View Full Version : Total fusion/Selective fusion

09-20-2012, 08:00 AM
Hello all! Just wanted to see how many of you had to choose between total fusions versus selective fusion. How did you come to the decision and did you regret it in the end? I have a double major curve with complete rotation in the lumbar region. I have surgery in a month and thought I was confident in my decision to do a selective fusion (bone on bone) to retain my mobility (due to the fact that I am a PA and think it would be better career wise) but have begun to think “what if” I decided on the wrong one. Any advice?


09-20-2012, 10:31 AM
Whoa, I've never heard of this. What is the difference? I definitely would have gone with the more mobile choice.

09-20-2012, 10:52 AM
Whoa, I've never heard of this. What is the difference? I definitely would have gone with the more mobile choice.

Basically what we are doing is taking 4-6 vertebrae’s remove the disks in between and try to correct and rotate from there. This allows mobility due to not fusing the entire lumbar or spine; however, there is a chance that the thoracic could compensate back and possibly need a revision later in the future. Or it could work, take the pain away, and never have any problems again. I just wish there was a guarantee!


09-20-2012, 07:03 PM
I left the decision of the length of the fusion up to Dr. Lenke. At first, I was disappointed that I needed to be fused to the sacrum, knowing that I would lose flexibility, but I'm back playing golf and doing quite well. If being fused to the sacrum increases my odds of not needing revision, I'm glad I'm fused all the way. On the other hand, I was 60 when I had my surgery and not too flexible anyway as my curves were fusing. I might feel differently if I was younger and needing surgery.

09-20-2012, 10:21 PM
When I had my first surgeries 20 years ago, I was given the option of just fusing the lumbar curve. My surgeon thought that the odds were that I would eventually need the thoracic curve fused, so I chose to go for the full fusion, as I was fairly certain that I would not want to go back for more surgery. I truly wish I had chosen the smaller fusion. I don't know if I would have required the thoracic curve to be fused anyway, but I think the risk/reward ratio warranted the more conservative approach.


09-22-2012, 12:59 PM
Tamena- that is such a surprise to hear that you are doing a selective fusion!

I've read about he selective fusion, too, but the drawbacks: less height ! (IMHO) I think with the selective bone-on-bone fusion there might be less restoration of my height, and I really want to stand straight and be tall again. Advantages: greater flexibility! it makes sense, right, to do a selective fusion! when I first read about it - I wanted it, too- just makes more sense.

I'm surprised to hear that you are doing the selective fusion - where did u find your surgeon?

I guess the biggest drawback would be - if you end up in later years having to be totally fused anyway . I don't know that there is much research about this - but I read about it in the scoli surgery book and i was intrigued but you are the first person I know who is having surgery this way! so I am very interested to hear who is your surgeon! God bless- Jamie

09-22-2012, 03:55 PM
Dr. Robert Gaines developed the bone-on-bone technique. He's published 6 year follow-up at this point. I can tell you that his first presentation many years ago met with a lot of opposition. The consensus seemed to be that the patients would end up with sagittal imbalance. This is not something that was apparently not reported in the 6-year follow-up, but until someone other than the inventor or other investors can repeat the results, I would be somewhat concerned.

09-22-2012, 05:17 PM
sorry for my ignorance...
what is bone on bone fusion...??


09-22-2012, 05:42 PM
Jamie-- Dr. Robert Gaines in my surgeon.

Linda-- you are correct that Dr. Gaines developed the bone on bone technique back in the early 90's.

Jess--From what I have researched is it is basically the same as having a traditional anterior with the exception that the disks are removed allowing more flexibility for correction and they try to do this fusing less vertebrae. Bone on bone means just that, natural fusion occurs from the removal of the disks and no synthetic bone is needed in aiding in the fusion.

For me the only thing that I worry is the idea that I may have to have a revision but no surgery is a 100% guarantee that a revision won't happen. For me, I was diagnosed at 12 with a Double Major Curve and in the early 90's refused surgery of I was just a young kid with no pain. It wasn't until I had my four children and turned 30 that the pain level has been severe. I am now 34 and keeping as much mobility to me is important. I am a physician assistant and in my office I do everything from taking x-rays to cutting casts.

As time is getting closer I have begun to think what if I am making the wrong decision, but I have complete faith in Dr. Gaines ability. I am just ready to be out of pain and able to be active at work and with my children.