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Thread: Posterior only vs. A/P?

  1. #1
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    May 2010
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    Indianapolis area
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    Posterior only vs. A/P?

    Did any of you have a choice in the type of surgery you had, i.e. posterior only or anterior/posterior? I have had both options recommended to me, and I'm wondering about the pros & cons of each. Thoughts?
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  2. #2
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    Nov 2009
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    66
    Well I had a posterior approach thankfully. Anterior approaches as you know are done through the front but are more complicated because they have to go through all of the stuff infront of your spine (insides). I know my doctor told me there would have to be another doctor there to do an anterior appraoch that monitors other things.
    Maliha

  3. #3
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    May 2009
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    Adelaide, Australia
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    I had both A/P. There was a reason for this (anterior), but my mind has gone totally blank at the moment. (I keep falling asleep at the computer). I will ask my surgeon on Tuesday, along with goodness knows how many other questions! He did tell me that my recovery would take a little longer than if i had posterior only. My incision at the front looks the same as a caesarian incision. I had the surgery explained to me as to how and why, but figured that he (the surgeon) knew best what to do and therefore placed my complete trust in him. He did a good job!
    Vali
    44 years young! now 45
    Surgery - June 1st, 2009
    Dr David Hall - Adelaide Spine Clinic
    St. Andrews Hospital, Adelaide, South Australia
    Pre-op curve - 58 degree lumbar
    Post -op - 5 degrees
    T11 - S1 Posterior
    L4/5 - L5/S1 Anterior Fusion

  4. #4
    Join Date
    Mar 2005
    Location
    Ukiah CA
    Posts
    891
    my surgeon said if my cuvre got to 60 or 70 dergees he whould do it from the front and back i was only 7 degrees from that evether way
    Kara
    25
    Brace 4-15-05-5-25-06
    Posterior Spinal Fusion 3-10-10
    T4-L2
    Before 50T
    After 20T

  5. #5
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    Mar 2008
    Location
    New Bern, NC
    Posts
    1,445
    My surgeon recommended A/P in my case because it would make for a much stronger fusion. He knew I wanted to be able to go back to rollerskating and be very active. Each case is different though. Maybe you need a third opinion to break the tie., or at least ask the Docs why they recommend or not the Anterior in your case.
    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  6. #6
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    May 2009
    Location
    Adelaide, Australia
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    I had my 12 month checkup today. I questioned him about why the anterior as i knew there was a reason for this. He said that the anterior was done for more stability. The two screws posterior would not have been adequate as the L4/5-L5/S1 discs had to be removed and replaced with cages. He said that in my case those two levels needed more stability, therefore A/P was needed.
    Vali
    44 years young! now 45
    Surgery - June 1st, 2009
    Dr David Hall - Adelaide Spine Clinic
    St. Andrews Hospital, Adelaide, South Australia
    Pre-op curve - 58 degree lumbar
    Post -op - 5 degrees
    T11 - S1 Posterior
    L4/5 - L5/S1 Anterior Fusion

  7. #7
    Join Date
    Oct 2005
    Location
    Chicago north suburb
    Posts
    772
    My surgeon originally recommended anterior and posterior, two big surgeries spaced a week apart. The anterior would have been a thoracoabdominal surgery with an incision beginning at the side and down the front. This is what two other Chicago surgeons recommended for me as well. My surgeon later changed his mind to only posterior. While I probably would have gotten a better cosmetic result with both approaches, in hindsight I believe my surgeon made the right decision for me. This surgery was very hard on me and I honestly don’t think I could have tolerated two big surgeries. I was initially concerned that lack of anterior might put me at higher risk for pseudoarthrosis, but thankfully that was not the case.

  8. #8
    Join Date
    Oct 2007
    Location
    Indiana
    Posts
    1,978
    I was also originally scheduled for both A/P and my surgeon decided a month or two prior (I don't remember now) that he could achieve what he wanted with just posterior. Sounded good to me!
    67 and plugging along...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
    CMT (type 2) DX in 2014, progressing
    NEW 10/2018 x-rays show spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  9. #9
    Join Date
    May 2010
    Location
    Indianapolis area
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    966
    Thanks everyone, for responding.

    Vali, appreciate you asking your doc about this. I heard something about cages at my last appt., too. I will ask about it at the next visit.

    Thanks again,
    Evelyn
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  10. #10
    Join Date
    Feb 2010
    Posts
    140
    I was a/p and my surgeon echoed what others have said in that a/p is typically done for a stronger fusion as apparently you can't remove the L4/L5/S1 discs without going through the front. If I understand correctly my surgeon wanted L4-L5-S1 fused in front and back to make sure my spine had a very solid foundation. If he just went from the back those vertibrae would only be fused in the back of the spine like the rest of my vertibrae.

    Rich
    Pre-Surgery Lumbar 65 degrees
    A/P Fusion T10-Pelvis by Dr. Christopher Good
    Virginia Spine Institute, Reston, VA 3/17/10, 3/18/10
    Post-Surgery Lumbar 19 degrees, and 2" in height

  11. #11
    Join Date
    Jul 2009
    Posts
    114
    I had an anterior approach...my scar goes from under my right shoulder blade and then continues down and across my side... and ends right above my right hip bone. They used my rib for the fusion and this seemed the best approach. My doctor had a team with him and also a general surgeon who he always works with. The general surgeon did the opening and closing...moving all the delicate things around as he said. After the fusion, he came back and put everything back into place and sewed me up...he also threw in a hernia repair!!
    Kathy, 43
    Diagnosed as a teen
    Boston brace 2 years
    63 degree lumbar curve
    Surgery August 26, 2009
    Anterior approach fused T12-L4
    now 28 degrees

  12. #12
    Join Date
    Oct 2009
    Location
    PA
    Posts
    798
    Quote Originally Posted by kt2009 View Post
    he also threw in a hernia repair!!
    Hmmm. I'd been thinking about asking for a tummy tuck...
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  13. #13
    Join Date
    Jun 2008
    Location
    Bucks County, PA
    Posts
    145
    One of the docs I saw had recommended an anterior release done minimally invasively followed by posterior instrumentation - they remove disk(s). He said it would increase flexibility and could be done during the same surgery, but would increase surgery time. The other docs I saw did not think it was necessary and not enough potential addtional correction would warrant the additional risks of an added procedure. Hopefully when I see Dr. Boachie in June he'll still feel posterior only is the way to go. I figure less is more for surgery, if poss., but they're the experts and of course a good result is the goal.

    Deb
    Debra
    Age 45
    Pre - surgery Thoracic 69, Lumbar 48
    Post-surgery Thoracic 37, Lumbar 39 (unfused)
    Fused T4-T12
    Milwaukee braced, 11 years old to 15 yo
    Surgery Sept. 1st, 2010 Dr. Boachie

  14. #14
    Join Date
    May 2009
    Posts
    3,745
    the discs can be removed from the side..and are...that is where my discs will be "cleaned out" and "spacers" (also called "cages") will be put in...IF/WHEN i have the surgery...

    jess

  15. #15
    Join Date
    Oct 2009
    Location
    PA
    Posts
    798
    I had three surgical recommendations, in retrospect unclear about how all would be accomplished.

    At least one was for A/P separated by days (up to a week, I think)

    Another wants to do me all posterior pending the judgment of his partner. Both would be working on me at the same time (hope the two sides of the tunnel meet in the middle of the mountain! ) Now I need to see his co-surgeon.

    Reading the report from a third, it appears he DOES want to do both posterior with an anterior release but cut from the side (I hadn't gotten that from our appt) - both would be done on the same day. (How could they turn me over to do both at once?)

    He'd be starting at much lower levels than either surgeon above. That would mean the surgery would take less time, even though it would all be at once and only one surgeon (I do NOT want my surgeon getting all tuckered out! No kidding) . I think it's pretty clear i need A/P - the question is how it's to be approached. That's because my lumbar area is such a mess.

    I have an appt to see another surgeon at the end of June. He tends to operate with the two parts separated by 4-6 weeks! Hard to imagine how I'd tolerate that! His belief is that it's easier on the body to allow for intermediate healing. So that's what I'm expecting to hear about me.

    When you speak of having a choice, you must mean in which surgeon you choose, right? Don't think many surgeons actually leave it up to the pt.!
    Last edited by Back-out; 06-02-2010 at 10:29 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

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