Is it my imagination or are more people having posterior-only surgeries?

[Singer]

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?

[txmarinemom]

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 ...

[nzgirl]

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)

[Singer]

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.

[rainbow2010]

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.

[Heathmoose]

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...

[CStadler]

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.

[MrsWh]

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.

Hazel

[Susie*Bee]

sources...

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.

[CHRIS WBS]

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.

Chris

[Singer]

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.

[trulyaries]

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.

[SusanGP]

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.
Susan

[SusanGP]

Normal Life

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.
Susan

[CHRIS WBS]

Susan,

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

Chris