posterior spine fusion

[nicoles mom]

My daughter is having posterior spine fusion on the thoracic cruve only.Than after surgery she will be wearing a braced to hole and control the lumbar cruve.My daughter has a 58 right toracic curve that corrects to 30--- 55 left lumbar curve that corrects to 15--- 47 kyphosis--- 66 lordordosis--- risser 0 .She is also pre-menarche.She is 12 yrs 8 months. Just wanted to know if someone had this type of surgery and did the bracing help hold the lumbar cruve.And how long did they wear the brace for.
Thanks
Theresa

[spincon58]

Dear Theresa,
I have never heard of that form of treatment..I'm sure you went to several different opinions...Did they all recomment the same as that???What are her levels that need to be fused? Should it be better to wait untill she stops growing and than have the surgery? Is that why she has to wear a brace?? That seems like a big ordeal for your daughter...Please get at least 4 different opinions....

[nicoles mom]

ITS CALLED THORACOLUMBAR POSTERIOR FUSION T-2 T-12.

[Alison]

Hi Theresa

Just a question, more of a curiosity one actually...sorry if it sounds a bit strange. Is the doc doing the fusion whilst Nicole still has so much growth left because he believes he can get greater correction whilst their is more flexibility in the spine?. I'm just curious why he's doing it when she's still pre-menarche (at least two years of growth left once she starts) and a risser score of 0.

One thing I'd be asking the surgeon, would be, what is the risk in Nicoles case of crookshank of the spine once the fusion was done. This can happen with posterior only fusions, when there's still considerable growth left in the spine. Its where the anterior (front part) of the spine grows and because the posterior part is fused and can't grow, you get a crookshank effect (spine starts to rotate like a "crookshank")

Spincon58,

if I understand right, the thinking behind only doing the top curve and not the bottom, is that if you straighten the top one, the bottom one (usually a compensatory curve) will straighten itself out now that the top one's "straight". It is (when its done) often done without a brace, but the support of the brace probably gives it a better chance of "working"

Alison

[Nicky's Mom]

I believe the term is "crankshaft phenomenon". Alison's description of it, however, is right on the money. It would definately be something that I would ask the doctor about.

Sorry Alison, hope you don't mind me correcting you!:(

Cathy

[Alison]

No probs Cathy :-), I knew my description was right, but I didn't think the word was quite the right one :-), but my word sounded nearish but I knew it wasn't quite right..., but now I know :-)

Alison

[Carmell]

Hi Theresa,

I agree with the others... please find another opinion or two to compare with your current recommendation. I know a few adults who had posterior-only fusion done before their spines were fully grown, and they have had problems with crankshaft or other issues that they shouldn't have had. If they are suggestions posterior AND anterior fusion (much bigger surgery) then the risks of crankshaft are less.

Each patient is very different. Scoliosis surgery is rarely an emergency situation. You should have plenty of time to research and find the right procedure, the right surgeon and the right time for her.

Is her body balanced (neck and pelvis well aligned)? What would the risks be if you wait a year or more to get her body and spine as much growth as possible before surgery? Does she have lung function issues yet? All of these things are valid reasons to question the ortho/surgeon.

Good luck and I hope everything goes well.

[susannajon]

Hi Theresa,

Dr. Boachie is one of the best in the world, but for your own peace of mind, I agree with the other moms. I would get a couple of opinions. My daughter is having surgery with Dr. Boachie on March 9th. I feel 100% confident in him, but we did also consult with several other docs just to be sure.

Here are some nationally recognized surgeons in NYC. These guys are all top in the field:

Ronald Moskovich, MD
NYU Medical Center - Hospital for Joint Disease
(212) 598-6622 between 10:30 and 3:15 or leave a message
240 East 18th Street
New York NY (The entrance is on 18th Street, just off 2nd Avenue)

Michael G. Neuwirth, MD
The Spine Institute at Beth Israel Medical Center
10 Union Square East, #5P
New York NY 10003-3314
(212) 844-8692

David Price Roye Jr., MD
Children's Hospital of New York Presbyterian
3959 Broadway (166th Street and Broadway)
New York NY 10032-1537
Appointments: (212) 305-4565

Susanna

[nicoles mom]

SUSAN THANK YOU FOR THE DOCTORS NAMES.
ONE OF THESE DOCTORS I DID SEE ONE ON YOUR LIST. BUT DR.BOACHIE WAS THE ONLY ONE WHO MADE US FEEL GOOD AND MADE SENSE.HE WAS OUR 3RD OPION.

ALISON WHAT YOU SAID IS WHAT HE IS DOING.I DIDN'T ASK ABOUT CRANKSHAFT, BUT I WILL.AND ITS T4 TO T12.I HAD T2--T12.

THE OTHER DOCTORS WANTED TO DO THE WHOLE SPINE KNOWING SHE STILL HAD TO GROW.THE HUMP ON HER BACK IS VERY (ROTATED) AND THIS IS WHAT THEY ARE WORRIED ABOUT.SHE HAS ALSO WHEN FROM 42 TO 58 UPPER CRUVE IN 3 MONTHS WITH WEARING THE BRACE 18 HRS A DAY. AFTER SURGERY THE LUMBER WILL BE 15 AND WEARING A BRACE SHOULD HOLD IT.IF IT DOESN'T HOLD AND MOVES UP TO OR PASS 40 THEY WILL DO SURGERY AGAIN AND ADD TO WHAT THEY DID AREADY.I'M PRAYING IT HOLDS OR MOVES JUST A BIT.
I WILL HAVE TO ASK ABOUT CRANKSHAFT WHAT IS THIS. I'M GOING TO LOOK IT UP. THANKS TO ALL OF YOU.

[susannajon]

Hi Theresa,

If Boachie was number 3 I say go for it. I felt 100% comfortable myself with him. So did my husband and daughter. You have done your homework, and the time has come to do what is best for your kid. He is one of the finest doctors in the world. I know I'm not any kind of specialist, but I am a mom who has also done lots of homework. In my humble opinion, "get 'er done!!!"

Susanna

[pat]

Hello Theresa/Nicole's Mom!
The things you'd want to ask your doctor about crankshaft is her riser and also whether her tri-radiate cartilage is closed yet? That's a good indication of crankshaft occurrence, which is pretty small to begin with. But good to know! Pat

[Carmell]

I know Dr. Boachie is a wonderful surgeon and a great guy (which means a lot to parents and patients - I know!). However, he does not specialize in PEDIATRIC cases. He does both peds and adult cases. The only reservation I have with him choosing this surgery is that he doesn't have a pediatric specialty. My suggestion is to email Dr. John Emans in Boston. He even calls people to discuss cases that are sent to him. If HE thinks Dr. Boachie's recommendation is correct for your daughter, then I would feel much better. You can find his contact information here...

http://www.spineuniverse.com/mdpage.php?doctorID=2143

Just thinking out loud...

[spincon58]

Hi ,
Hi just a note , here is a ped. scoliosis surgeon in New Jersey
Dr. Samuel Laufer 732530-3311..he only does pedi
good luck