View Full Version : surgery planning question: UIV and LIV

07-16-2016, 07:20 PM
Is the upper instrumented vertebrae (UIV) and lower instrumented vertebrae (LIV) pre-determined before surgery?
A doctor that I consulted (not my surgeon, though) told me they adapt or change the number of vertebrae to fuse during surgery as they are adjusting or aligning the spine.

My surgeon told me I was to be fused from t3-t10 and that was the final result. I am glad he planned the surgery before and follow the rules to a T.
Has anyone woken up from surgery and told that more vertebrae were fused than the ones you were told?

I gave my surgeon total permission to do what he thought was the best, but I asked him first how many vertebrae were to be fused. I am concerned that he may not have done the best he could just to do what he promised me he would do.
I know spine surgery is complex and some surgeries won't go as planned. Thus, sometimes the surgeon has to change plans on the OR during surgery.

1. What was you experience? Did the surgeon told you the expected outcome in terms of vertebraes fused before surgery?

My surgeon did and he put the x-ray used to plan surgery with the marks of where he would put the screws, on the bag I brought home with the exams after discharge. The final result matched the sketch.

07-16-2016, 07:47 PM
You should ask your surgeon how he determines levels to fuse and if the rules are different for congenital versus idiopathic.

As far as I know, our surgeon determined the lowest level to fuse on my daughters based on what gets leveled on the bending radiograph. The first kid he said T4 to L1. The second kid she said T4 to L1 or L2. This immediately alarmed me because the further into the lumbar you fuse, the higher chance you will have to go further in the future. I coached her immediately before the bending radiograph to bend as far as possible and that it was important to try her best. It was enough and she was only fused to L1.

I do not know how they select the upper level and think there are rules that relate to shoulder balance.

07-16-2016, 08:00 PM
You should ask your surgeon

My surgeon told me the levels to fuse before doing the bending x-rays. I assume that the lowest vertebrae to fuse has something to do with the vertebrae that touches the centeral sacral vertical line (CSVL). Again, I am not a doctor.

I am not sure but I assume that the bending x-rays are done to get an estimation of the correction possible to achieve. Anyway, you gave great advice to your daughters because I suppose those x-rays are done to test how flexible vs stiff is the area to be instrumented.

07-16-2016, 11:15 PM
I am not sure bending radiographs apply to congenital scoliosis. There it is a matter of wedged vertebrae causing the curve. I think they straighten the curve by fixing the shape of the vertebra. Stiffness seems irrelevant.

I suspect the extent of the osteotomies alone determine the amount of correction with wedge-shaped vertebra.

Obviously I am not a surgeon and that is a question for your surgeon. Just seems like congenital and idiopathic are completely different animals.