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  • #1

    Latest research

    What is the currently used research based "magic formula" that is used today to determine where to begin and end a fusion? In addition, I would like to know what types of hardware is currently being used.

    I have read several books and talked to over 6 surgeons. All six come up with a different plan of action. Many of these surgeons are listed on this site so I have to believe that they are all good at what they do. Where do I go to get more up to date information?

    On another note, I am struggling to figure out why the doctors who have been in practice for over 35 years are much more conservative; while the younger doctors who have been in practice for 10+ years are recommending more drastic fusions. Any thoughts on the lasted research is welcomed!
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  • #2
    Hi Kari...

    We're all very different, so there isn't one formula that works for everyone.

    I believe that the latest research states that the bottom most instrumented vertebra should be as level as possible. And, if you have a double curve, some surgeons prefer to leave the compensatory curve unfused in the hope that it will correct somewhat on its own. Those are two very general rules, but there is so much more that goes into the calculation.

    If you've really seen six surgeons and no two agree at least in terms of the basic approaches, I'm guessing that you're seeing the wrong doctors. Could it be that you're interpreting what they're telling you incorrectly? You might want to ask for a copy of each doctors' notes, which can give you more insight.

    In general, I usually tell people not to get hung up on trying to determine which approach, implant, levels, etc. might be best. As laypeople, there's no way we could possibly know that. Instead, find a doctor whom you feel you can trust, and then let them do what they feel is best.

    By the way, when all is said and done, no surgeon can tell you definitively what they'll do once your surgery has begun. There are many things that can come up which might change the surgeon's plans.

    Best of luck in your decision.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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    • #3
      Interesting observation, Kari. I'm finding just the opposite though. I have found that the longer-practicing surgeons are the ones who recommend the most drastic procedures. Like you, I have seen several surgeons, five to be exact, and I've heard everything from leave it alone to fuse my entire spine. Go figure. Going for my sixth consultation next month.

      Chris

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      • #4
        I believe my surgeon proposed fusing me from T-2 to the sacrum, on my chart...but when it came time for surgery, I was fused T-11 to L-5...go figure..Ly
        august 1 2006 ant/post..
        http://lynnebackattack.blogspot.com

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        • #5
          My surgeon is in his 40's so he's in the 10+ years of practice group... and he's on the conservative side. It just depends on the surgeons and isn't necessarily related to the years in practice.
          30 something y.o.

          2003 - T45, L???
          2005 - T50, L31
          bunch of measurements between...

          2011 - T60, L32
          2013 - T68, L?

          Posterior Fusion Sept 2014 -- T3 - L3
          Post - op curve ~35


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          • #6
            Kari,

            Have you read Adolescent Idiopathic Scoliosis published by the American Academy of Orthopaedic Surgeons? Although the case samples are all adolescent, there is some good information about choosing fusion levels.

            We had a large variation of recommended fusion levels and proposed instrumentation when seeking opinions for our daughter. After gaining some knowledge, we tried to get the surgeons to explain their reasoning behind their recommendations, and chose the doctor based on our comfort level with his answers among many other things.

            Good luck,
            Mark
            Mark & Jane, Parents of Lisa
            Daughter 15 years old
            Posterior surgery was in October, 2005, with Dr. Paul Sponseller at Johns Hopkins. Fused T2-L2 w/4 rib thoracoplasty. Rib and local autograft. All pedicle screw and stainless construct.
            Before: PT – 33, MT – 63, L – 32, kyphosis – 46.
            After: PT – 7, MT – 4, L – 15, kyphosis – 32.

            Comment

            • #7
              Hi Kari,

              We all understand your questions, concerns and fears. Whether we've had the surgery or not. I personally don't think there is a "magic formula" even though we all have scoliosis. None of our backs are the same.

              I have to agree with everyone else here, that you have to find the right doctor, the one that you feel comfortable with and trust in your heart. It's not like having your gall bladder removed or any other surgery that's routine!!!

              It's a surgery where you have to trust your surgeon because they have to be able to adapt and adjust to your particular condition. There's nothing wrong with being cautious and asking lots of questions.

              Shari

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