Surgical Approach

[CHRIS WBS]

I met with the surgeon last week and he’s rethinking his position on surgical approaches. Initially he suggested A/P from T-4 to the sacrum but now feels that because I am balanced, I can get by with posterior alone from around T-9 to the sacrum. (Maybe because I am balanced, my deformity is not that noticeable unless I’m naked). He’s also taking into consideration increased morbidity with A/P for someone my age. My thoracolumbar curve now measures 80º and in my bending film it corrected to around 55º. Granted, I would not get as good a correction as with A/P, but this latest recommendation would eliminate the need for two surgeries, a longer hospital stay and lessen the risk for complications. But I’m wondering if I might be disappointed if I did not see much of a cosmetic improvement. After all, that is one of the benefits from this surgery. Would appreciate hearing from those of you in your 40s, 50s and 60s who have undergone a two-staged operation and are now pleased that you did or would you have preferred a less invasive surgery even if it meant a reduced cosmetic result?

Chris

[Susie*Bee]

Chris-- are you sure it would really lower the cosmetic result? My doctor had initially planned to do A/P surgery for me and that is what we scheduled, but then he changed his mind and decided he would be able to do the correction with just posterior surgery. I was worried about that a little, but also relieved that I wouldn't have to go through the two surgeries. He was able to correct me more than he thought he would. Tomorrow I go for my check up and will try to find out what my correction is. In the x-ray I look almost straight. I did not have kyphosis or lordosis problems, but did have substantial rotation and my curves, but my two compensatory ones balanced out my major one. Anyway, maybe some others know more than I do, but thought I'd mention that maybe it won't reduce your cosmetic outcome. Best wishes with this. Susie

[crepehanger]

Chris- I was told I was going to have 3 operations, one of which was to be a thorocoplasty ( spelling?) So, a couple of weeks prior when he told me he was going to do only 2, I was thrilled. I can see why you'd be glad to hear that you might only have the one. Personally, I am very happy with the results of the two surgeries, as he got an even better correction than he had planned. He built me in an excellent lordosis curve in the lumbar area in the first surgery when he fused it, and in the second surgery, balanced the thoracic spine, based on the new changed sagittal plane that evolved from the fixed lumbar. BUT, I would think if your doc thinks he can do it well in one, then i would imagine he has it all figured out. I bet you get a better correction that you imagine and you will be thrilled! hang in there and ask lots and lots of questions! lisa

[mouna]

Chris
I had the same curve as you,and was also quite balanced . I had one posterior surgery and got corrected to 23°. A/P was never really discussed, even though i'm fused T3 - L5. I'm very pleased with the cosmetic results. My surgeon did not commit to exact fusion levels before, although he did give me a pretty good idea.

[CHRIS WBS]

Ladies, thanks for your responses. Mouna, that is a fantastic correction you got with just a posterior surgery. Your spine must have been very flexible though. I would be thrilled with that kind of result. Susie, I think most surgeons will say roughly 50% correction with A/P and 30% with posterior alone, but obviously results will vary.

Chris

[Singer]

Chris, we've discussed this before, but I wanted to add that in the first 2-3 months of my recovery, I could have cared less about the cosmetic aspect of it all because I was having so many problems. But when things started to calm down and the swelling went away and my new figure started to emerge, I was amazed. I have an entirely new body. I almost cried when I first went shopping for new clothes because I can wear anything now and look good in it. So now I'm glad I got such a dramatic correction.

On the other hand, my right leg is still weak and I still need a cane outside of the house. My physical therapist says it will probably be another 6 months before it comes back fully -- IF it comes back fully. That complication was a direct result of the anterior cut.

If I were you I would follow your surgeon's recommendation because when it's all said and done he is the only one qualified to make a recommendation that's best for your particular case.

[Susie*Bee]

Chris--I just got back from my appointment in Chicago and all went well. My cobb angle measurement now is just 15 degrees, so it really looks good to me compared to before. I took pics of the x-rays, but don't know if it's possible to post them on here anywhere, but the before and after results are pretty impressive to see. I'm very happy. I get to start back on my arthritis medicine now, so hopefully my hip won't bother me so much.

[Karen Ocker]

Chris:
In my case the anterior approach was particularly necessary because that was the only way to take down the old fusion from 1956.
That's not an issue with you. I got a 50% correction on all 3 curves.
Everyone said I got spectacular results compared to how I looked before: shoulders and hips even.
I have no pain 5 years out.

[CHRIS WBS]

It’s important to let your surgeon know how you feel. And this was brought up by Dr. Michael Neuwirth in his book. Last night I re-read a passage from his book where he cites a 57-yr-old patient who came to him with a curve that was close to 100º. He discussed approaches with her and she said she did not care about cosmetics; she just wanted her spine stabilized so she could get on with her life. So he performed a posterior surgery on her and corrected her spine to 46º. When she saw the x-ray, she asked, “Is that the best you could do?” I was told that posterior would only correct my spine to somewhere in the 50s, so it must be quite stiff. I thought too that anterior is required when a fusion involves the sacrum. Oh well, I will discuss this with the surgeon when I see him again in March. I’m planning on surgery in June when my sister who’s a teacher offered to come and stay with me when school is out.

Chris, I bet you’ll be able to discard that cane soon and will be ready for “Dancing With The Stars” next season. What beautiful backs those dancers and celebrities have!