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View Full Version : Surgery Booked for June 18!



VincySweety
02-15-2007, 03:34 PM
Well everyone, it's been decided that I'll be having Posterior Spinal Fusion on June 18, 2007. Now that it's for sure I'm so scared!! and I have 4 long months to worry about it. I especially started to worry when they gave me a prescription for the iron tablets that I'll have to start taking 2 months before the surgery and before the blood donation, as well as info booklets for me and my family. They also said they'd call me when I have to come in for my pre-op tests ... so I guess reality just sank in when they told me all that. I guess it's too early to be worrying but I definitely am scared.
Despite being scared though, I definitely feel comfortable with my surgeon. We talked for a long time at her office today and she explained everything to me and answered all of my questions. She also said that if I have any more questions I could call and she would talk to me over the phone. She said she does scoliosis surgery every other week and has been doing it for 13 years, so I'm confident in her abilities.

I'm not sure what levels will be fused yet because she said that I'd do bending x-rays a month before surgery and that's when she'll plan the surgery in exact detail and let me know. But she did mention that because my lumbar curve is compensatory she wouldn't have to go down too much into the lumbar region. Also, she said that she will be using titanium rods not stainless steel ones. Is titanium better?

Oh, I read the info booklet and one of the things it says is that I'll have to take antibiotics anytime I'm going to have dental work done because of the metal that will be in my back... does anyone know what that's about?

Scared and worried,
Nadia

debigolebiwski
02-15-2007, 03:46 PM
I want to wish you the very best of luck.

geo
02-15-2007, 05:14 PM
Hi Nadia,

I am very happy for you, having a set date and finding a doctor you trust. I totally understand your fears, but I will be honest with you and say I have a bit of envy that you have made it through the first big steps of choosing a doctor, and choosing a day. That's huge!!
I have recently been recommended for surgery myself, so I've been reading all I can. You've probably seen David Wolpert's book about scoliosis surgery recommended elsewhere on this forum, and I think it is a must-read. He's got tons of information, lists the pros and cons of many decisions people with scoliosis face, and of those facing scoliosis surgery. He also touches a bit on the pros and cons of titanium vs. stainless steel (titanium has shown to have "metal memory" in studies, which is a con, but allows MRI's after surgery), stainless steel could produce allergic reactions in those allergic to nickel, and so on.
He also talks about how having your teeth cleaned, etc. releases all sorts of bacteria, hence the antibiotics.
These are the same types of questions I have just e-mailed off to my surgeon. I would suggest the same for you -- your doctor or his/her assistant should be able to answer your questions in depth.

All the best to you!

Houston Curves
02-15-2007, 06:12 PM
The best of luck to you! I too hope to have a "date" soon. Email me anytime.

Ann

LindaRacine
02-15-2007, 06:42 PM
Hi Nadia...

Titanium is neither better or worse than stainless steel... just different. Titanium is more brittle so can actually break more easily than stainless steel. That's usually not an issue. The big advantage to titanium is that it doesn't interfere with diagnostic tests like an MRI.

Good luck with your surgery.

Regards,
Linda

bbest
02-15-2007, 07:08 PM
Nadia -

Best wishes for a successful surgery. It's a big decision, but it sounds like you made the right one for you.

Suzy
02-16-2007, 02:00 PM
Hi Nadia,

You do not need to pre med before having dental work done. (That is the taking of antibiotics before dental work.) I am a registered dental assistant here in Calif. The only people who need to pre med are those with mitro valve prolapse or who have transplants. I double checked on this before I had my surgery. Sorry your info booklet is mistaken.

Now that you have a date for your surgery you need to start to think of it as the beginning of a new life as it has been for most of us here. At your age you are going to be up and around in no time at all!! Read back some of my story, at 43 I was back driving at 4 weeks! I was ready to have restrictions lifted at 3 months. You will be fine. Best wishes

abhbarry
02-16-2007, 04:30 PM
Congrats on making the BIG decision. I will probably be having surgery around the same time as you, but nothing will be set in stone until March.

Just a thought about pre-medicating for dental work . . . I have to pre-medicate because of my mitrol-valve-prolapse, and apparently my mother was supposed to pre-med after her hip replacements, but only for a while. A couple years out, she does not have to. Quite frankly, my mother doesn't like taking any medications and never pre-medicated for dental work even when the surgeon told her to. Hmm. . .

Best,
Anya

Houston Curves
02-16-2007, 06:32 PM
... or anyone who is at an increased risk of endocarditis. One of my twins was very sick in the NICU. She developed a clot in her right atrium, which led to SVC syndrome, which led to more clotting, stroke, etc. Anyway, I have a medical "card" for my wallet that says she can't even have her teeth cleaned without antibiotics. Sorry, I digress... :(

Heathmoose
02-16-2007, 06:36 PM
Since having my surgery, I have been told to pre-medicate before going to the dentist...hmmm, now I wonder if I really need to??? My surgeon's office recommended it and the first time I went to my dentist after surgery, I totally forgot, and when I mentioned what type of surgery I had, they said I had to reschedule b/c I needed to be pre-medicated. Maybe it's just for a precaution.

VincySweety
02-17-2007, 11:34 AM
Thank you all so much for your best wishes and for answering my questions :)

Geo - I got the book and I think it's great!! I think I'm going to get my mom to read it when I'm done because I think it's really informative. Hopefully she will... she used to think ignorance was bliss, but I think she knows better now! I think after realizing how much I read about scoliosis and talk to all of the great people on the forum, she knows now how much better it is to be well informed. :)

Suzy
02-17-2007, 04:39 PM
Mitro valve prolapse and transplant patients are the MAIN ones we were on the look out for. I didn't mean they were the ONLY ones who needed to pre med. Sorry. There is a list on The Pankey Institute website under hot topics "Do you need antibotics before dental work." The majority of pre medication is for cleanings and root planing. Not for fillings. When you have a cleaning or root planing bacteria around the base and root of the tooth are disturbed and thus can inter the blood stream. (This can also happen in the prep for a crown.) "This can cause bacterial endocarditis in the heart, infection at the site of a replacement joint or complications for other illinesses." (From the Pankey Institute")


My Dr. (Surgeon) said it would be totally unnessary to pre med after this surgery. I also double checked with my Dentist (And previous boss) and he agreed totally.

spincon58
02-18-2007, 11:59 AM
WOW,
Congrats on The hardest decision you just made. I remember pondering over that decision because I knew it was up to me to decide .....no one else...The doctors took the surgery as an elective surgery....some elective surgery lol..anyway I wish u good luck..you'll have better quality of life now that your having the surgery...I was rock climbing 6 months after surgery...be brave and dont worry it takes u no where....

Cena75
02-18-2007, 01:29 PM
Titanium vs. Stainless Steel - titanium is lighter, and you are less likely to get an allergic reaction to it. My titanium rods were slightly bent to support my large curves when I had my first surgery - they couldn't get 100% correction at the time. Linda, I actually heard it was just as strong overall as stainless steel (from a specialist a long time ago)... I'm not sure, but found some info. on the net:

The two most useful properties of the metal form are corrosion resistance, and the highest strength-to-weight ratio of any metal. [4] In its unalloyed condition, titanium is as strong as steel, but 45% lighter.[5]

Titanium is a strong, light metal. It is as strong as steel and twice as strong as aluminum, but is 45% lighter than steel and only 60% heavier than aluminum. Titanium is not easily corroded by sea water and is used in propeller shafts, rigging and other parts of boats that are exposed to sea water. Titanium and titanium alloys are used in airplanes, missiles and rockets where strength, low weight and resistance to high temperatures are important. Since titanium does not react within the human body, it is used to create artificial hips, pins for setting bones and for other biological implants.

Best wishes for your surgery! Whatever the implants, I wouldn't worry - they'll do the job they're meant to do!
BTW - I never even heard of taking antibiotics before teeth cleaning after you've had scoliosis surgery. I've had my original rods for 18 years and although I couldn't get into a dental chair for about 9 months after the op., and HATE the vibrations from scaling, I never had to medicate. Does anyone have any more info. about this?

gc10107
02-18-2007, 07:22 PM
Hey Nadia I'm Goodcharlotte101 off SK I posted too much and got knocked off I think I tried too make another account but it won't work either I can't get into my email either...Anyways I want to wish you the very best of Luck and I hope it all goes well and you make a full recovery I know your scared but it will be worth it in the long run and Good Luck for a smooth recovery and a succsesful operation! :)

LindaRacine
02-20-2007, 10:53 PM
Titanium vs. Stainless Steel - titanium is lighter, and you are less likely to get an allergic reaction to it. My titanium rods were slightly bent to support my large curves when I had my first surgery - they couldn't get 100% correction at the time. Linda, I actually heard it was just as strong overall as stainless steel (from a specialist a long time ago)... I'm not sure, but found some info. on the net:

The two most useful properties of the metal form are corrosion resistance, and the highest strength-to-weight ratio of any metal. [4] In its unalloyed condition, titanium is as strong as steel, but 45% lighter.[5]

Titanium is a strong, light metal. It is as strong as steel and twice as strong as aluminum, but is 45% lighter than steel and only 60% heavier than aluminum. Titanium is not easily corroded by sea water and is used in propeller shafts, rigging and other parts of boats that are exposed to sea water. Titanium and titanium alloys are used in airplanes, missiles and rockets where strength, low weight and resistance to high temperatures are important. Since titanium does not react within the human body, it is used to create artificial hips, pins for setting bones and for other biological implants.

Best wishes for your surgery! Whatever the implants, I wouldn't worry - they'll do the job they're meant to do!
BTW - I never even heard of taking antibiotics before teeth cleaning after you've had scoliosis surgery. I've had my original rods for 18 years and although I couldn't get into a dental chair for about 9 months after the op., and HATE the vibrations from scaling, I never had to medicate. Does anyone have any more info. about this?
Hi Cena...

I addressed this question to Dr. Serena Hu, because I was fairly certain that I'd heard papers presented that concluded that titanium is more brittle than stainless steel, and she confirmed that is correct, and quoted the following studies:


Titanium versus stainless steel for anterior spinal fusions: an analysis of rod stress as a predictor of rod breakage during physiologic loading in a bovine model.

Wedemeyer M, Parent S, Mahar A, Odell T, Swimmer T, Newton P
Department of Orthopedics, Children's Hospital, San Diego, San Diego, CA, USA.

STUDY DESIGN: In vitro biomechanical evaluation of rod stress during physiologic loading of anterior scoliosis instrumentation. OBJECTIVES: To determine effects of material properties and rod diameter on rod stresses in anterior scoliosis instrumentation. SUMMARY OF BACKGROUND DATA: Relationships between instrumentation dimensions, materials, and potential rod failure in anterior scoliosis instrumentation remain unclear. METHODS: Eighteen immature bovine spines were randomized to 3 groups: 1) 4.0-mm stainless steel, 2) 5.0-mm stainless steel, and 3) 4.75-mm titanium alloy. Spines underwent physiologic tests in flexion-extension, lateral bending, and torsion. Rod surface strains were converted to rod stress and normalized to each material's yield stress. Construct stiffness and the normalized rod stresses were compared with a one-way ANOVA (P < 0.05). RESULTS: The 4.0-mm steel and 4.75-mm titanium construct stiffness was similar across all tests. The 5.0-mm steel system was significantly stiffer than 4.0-mm steel (lateral bending/torsion) and 4.75-mm titanium (torsion/flexion) constructs. Rod surface stress was significantly lower for the 4.75-mm titanium rod compared with 4.0-mm and 5.0-mm steel rods for all tests. CONCLUSIONS: The percentage of yield stress was lowest for the 4.75-mm Ti rod for all tests due to titanium's greater yield stress. This suggests the 4.75-mm rod has a lower fatigue failure risk than either steel construct.





Spine. 2006 Jul 1;31(15):1680-7.
The effects of rod contouring on spinal construct fatigue strength.

Lindsey C, Deviren V, Xu Z, Yeh RF, Puttlitz CM
Department of Orthopaedic Surgery, University of California, Berkeley, CA, USA.

STUDY DESIGN: In vitro fatigue loading using a corpectomy model outfitted with posterior pedicle screw instrumentation. OBJECTIVE: The purpose of this study was to detect differences in fatigue resistance of titanium and stainless steel spinal constructs that use rods contoured using a French Bender, and to compare differences in fatigue resistance of contoured and straight titanium rods. SUMMARY OF BACKGROUND DATA: Instrumentation failure is generally thought to be caused by fatigue or cyclic loading. Intraoperative contouring of the posterior rods is almost always required to match the native kyphotic (thoracic) or lordotic (cervical or lumbar) spinal curvature. How bending these rods affects their overall fatigue resistance is not well described. In addition, changes in fatigue resistance may be a function of material type. METHODS: Spinal constructs were evaluated using the ASTM F1717-01 model. Two different titanium-based rods (Ti6AL4V and CpTi) and two different steel-based rods (Orthinox and 316L stainless steel) were evaluated in this study (n = 6 for each group). Rods were contoured at two points using a French Bender and were rigidly coupled to polyaxial pedicle screws within UHMWPE vertebral bodies. Constructs were cycled at a load ratio of 10 between a minimum and maximum loading regime of -250 N/-25 N and -700 N/-70 N at a frequency of 4 Hz. Estimated maximum nominal stresses at various points of interest in the spinal constructs were calculated using beam theory. Effects of the rod material, load, and stress on the number of cycles to failure were analyzed using Cox proportional hazards regression. RESULTS: All of the spinal constructs with contoured CpTi rods and contoured Ti6Al4V rods failed at one of the bends in the rods. Almost all of the spinal constructs with straight CpTi rods and straight Ti6Al4V rods failed where the blocker screw fastens the rod to the coupler of the polyaxial screw head. Contoured titanium constructs demonstrated significantly lower fatigue life than contoured 316L constructs. Contouring tended to lower the fatigue life of both the Ti6Al4V and CpTi constructs. CONCLUSION: Intraoperative rod contouring using a French Bender significantly reduces the fatigue life of titanium spinal constructs.

Regards,
Linda

joeb-z
02-21-2007, 03:52 PM
Hi Nadia...

Titanium is neither better or worse than stainless steel... just different. Titanium is more brittle so can actually break more easily than stainless steel. That's usually not an issue. The big advantage to titanium is that it doesn't interfere with diagnostic tests like an MRI.

Good luck with your surgery.

Regards,
Linda

I hate to differ with Linda, but titanium is far superior to stainless steel. Titanium is not more "brittle" than stainless steel. I won't get into a bunch of engineering jargon, but titanium is actually rather springy or resilient. Broken titanium implants are probably the result of first generation hardware that duplicated SS designs.

Titanium is much more bio-compatible than SS. It is less dense and better matches the stiffness and density of bone, which results in more natural load paths. Ultimately the loads will be through the new bone, but because the titanium is more flexible, it is likely to minimize loose screws and other hardware damage to the bone. Titanium is better for the tissues because it does not emit harmful metal ions. SS emits nickel which is not well tolerated by the body.

I could go on and on with this, but I doubt any surgeon who has a choice uses stainless steel unless a particular construct has a serious strength problem.

LindaRacine
02-21-2007, 05:18 PM
Hi Joe...

Differ all you want. :)

I'm not a metal engineer, so can't really debate this issue. All I know is what I've heard at SRS meetings. I suspect it has to do with the fact that the rods have to be bent.

--Linda

Cena75
02-21-2007, 08:43 PM
Linda, thanks for the info.! I always appreciate what you have to share! Thanks too Joe for your info! Speaking of the flexibility of titanium, if that is what was used on my first 2 rods, (my Mom thinks it was) it was because they were slightly bent to contour with my curve that couldn't be corrected, rather than the rigid stainless.

LindaRacine
02-21-2007, 10:26 PM
Linda, thanks for the info.! I always appreciate what you have to share! Thanks too Joe for your info! Speaking of the flexibility of titanium, if that is what was used on my first 2 rods, (my Mom thinks it was) it was because they were slightly bent to contour with my curve that couldn't be corrected, rather than the rigid stainless.
Cena...

Except for the early Harrington rods, all posterior rods are bent, whether they're titanium or SS.

--Linda

Cena75
02-21-2007, 11:48 PM
Thanks again Linda :) !I've learned so much additional info. from the forum! A quick question though...are they pre-bent or do they bend them in the OR? I have a bad cold, and reading back, that last post of mine didn't even make much sense - sorry :o ! Whatever those 2 rods are, they did their job!
Take care,
Cena

LindaRacine
02-22-2007, 12:11 AM
They're bent in the OR. :)

--Linda

joeb-z
02-22-2007, 10:05 AM
Let me elaborate a bit about the complexity of selecting materials for orthopaedic implants. The issues with titanium rods are a result of bending (shaping) the rods in the operating room. The same basic metals have different properties based on the alloys and the processing of the metals (typically thermal processing like heat treating). Metals have elastic deformation (like a spring that returns after stretching) and plastic deformation (like a spring that gets stretched too far and is longer when relaxed). The point where plastic deformation begins is the yield point. Most of these properties relate to the hardness of a metal. So for a given metal the harder alloy and heat treatment will typically be more brittle and have a higher yield point.

Lets consider gold. Pure gold can deform (plastically yield) into sheets so then you can gild a pictrure frame. Yet the 14K alloy in a ring is quite resistant to bending.

Heres the problem for implants. Many alloys "work harden". That means the metal becomes more brittle when deformed. So if you straighten out a paper clip and bend it back and forth, the deformed area hardens, then cracks and then breaks. Typically, the harder the alloy is to start with, the greater the work hardening. So in the case of implants, the not too startling conclusion is that if you bend certain alloys with too much zeal, that is where they break eventually. As to the titanium rods selected for the studies, commercially pure titanium is quite weak to start with and the 6AL4V is a poor choice for interoperative bending. A titanium alloy could be optimized for interoperative bending but I'm not sure this is done. Pre-bent rods are available and that would be the better choice, with fine tuning by the surgeon.

To return to practical considerations, given a choice I would go with the latest generation of titanium hardware. If in some way you can assess your doctors mechanical skills, all the better. Constructs that have relatively sharp bends in the rods and look overly complex are not a good thing. If I had a choice in rod size for titanium, I would go a size up from stainless steel (which is what the first article implies).