View Full Version : Is it my imagination or are more people having posterior-only surgeries?

01-01-2008, 06:31 PM
Perhaps it's just an age thing -- the younger the patient, the more likely they will have posterior-only surgeries. But I've been following the December recoveries thread and marvelling at how well these ladies are doing. I believe they all avoided the dreaded anterior approach....does anyone think there's a trend these days toward posterior-only surgery or is our Forum too small a cross-section to draw conclusions from?

01-02-2008, 01:47 AM
Singer, I'll be 39-1/2 when I have surgery (posterior only - from T5 to L1) ... Feb 5th, 2008.

It has more to do with curve location than age.

The "December Bunch" has been largely "T"-chicks ... some barely older than my kids, some not, and most of their fusions have ended before L1/L2 ...

01-02-2008, 03:26 AM
I think it has more to do with curve location. I have a thoracolumbar curve, and anterior surgery is supposedly better for that. As you can see my signature below, I've now had both! The posterior surgery is needed to get higher thoracic curves, because you can't reach it with anterior (important things like heart and lungs are in the way)

01-02-2008, 07:39 AM
Interesting....all I know is, if I ever need revision surgery, I cannot imagine having my side opened up again. That was by far the most painful and traumatic part of my surgery. It still hurts like hell a lot of the time.

01-02-2008, 08:44 AM
When I had mine done years ago, they only did posterior. My daughter's surgery was posterior also. I think the doctors go through phases as to which way they think is better. It also might have to do with where they were trained.

01-02-2008, 08:56 AM
I think the location of the curve/curves determine the posterior and/or anterior approach...my curves were thoracic and lumbar, with lumbar being the more severe curve that was fixed. There definitely is a huge difference in the recovery for both anterior and posterior. I had both anterior and posterior and spent the majority of my hospital stay in the step-down unit and I think only 3 nights in a regular room. There's much more involved with a/p, espeically nerve damage in the rib cage area. I still have numb spots and some itching...

01-02-2008, 09:41 AM
My surgeon explained the need for the anterior approach was because my curve was not only to the side but twisting forward as well. I think in a lot of cases as we age the curve becomes worse. Mine never bothered me until about 2005 and then it went downhill quite quickly. I've never had just the posterior approach but getting over anterior/posterior was much harder than I thought it would be.

01-02-2008, 09:42 AM
I'm due for surgery in 3 weeks, anterior first followed by posterior 2 weeks later. My main curve is thoracic with a compensatory lumbar curve but all my lumbar discs have collapsed causing me a lot of pain. They are all going to be removed barring the one between L5/S1. I'm 44 and the problems with my lumbar spine have only occurred as I've got older. Reading this forum, it seems to me that everyone's scoliosis is a little bit different so there's no one cure fits all.


01-02-2008, 09:45 AM
Singer--it's my understanding that many factors are involved in whether the surgery is A, P, or A/P... both books I have cover that information pretty well. Do you have either the Wolpert or Neuwirth books? If not, you might want to purchase or get them from the library, so you can read about it. Youth, flexibility/rigidity, length, area of fusion, surgeon's preference, etc., all play a role in the approach chosen. In the past, better correction was achieved by using A/P, but Wolpert says that gap has been closed in recent years, through improved techniques and instrumentation. It also depends on what other problems there may be--with lordosis, etc. Some scoliosis patients will require both approaches to address the parameter of problems they have...

I was fortunate (in my mind, anyway) in just needing the posterior approach. Fusing fifteen vertebrae seems like plenty to recover from, even if just from the back! Initially, my doctor said he would do A/P. I'm not sure why he changed, although I was fairly flexible in the bending x-rays-- so I'm assuming that is why...

I don't think the decision of which approach to take is something simple. If you wonder why you had A/P, maybe you can ask your doctor why it was necessary to do both. Hopefully he would put your mind at ease that it was for needed for your best correction. From all I've read, (and if I remember correctly) you have an excellent surgeon who can be trusted to the utmost to know what he's doing.

Almost all of these December surgeries were with young people-- and they bounce back MUCH QUICKER than any of us "older" scoli people. They would recover faster from any approach, although A/P would take longer. So comparing our surgeries to theirs is like comparing apples to oranges, both going through a turmoil, but the apples definitely get bruised more...

Heather--as far as numb spots go, I still have numbness and some super-sensitivity in my armpit from when I had my lymph nodes removed 30+ years ago from melanoma surgery. I think sometimes the nerves get damaged and even with time, the normal feeling doesn't return. Hopefully our backs will get to feeling normal, but I know mine isn't at that point yet, and it's been 8 months now.

Hope this might help a little... but I'm definitely not in the medical profession, so take it as just my humble opinion, based on reading and personal experience.

01-02-2008, 11:36 AM
Chris, I think final recommendations are based on what bending film reveals, regardless of age; although I know Dr. Bridwell is performing fewer anterior releases especially in older patients because of the heightened risk for complications. When I saw Dr. Schafer last year, his immediate recommendation was A/P from T2 to the pelvis with iliac bolts and an additional ALIF (3 surgeries). However, he had not seen any bending film. When I saw Dr. Gupta a couple of months ago, I asked him what is his recommendation based on my long cassette standing film, and he said A/P from T4 to the pelvis. After reviewing my bending film though, his recommendation is now for posterior only from T9 to the pelvis.

BTW, congratulations on your superb six-month post-op assessment and continued successful healing in the New Year.


01-02-2008, 01:07 PM
Thanks, Chris. And I'm glad that your fusion is going to be posterior only. I'm sure it won't be a walk in the park, but anything less invasive is a good thing.

01-02-2008, 07:05 PM
I have had three posterior only surgeries. As I posted on another thread, I am potentially facing an anterior (abdominal incision) procedure next month because I am having difficulty standing upright since my third surgery, which was supposed to correct my bending over problem from my second surgery (if that makes any sense!). I haven't had too many people report that their anterior surgeries took place so long after the posterior procedure. My surgeon told me that this surgery would not be as serious as my last revision but it scares me to read here that the anterior procedure might be difficult. I am pretty devastated, confused and pessimistic that I will ever get back to any semblance of a normal life again. After 20 years of fighting, I think my back is finally getting me down. :(

01-02-2008, 09:02 PM
I'm not sure if this is the right thread to ask this question but here goes. I had A/P surgery on Oct. 15 and 22, 2007. The anterior was the first surgery. My abdomen was extremely swollen for weeks which I expected and was not too concerned about, but I am over 8 weeks out and my left side above the top of the incision (about belly button level) up to the bottom of my breast is swollen still and kind of hard, like a muscle. It always felt strange since the surgery but I didn't have any pain until today. I kind of over did things yesterday and perhaps strained it... But, my question is, has anyone else had this kind of a problem? I don't know what this is? At my six week post-op check-up I asked my doc and he said I would have all kinds of strange things going on since my insides were all moved out of the way for the surgery and not to worry yet. I'm trying not to call and ask about it since I see him again on Jan 15. I know he would tell me to see my primary care doc here in my hometown three hours from my surgeon. My primary care doc always says something like "he did the surgery, ask him", so I don't know what to do but wait. I took it easy, just rested today. Just since getting on-line and sitting here for about 30 minutes it is getting painful and feels hot. The swollen area is about 3 inches wide and 8 inches long give or take. The right side is very normal and I have a waist back. Anyone have any experience with this or ideas?

It has been great hearing the reasons for A or P or A/P procedures. Everyone is so helpful here.

01-03-2008, 10:04 AM
Trulyaries, I understand what you mean about "normal life", but keep the faith, there is still hope. Listen to me, I also am pessimestic a lot of the time. I just wanted to mention that my anterior surgical incision is right down the middle of my abdomon, just a teensy bit to the left of my belly button. Other than the problem I mentioned in my last post and an initial problem of not being able to have a bowel movement for several days, I felt that the anterior was the easier recovery.

My husband insists that the swollen area that I have is a muscle. He says that since they cut most of the muscle that they left one alone and that is what I feel. This definitely doesn't make sense to me AT ALL. Looking in the mirror there is a pouch look to my left waist area and my right side has a normal curve in at the waist. I got on here to encourage you Trulyaries and here I am back to my problem.

I am thinking about you and many others and will keep you and everyone in my prayers.

01-03-2008, 10:32 AM

Could it be that you're acquiring an incisional hernia?


01-03-2008, 11:00 AM
Susan, it took months for my belly to go down, and the incision side of my belly is exactly as you describe, hard like a muscle. It is also numb but painful -- hard to describe. Sometimes it itches inside but of course I can't scratch numb skin! It's very weird. From what I hear, that can take a year or more to feel more normal again.

Trulyaries, I feel badly that you are facing yet another surgery. But the anterior approach will be worth it if it finally stabilizes your spine!!

01-03-2008, 04:14 PM
Chris, I thought about the incisional hernia myself. I finally just a moment ago called my surgeons office. He is out of town until next Tuesday, but one of their PA's will be getting back to me either today or tomorrow to address my concerns. I may sound like a big baby but I just do not want any other surgery right now (or ever). I know none of us do and several are looking at revision and other surgeries and my heart goes out to them as well. Thanks for your input.
Take care,

01-03-2008, 04:25 PM
Singer - Sounds like mine, so hard to describe and mine feels like it itches inside too. Did your swelling finally go down? Is it still hard like a muscle? Sorry you have the same problem but hearing from you helps me feel like I may not be so different after all. Maybe in time it will go away, I hope.
Thanks for your input!

01-03-2008, 05:53 PM
Yikes, Susan and Chris - you're not making me feel any better about the anterior surgery! :eek: Susan, please post and let us know if you find anything out from your doctor. My stomach has already gotten so big just from my inactivity and bending over for so many months - I asked my doc if he could do a lipo and tummy tuck while he's in there. :D I hate to think that my stomach will get any bigger than it already is!

The hardest part of all this is family and friends asking why I have to have yet another surgery. "Can't those doctors do it right the first time??" That's mainly what got me down during the holidays.

Anyway, thanks for your kind comments and support, and allowing me to vent a little. I'll be interested to follow your progress.

01-03-2008, 10:58 PM
Trulyaries, Boy I didn't mean to make you feel any worse about having your anterior surgery. I really feel that the healing is good and the pain level is minimal compared to prior to the surgery. I just sent a message to Chris and hadn't checked the forum yet or would have posted here first. I had some encouragement tonight. My 38-year-old daughter (she is a nurse) stopped by tonight to check my abdomen. She doesn't think it is a hernia. She feels that it is muscular by the way it feels. Of course she doesn't know for sure but I do feel better and I will let you know what I hear from the Dr.'s office. Before my surgery the left side of my lumbar area in the back was huge with this hard muscle, all my muscles were twisted every which way. My daughter said that with all the hardened muscle I had that it had to go somewhere when they straightened my spine and perhaps that is what I am seeing and feeling. I still look 99.9 percent better than before but when you don't know for sure what something is and it feels hot inside your body you worry. I do anyway. I will keep you in my prayers for your surgery. Keep the faith and keep us posted.
Take care,

01-04-2008, 06:21 PM
Not to worry, Susan - I won't let your experiences stop me if I decide to go ahead with the surgery,which looks more and more likely. My 1/15 appointment will be the "go/no go" decision day. I had an abdominal surgery many years ago (my spleen was removed) so I have some idea of what to expect. Hope the news from your doc is good.

Linda W
01-04-2008, 08:56 PM
Dear Trulyaries,

I was more than a little nervous about having an abdominal incision to deal with as part of my second stage. My incision starts at the navel and runs down to the sacrum. A vascular surgeon was in charge of making the incision and moving all the assorted organs out of the way so they could place implants at L3,L4 & L5. I was very pleasantly surprised that it was minimally painful compared to having my back opened on both days. Sorry to hear that others have experienced far more discomfort for side incisions. My scar is healing nicely at six months and looks good to me. I have an old scar going crosswise from some gyn surgery many years ago. If I have any more surgery, I will be able to play tick tack toe on my abdomen!

I spoke with a 59 year old patient of Dr. Rands who at 9 months postop from A/P surgeries had a hip replacement. She said it was a piece of cake after having the "big kahuna" of spine surgery. You are a strong surgical veteran and a "big kahuna" as well! Best of luck to you at your appointment on the 15th.

Linda W.

01-05-2008, 01:38 AM
I had an A/P surgery on 12/5 with a horizontal incision just a couple inches long a little below my belly button on the left side. I feel the exact same thing you are describing and I had wondered if it was normal and what it was. I hadn't really started to worry about it yet since I am only a month post op today. I will ask my surgeon on the 15th what this is and how long it takes to return to its pre surgical state when I see him. I also found that my anterior surgery was easier to recover from than the posterior. While from time to time I get some minor pain at the incision, I don't really notice that it is there (besides when I sneeze).
I also have problems with having a regular bowel movement. I have been taking senna kot (stool softener with a laxative) to help aid in keeping things moving.

You can mark me as a A/P December surgery on a young person (20 y.o.). I had my 4th surgery for Flatback, Loose Screws/Pseudoarthrosis, Herniated discs, a curve above the fusion and correction of junctional kyphosis. The surgeon did the anterior procedure first and removed the discs at L4-5 and L5-S1 and replaced them with bone wedges and BMP. Then he did the posterior procedure and removed all my old hardware (T4-L5) and replaced it from T2-Sacrum also anchoring it in the ilium on both sides. I had 96 staples in the posterior incision, I havent measured it to see how long it is. I spent 6 days in the hospital and went to rehab for another 5 days. I am now recovering at home using a walker and a wheelchair to get around.

01-05-2008, 06:08 PM
LindaW: Thanks for your good "big kahuna" comments - I appreciate the support!

CurvySAT: You go, girl! That was some surgery you had. I feel for you having so many back issues at your age, but it sounds like you are coming through with flying colors.

My appointment can't come too soon so I can plan the next few months of my life. I feel much better with the support I'm getting here. Thanks to all.

01-05-2008, 11:40 PM
Hi CurvySATO5, Trulyaries, LindaW, and others,
At the end of the day I think I had a good surgical experience except for this weird "pouch" thing. My anterior incision was also horizontal, a little above the belly button down to the sacrum, started a little to the left and then below the belly button it is right down the center. The incision area itself is hard from the scar tissue, this other thing is???
Anyway yesterday after my husband went to work I discovered my phone didn't work. I called (from my cell phone) a friend who reported it. Then my cell phone wouldn't hold a charge so it was out. Needless to say I didn't hear from my doctor. I think instead of worrying I will wait until my Jan. 15 appointment since it is only 10 days away now and see what he says. I don't have unbearable pain, just strange feeling.
Wow, Curvy, that is a lot for a person your age. Having it done while you are young is a plus. My husband works with a woman in her 50's who had the surgery when she was in her early 20's and she works for the Post Office, on the dock, lifting packages, heavy items, pushing carts, working hard and on her feet all day and handles it very well. All the best to you Curvy. I must be wordy, ran out of room. Susan

01-05-2008, 11:45 PM
I just noticed we both have appointments on Jan.15, guess we will find out what is going on with our abdomen. I too take stool softener every day.

Hope everyone has a good weekend. You are all an inspiration to an oldie like me...

01-06-2008, 07:46 AM
My appointment's on the 15th also. It's going to be a big day in Scoliosis World ... ;)

01-21-2008, 01:50 PM
This womanís curve looks identical to mine. http://drlloydhey.blogspot.com/2007/11/78-degree-scoliosis-surgical-correction.html
The only difference I can see is that her thoracolumbar curve has the more common right convexity whereas mine is to the left. Note the rib cage resting on her pelvis. Thatís exactly what has happened to me. Within just the past few years I have lost my waistline. Thereís so much discussion about heart/lung compression with a big thoracic curve, but I think these big lumbar curves can be just as detrimental to abdominal organs. I have noticed changes in my bowel habits and am experiencing intestinal problems. Last year I had a colonoscopy to rule out anything serious, but I seriously suspect my scoliosis is the offender. I note this woman was treated with a posterior only approach.


01-21-2008, 04:13 PM

I have been looking through Dr. Hey's sight for several months now. I am very impressed with the blogs, info. provided about the surgeries, pictures, videos, testimonials, etc...very interesting . It is me I'm sure, but on the x-rays does it look like screws are fewer and more spread out? Maybe there are different schools of thought on this???

age 41

01-25-2008, 01:33 PM

I think these surgeons are comparably trained in screwing techniques (no pun intended), but as in any profession, some are obviously more skillful than others.