, resident, PA, or other surgeon do the other side. If that's the case, the surgeon would be able to scrub out if they wanted. If there are no natural breaks, the surgeon can just call for a time out.

--Linda

Irina
06-17-2012, 08:41 PM
There are usually some natural breaks during long surgeries. For example, if a plain xray needs to be taken, the surgeon will have enough time to scrub out and back in. There can also be a relatively long break if both front and back surgeries are being done in one stage. Some surgeons only do one side of the implants and let a fellow, resident, PA, or other surgeon do the other side. If that's the case, the surgeon would be able to scrub out if they wanted. If there are no natural breaks, the surgeon can just call for a time out.

--Linda

Having a resident or PA do implants would be a concern for me especially if the surgeon scrubs out at this time. I know they are all trained and a surgeon is confident in their skill etc, but still... That would be a good question to ask on consultations. Would a surgeon give a clear answer to a question like "What would be a resident/PA involvement in my surgery? What exactly would they do?".

How is it done in UCSF? Is there a surgeon who inserts implants in both sides and residents have minimal involvement?

LindaRacine
06-17-2012, 08:47 PM
Hi Irina...

To be honest, I don't really know. I'm sure it varies by surgeon, the skill of the assistant, and by complexity of the surgery. I think that most surgeons will tell you that they will do all of the important parts of the surgery. These can be really big surgeries, and I don't think it's reasonable to expect a single surgeon to do 100% of the procedures.

--Linda

susancook
06-17-2012, 09:37 PM
Hi Irina...

To be honest, I don't really know. I'm sure it varies by surgeon, the skill of the assistant, and by complexity of the surgery. I think that most surgeons will tell you that they will do all of the important parts of the surgery. These can be really big surgeries, and I don't think it's reasonable to expect a single surgeon to do 100% of the procedures.

--Linda

Irina: That's exactly what I asked my surgeon. See my post earlier. He does the setting of the major hardware w/ the fellow at Oregon Health Sciences University. The BIG parts of the surgery, he's there. Like I said, it's a team effort at all major institutions. Ask your surgeon how he handles it at his/her institution. Susan

Irina
06-17-2012, 10:24 PM
So, is it a reasonable assumption to make that residents/fellows would have less involvement in two-step surgery vs. one-step because each part of two-step surgery would be shorter and your surgeon would be able to handle the majority of it? If this is true, then, if given a choice, I would probably choose two-step.

kootenaygal
06-17-2012, 11:53 PM
Hi Kootenaygal, I was wondering if you ever had your surgery? I just had 2 part surgery this past May 2012. Originally the surgeon thought he could do it all at one time but then he decided against that. A good thing too because the first surgery took 5 hours but the second surgery was 11 hours. He stopped the first surgery short because he said I lost more blood than he anticipated but he was able to set everything up and get all the screws in place.

My surgery produced good results reducing my thoracic curve from 72 degrees to 25 degrees. I don't know the current degrees of my lumbar curve, previously it was about 45 degrees. I'm about 3 inches taller and stand much straighter than I ever have. I'm looking forward to the day when everything in my body settles down and I can resume my normal activities. Right now I'm still dependent on my adult daughter helping me out as I'm only 4 weeks post-op but all things considered I'm doing quite well.

Hope to hear back from you to learn about your progress.

I'm so glad to hear that you are doing well, in your recovery! My curve is mainly in my thoracic. My spine is collapsing, also have numerous compression fractures. My ribs are sitting on my hips, especially on my one side. In fact, I had to turn suddenly ( went completely against my curve, in that move)...my rib DID go under the crest of my hip. I have never felt so much pain....ambulance >laughing gas > ER.
I do know that my surgery will be posterior, and done in one day. I just got a message, that I have a date for another MRI. I hope my surgery will be shortly there after. I'm in so much pain, especially in the morning...it usually takes me a hour or so, to get going. ( pain meds, hot pack, & my coffee)

How old are you? I'm 61..was concerned about my age, but in my consult with the surgeon. He said, I had nothing to be concerned about. I'm so looking forward to putting this surgery me. I'll be watching for your posts, to see how you are progressing. I'll be keeping everyone "in the loop" re; my surgery.
Kootenaygal.

Irina
06-18-2012, 11:05 AM
Hi kootenayagal,

I am glad to hear that your surgery will be all posterior and hope you'll get a date soon. I also have ribs on hips discomfort. I can't say it hurts a lot, but it is very uncomfortable. How did your pain progress? Did it start like discomfort and then gradually increased to severe pain from rib cage pushing on pelvic bone? Do you remember when you first noticed that pain?

annabeller
06-18-2012, 11:35 AM
My first surgery when I was 15 was just one surgery. But the rod broke and a screw came loose! Then by 30 I was bedridden and my lower back was being crushed by all the weight. SO I just had 2 surgeries in January. I think its good when they do two because it means the Doctor is solidifying all his work so it fuses better. Its really not a big deal. He took out 2 ribs and made 4 incisions. Two on my side one on my back and one in the front. I had the surgeries a week apart. I feel for you. I don't know how you handle that pain. I am very excited for you that you finally get to feel a little better. I wish you the best

kootenaygal
06-19-2012, 12:20 AM
Thanks for all of your postings! I was just phoned, saying that I was booked for another MRI, in August in Edmonton, at the hospital where the surgery will be done. I asked if my surgery would be done soon thereafter. The answer was NO, still on the wait list. It's hard to believe that this surgery is classified as Elective. I'm in more pain,& feeling worse as the days pass by...but still elective.

Thanks again for your help. Kootenaygal

titaniumed
06-19-2012, 12:43 AM
Koot

That sounds incredibly painful having your rib getting caught under your pelvis....wow!

I had a 2 part A/P with 2 scoli surgeons and a vascular surgeon for the anterior. My vascular surgeon basically dug the hole from the front. These guys are just hardcore. 3 superheroes, Superman, Spiderman, and Batman. I donít know if Robin was there... (smiley face)

At first I was going to be done in a posterior only, but the anterior decision came later. I didnít question this method, and left the call completely up to my surgeon. It was his call.

Sounds great if you can get done in a posterior only....

Hope you can get a surgery date soon.

Ed

leahdragonfly
06-19-2012, 09:23 AM
So, is it a reasonable assumption to make that residents/fellows would have less involvement in two-step surgery vs. one-step because each part of two-step surgery would be shorter and your surgeon would be able to handle the majority of it? If this is true, then, if given a choice, I would probably choose two-step.

Hi Irina,

I don't think this assumption is necessarily correct. Remember, the fellows and residents are there to learn (if your hospital is a teaching hospital--if not, no worries). They are going to be there on the big surgeries and the smaller surgeries. I think if you are concerned about this I would ask your surgeon specifically about his role vs that of the fellows/residents. I personally would never submit to two separate surgeries merely for the hope that the fellow/resident wouldn't be operating on you. I just don't think it quite works that way.

I don't think a good surgeon whose reputation is on the line would allow a resident/fellow to do a portion of the operation that they were not ready to do without supervision. There has to be common sense involved, and the best outcome for the patient should always be the foremost concern. Please consider discussing your concerns honestly with your surgeon. This surgery is scary enough going in to, it would be 100 times more scary if you are concerned about whether or not you will get the best surgical care!

Good luck,

Irina
06-19-2012, 03:39 PM
Thank you, Gayle. I'll definitely discuss it with the surgeons.

hasteffen
06-20-2012, 06:45 PM
My surgery was just one part, 9 hrs. Good luck to you, I hope you don't have too long a wait. The wait is the worst part--even worse than the recovery.

I hope you are so right! I am in the waiting mode right now. Scheduled for surgery with Dr. Lenke in October 2012. I can't believe I am less then 4 months out.

Heidi

Confusedmom
06-20-2012, 09:34 PM
Irina,
Also, David Wolpert's book says two-stage surgeries have a higher complication rate than all posterior. Plus, I believe all posterior is generally thought to be easier to recover from.

I asked Dr. Lenke point blank if he would be doing all the of the operating on me. He said he would do everything but the closing--stitching the incision, etc. I was fine with that. Plus, the resident who assisted him left shortly after to start his own practice, so I figured he could handle stitching me.

Best,
Evelyn

Irina
06-20-2012, 10:46 PM
Irina,
Also, David Wolpert's book says two-stage surgeries have a higher complication rate than all posterior. Plus, I believe all posterior is generally thought to be easier to recover from.

I asked Dr. Lenke point blank if he would be doing all the of the operating on me. He said he would do everything but the closing--stitching the incision, etc. I was fine with that. Plus, the resident who assisted him left shortly after to start his own practice, so I figured he could handle stitching me.

Best,
Evelyn

Thank you, thank you Evelyn so much! You, guys, are amazing! I am going to buy this book right away. Not only I am only learning so much here, but getting a courage because I don't think I have a choice. May be the fact Dr. Lenke is doing most of the surgeries himself with minimal resident's involvement is one of the reasons for his high success rate?

Irina.

susancook
06-21-2012, 01:40 AM
So, is it a reasonable assumption to make that residents/fellows would have less involvement in two-step surgery vs. one-step because each part of two-step surgery would be shorter and your surgeon would be able to handle the majority of it? If this is true, then, if given a choice, I would probably choose two-step.

There is no logic in your assumption from what I can gather. Everyone that operates on you is qualified or they wouldn't be there.Your surgeon would not turn over any responsibility unless he/she was 100% sure of that person's skill.....Susan

Irina
06-21-2012, 11:31 AM
There is no logic in your assumption from what I can gather. Everyone that operates on you is qualified or they wouldn't be there.Your surgeon would not turn over any responsibility unless he/she was 100% sure of that person's skill.....Susan

Susan, there is no need to put me down.

Confusedmom
06-21-2012, 04:09 PM
Hi Irina,
I'm sure Susan didn't mean that to sound like it did. She is generally very supportive.

Anyway, definitely get David Wolpert's book. You can order it through this website or amazon.com, I think. It's called: Scoliosis Surgery, The Definitive Patient's Reference. It's a must-read, in my opinion.

Best,
Evelyn