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pmsmom
02-11-2009, 12:51 PM
I know there are various kinds of instrumentation used. Any ideas on pros/cons or how surgeons decide on what to use?

Getting my questions lined up for next week's apt.

Marian

laurieg6
02-11-2009, 08:45 PM
Our surgeon chose stainless steel. He said one reason was that it was less likely to break than titanium (although it is heavier) and I've read about that too. I was leaning toward wanting titanium because of its greater flexibility and lighter weight but since Alexander still, presumably, has a lot of growing to do, I was okay going with the strength of stainless.

LindaRacine
02-11-2009, 11:26 PM
Hi Marian...

I think surgeons mostly use what they're trained on, although they may pick up expertise with new implants with good results that are new to the market.

I don't think there's any way that we (consumers) can tell what might be the best implants for our surgeries. Instead, I think the best thing we can do is find a surgeon with a lot of experience, and good references, and then trust that they'll use the appropriate implants.

By the way, I think there are sometimes issues with insurance companies. That is, some insurance companies, will limit the amount allowed, so the surgeon may be forced to use less expensive implants.

Regards,
Linda

txmarinemom
02-12-2009, 01:53 AM
I have 6mm Vitalllium rods (a propreitary Stryker XIA system - cobalt, chromium, moly - CoChMo) alloy I've yet to see anyone else post they have this XIA (and it was placed just over a year ago). My x-braces and screws are titanium.

It's lighter than 316 SS (or 316L SS) by far, and stronger/lighter than titanium (Ed, I'm counting on you to back up my safety factors. Hanson told me I'd most likely never snap a rod living my life as I do ;-).

The same SS system would have weighed > 1 lb.

Hanson estimates mine at 6 oz - T4 to L1.

Pam

pmsmom
02-12-2009, 07:09 AM
Thanks for the input!

Does the type of material make any difference in terms of infection rate either right after surgery or after?

I was also wondering about the differences between things like Cotrel Dubosset, Moss Miami, etc.

Keep 'em coming! :)

Marian

smileyskl
02-18-2009, 11:12 AM
Hi Marian,

My daughters surgeon chose to use titanium because of her needing future MRI's. I am not absolutely sure why but I don't think you can have an MRI with stainless steel rods (maybe because of the magnet). Anyway, when he mentioned that it could interfere, we chose titanium since with her past tethered cord she has to have it checked by MRI every few years. I think we would have chose that anyway since your never know when you may need an MRI for something. It may be something to ask your doctor about. Just a thought. Wish I could explain it better but I am sure the surgeon will know exactly why. :):)

Sharon

smileyskl
02-18-2009, 11:19 AM
Hi again,

I googled what I said about the MRI and steel. It has to do with the magnetic heating of the steel. I found several places explaining it when I typed it in my search bar. Sorry, I am not really sure how to add a link on here. I need to figure that out I guess. Hope this helps.:)

Sharon

titaniumed
02-18-2009, 10:10 PM
I agree with Linda's statement.

The fact that hardware breaks upon pseudoarthrosis is a testament to the forces we put our backs under. With the leverage that the fused sections of the spine have above and below a non-union, just about anything can break, with the repetitive see-saw motion. A successful fusion is key here. Successful fusions have been done with Luque wires.

One of the factors we face in metalworking, is a thing call inclusions.( I'm forgetting all this stuff ) LOL

http://www.matter.org.uk/glossary/index.asp?dbid=210
http://www.matter.org.uk/steelmatter/applications/can_strip/cleanness/5_1_2.html

I'm sure they x-ray all the hardware to look for flaws, but that is no guarantee of 100% integrity.

Titanium has excellent anti-corrosive properties, non ferromagnetic for use in MRIs and osseointegration. Now Pam knows why her screws were made of Ti. It is not selected for its lightness for implants.

http://en.wikipedia.org/wiki/Titanium
http://en.wikipedia.org/wiki/Osseointegration


Making steel is just like cooking in the kitchen. A group of ingredients added and heated up. They will let the batch cool off into an ingot, and possibly do a vacuum arc remelt(VAR) or electroslag remelt(ESR)to remove impurities, then roll it into a bar, like using a rolling pin when you bake.

http://en.wikipedia.org/wiki/Vacuum_arc_remelting
http://en.wikipedia.org/wiki/Electroslag_remelting

Medical grade stainless steels or any groups of medical grade metals or alloys go through a strict set of manufacturing parameters. BTW, we do make the best steels here in the United States. I specify only domestic made materials period.

Exam next week folks.

Ed

txmarinemom
02-18-2009, 11:58 PM
You think I can wait for a pop quiz next week? Laff. You *seriously* underestimate my ADHD.

... and Vitallium rods? VERY MRI-able ... even more so than Ti. Your view, por favor?

I know why my screws were made of Ti. High shear resistance, MRI-ability ... and, LOL, compatibility with CoChMo. They don't make Vitallium screws for medical grade use ... ;-)

Regards,
Pam

LindaRacine
02-19-2009, 12:21 AM
Hi Marian,

My daughters surgeon chose to use titanium because of her needing future MRI's. I am not absolutely sure why but I don't think you can have an MRI with stainless steel rods (maybe because of the magnet). Anyway, when he mentioned that it could interfere, we chose titanium since with her past tethered cord she has to have it checked by MRI every few years. I think we would have chose that anyway since your never know when you may need an MRI for something. It may be something to ask your doctor about. Just a thought. Wish I could explain it better but I am sure the surgeon will know exactly why. :):)

Sharon
Hi Sharon....

It's perfectly safe to have an MRI with stainless steel implants. However, the stainless steel makes the MRI unreadable in the area directly around the implants.

Regards,
Linda

LindaRacine
02-19-2009, 12:25 AM
Thanks for the input!

Does the type of material make any difference in terms of infection rate either right after surgery or after?

I was also wondering about the differences between things like Cotrel Dubosset, Moss Miami, etc.

Keep 'em coming! :)

Marian
Hi Marian...

The differences between posterior spinal implant systems used for scoliosis are pretty subtle. Almost all of these systems are considered "universal." That is, they all pretty much accomplish the same thing.

I've never heard that there are any differences in infection rates between the various metal implants, and I can't imagine why there would be.

Regards,
Linda

titaniumed
02-19-2009, 01:01 AM
LOL. Pam, that was fast! I figured this thread to be quiet.

One of the things that my surgeon was concerned with was the backing out of my screws. I guess that has been a problem otherwise Synthes wouldn't have a non-linear lead and pitch on the threads of the screw. The combination of the increasing torque to 15NM and the osseous integration or direct attachment of titanium oxide permanently fusing to the bone is the cats meow I guess. That and maybe a little gift from the hardware people?

No test, that was just a catalyst.

Oh no, I think Im burning pizza in my oven! roughing it tonight

Ed

Pooka1
02-19-2009, 07:36 AM
Any Galvanic action going on between any of these metals and alloys?? Would it matter? Maybe it would make folks clairvoyant or something. :D

Beckymk
02-19-2009, 03:21 PM
I just feel like a bad mom. I didn't even ask what TYPE of metal they are using. I just figured it was standard and they use, whatever it is they usually use in spinal fusions. Similar to when we got her braces on her teeth, we used the basic ones that were recommended for her teeth. Didn't really think to ask about other kinds.

They *might* have told me but when we found out she was having surgery, they were shoving a bunch of papers at us at the same time as they showed us x-rays of previous people and a model of how it was done. Since, I had already done my research, I 1/2 paid attention since I knew the basic concept.

HMM....maybe I should ask when we go for our pre-op appt. next Friday.

pmsmom
02-19-2009, 04:43 PM
Hey, Becky,

Don't feel like a bad mom. Is there an echo in here? ;)

I couldn't even communicate the information to the surgeon til I started throwing out terms like "Moss Miami", etc.

He did say that he uses something called "Isola".

Marian

LindaRacine
02-19-2009, 11:05 PM
I just feel like a bad mom. I didn't even ask what TYPE of metal they are using. I just figured it was standard and they use, whatever it is they usually use in spinal fusions. Similar to when we got her braces on her teeth, we used the basic ones that were recommended for her teeth. Didn't really think to ask about other kinds.

They *might* have told me but when we found out she was having surgery, they were shoving a bunch of papers at us at the same time as they showed us x-rays of previous people and a model of how it was done. Since, I had already done my research, I 1/2 paid attention since I knew the basic concept.

HMM....maybe I should ask when we go for our pre-op appt. next Friday.
Becky...

There's really no need to feel inadequate. The choice of surgeon is far more important, and I doubt any of us would want to dictate what type of implants our surgeon should use!

Regards,
Linda

pmsmom
02-20-2009, 07:23 AM
Becky...

There's really no need to feel inadequate. The choice of surgeon is far more important, and I doubt any of us would want to dictate what type of implants our surgeon should use!

Regards,
Linda

I agree with Linda--I'm one for TMI. Sometimes, I think I'd rather not know. ;)

Trust your surgeon--he knows what's best!

Marian

Pooka1
02-20-2009, 07:28 AM
You pick your surgeon who picks the instrumentation.

You can ask why the surgeon uses certain instrumentation but that's about it I think. JMO.

Beckymk
02-20-2009, 07:40 AM
Thanks everyone. I guess in my head it never occurred to me because it was more or less -- the surgeon knows what he is doing so he is putting in whatever he feels is necessary.

Then I started reading here and wondered.

I wonder if it's one of those things though that it might be good to know what type he did use for future reference. For example, the MRI stuff. Who knows what the future will hold for my DD, so it might be good to know.

Then again, I got an implant done for a tooth and I haven't got a clue what type of metal was used in my mouth. I just knew they put a screw in, with a post and let the bone heal around it (Hmm...sounds familiar doesn't it? ;) )

pmsmom
02-20-2009, 07:44 AM
Then I started reading here and wondered.

I wonder if it's one of those things though that it might be good to know what type he did use for future reference. For example, the MRI stuff. Who knows what the future will hold for my DD, so it might be good to know.



I know I should ask the nurse practitioner about future MRI's as well since the surgeon will be using stainless steel.

Off to find my notebook and write down another question! :)

Marian

Moon Godess
06-08-2009, 02:29 AM
Hi There:
I myself have had a Luque Rod. Much more lighter as I have a small body stature. From what I understand, they prefer to use Luque's in wheelchair patients too, but that may have changed since I had surgery in 1982.

momw/scoli
06-08-2009, 07:32 PM
Hi Miriam,
I bought a book called Scoliosis Surgery the Definitive Patient's Reference that you can buy from the National Scoliosis Foundation website and it talks about the difference between stainless steel and titanium. It says they both have risks. Titanium rods can have a "metal memory" and over time could revert back to their original shape and stainless steel can cause an allergic reaction if you are allergic to nickel. I think both rarely happen. Emily's dr uses titanium and our second opinion uses stainless steel. Emily is allergic to nickel so I was happy with the titanium. I would recommend the book to anyone. It helped answer a lot of questions and if even gives you questions to ask the Dr. It's geared more towards adults, but it helped us out a bunch. I know I sound like a commercial!
Becky
Mom to Emily 14
Had surgery 5-28-09
T2 to T11

tonibunny
10-31-2009, 09:19 PM
Hi There:
I myself have had a Luque Rod. Much more lighter as I have a small body stature. From what I understand, they prefer to use Luque's in wheelchair patients too, but that may have changed since I had surgery in 1982.

Yes, this has changed a lot since 1982 :) Luque rods haven't been used for many years.

LindaRacine
11-01-2009, 12:29 PM
Yes, this has changed a lot since 1982 :) Luque rods haven't been used for many years.

Actually, Moon Goddess is correct. The Luque technique is still used by some surgeons, in some cases of neuromuscular scoliosis. Also, the Luque technique is used extensively in India.

Regards,
Linda

tonibunny
11-01-2009, 01:53 PM
Sorry, my apologies Moon Goddess. I tend to assume that treatment is pretty much the same in the UK (where I am) as in the US, and I wrote that very late last night when my brain wasn't too engaged! :o