Posterior only vs. A/P?

[JenniferG]

Hmmm. I'd been thinking about asking for a tummy tuck...

I wondered at the time if my surgeon would nick off a mole on my back, right in the middle of my spine. But the incision passed by it, missing it by mms. I would hope if he thought it looked dangerous, that he'd take it off at the same time, but it's still there and I'm looking at getting it taken off soon. Shame, would have been nice to have avoided that little surgery.

[Confusedmom]

Don't worry, Ed, I won't really steal your name! But I DO like Rod Stewart! Wow--that's one impressive xray.

Jess, I could be wrong, but I thought that minimally invasion (oops, that was supposed to be invasive!) actually was supposed to take MORE time than open surgery--the advantage being an easier recovery. Of course it depends on the case, I'm sure.

Debra, I'm currently scheduled with my regular ortho in Indianapolis, Dr. Dietz, but since joining the Forum have learned about other probably more experienced surgeons. I'm going to see Dr. Bridwell in St. Louis and Dr. Gupta in Chicago this month. Doc #2, another doc in Indy, recommended postponing surgery a few years to see if my curve gets up above 70 degrees. And he said if he did surgery it would be all posterior. I don't really get the point of waiting (if I have to do it eventually), since it has been steadily increasing for decades, but I am trying to sort out A/P vs. posterior. Thank you for the suggested questions!

Evelyn

[jrnyc]

hi Evelyn
welllll...if it took longer than the originally estimated 10 plus hours for A/P, i'd be surprised...cause 11 hours on table is about the longest i've heard of so far! and that's a loooong time!!

jess

[leahdragonfly]

Evelyn,

I think you're right that minimally-invasive ("minimal access") frequently takes more time than traditional surgery. I think this is a fact about minimally-invasive surgery that is frequently glossed over. And that is not just for spine surgery.

The bonus is supposed to be a quicker recovery and less disruption of the surrounding tissues. It is more difficult for the surgeon, though.

[jrnyc]

i once had arthroscopic surgery for an ankle...it was quick! very little swelling or scarring..not saying it compares, just that it was quick...and easy, compared to the old way of opening up the ankle!

when i have back surgery, i will opt for minimally invasive...or not do it! i want the least cutting/poking possible...even though i've been told (honestly) there is no such thing as completely sparing the muscles, i want them disturbed as little as can be! since i was told the (older) A/P surgery would be 10 plus hours for me, i dont see a real difference for time...i was told minimally is smaller incisions too...not that i think any back surgery will be easy!

jess

[Confusedmom]

Jess,

If min invasive was an option for me, I would definitely consider it as well. As with all surgery, I'm sure this is the way back surgery is heading. The docs near me don't seem to specialize in it yet, though, other than anterior release (I think it's called).

Anyhow, there are many potential advantages of min invasive, so I do hope it works out for you if you decide to have surgery.

Evelyn

[jrnyc]

i think you're right about the future, Ev..and it will probably bring other things we dont even dream of...yet...

wish you the best...

jess

[Back-out]

MI is certainly easier on pt short term, and maybe in right hands LT as well, depending on what needs doing. Having had lapascopic examination of abdomen, and MI/arthoscopic surgery on three knees (two rt leg; I'm only a biped) plus MI cervical decompression for spinal stenosis...

I much researched the latter as even five yrs ago when I began, it was in its infancy, relatively. I only did it against much medical advice including 2/3 neurosurgeons apart from my surgeon, and after I'd had my surgeon well vetted by someone who'd worked with him.

That surgery only involved an overnight instead of having a regular fusion with cadaver bone and hardward, and involving much more blood loss, risk of infection and longer/more difficult recovery. For the spine, the muscles are spared more too.

I wish I could wait until this surgery got to the pt I felt comfortable having it done MI! I fear for a very complex spine like mine, it's still too risky and it seems I don't dare wait. Progression appears too rapid plus I have insurance l and helper issues. Sucks to have to make such a decision under the gun! Definitely, better to wait if one can (ie., no such worries). Research only makes things better and meanwhile other people can serve as learning tools.

I haven't forgetten that ex-basketball player I posted about. He needed SUCH heavy instrumentation put it to support his lumbar spine! I was amazed. I think MI of spine involves a bit more "invasion" than elsewhere.

The visualization needs to be so 3-D for scoliosis correction, that lumbar work especially. That's part of what I think needs to be worked out now to do a long fusion MI.

[jrnyc]

i have degenerative disc disease, scoliosis, spinal stenosis(lumbar), rotation, arthritis of spine, listhesis, etc etc etc...it CAN be done minimally...i do not believe there is a limit to what they can now do by minimal invasive approach, and in the future it will more than likely go the same direction...the future may bring less opening of the body, i believe, and from what the doctors tell me....i wouldnt have it any other way!

jess

[Debra JGL]

Hi ladies, I was very hopeful to be a candidate for minimally invasive (vats) and so I went to see Dr. Lonner in NYC, 2008. He specializes in this approach. He told me though that my spine wasn't flexible enough, due to my ripe old age of then 42. From what I've read this procedure is reserved mostly for the 20 somethings and under at this point in time. It's tricky business waiting for technology to advance, as our bodies keep on advancing too. Hopefully, one day this surgery will be alot less stressful on future scoli peeps. One thing about vats, min. inv. is that I think they deflate a lung - but then of course they inflate it back up. But, there are so many benefits that it's a great option if you have it.

Debra

[Back-out]

Evelyn,

I think you're right that minimally-invasive ("minimal access") frequently takes more time than traditional surgery. I think this is a fact about minimally-invasive surgery that is frequently glossed over. And that is not just for spine surgery.

The bonus is supposed to be a quicker recovery and less disruption of the surrounding tissues. It is more difficult for the surgeon, though.

To both of you, on a video-interview with U Chicago's Fessler (while he was performng an MI lumbar fusion) he said he was unable to perform a longer fusion for just that reason. Time and surgeon fatigue.

Not that it was the only reason but that it sufficed. He said in the "right, hands" (experienced) MI was quite safe but that it WAS exhausting. Said if the surgeon got too tired, it was not good for the outcome. Thus, for the time being, he was only doing limited (length) MI fusions.

One of the surgeons I consulted, would operate on me in only one day with a colleague sharing planning and surgery. I guess such collaboration isn't possible for MI surgery or else perhaps longer fusions would be possible - at least , from POV of fatigue. I have the feeling only one mind can process just what they've done in MI, even more (if possible) than in a standard fusion.

Those teeny tiny cuts must be far more pains-taking, bound to be (even) more demanding of the surgeon. Like needlepoint compared to painting.

[jrnyc]

how were they going to do my original A/P fusion in over 10 hours??...that is a long time!! ..i am going to ask my surgeon..because i do not believe minimally invasive on me would take more than 10 hours! and i am alot older than 42! he would be doing my minimally invasive from T11-pelvis...not as long as TitaniumEd's...but as long as i want to think about! and there is NO lung deflation for lumbar......and Dr Anand never mentioned any when i saw him...i dont know about high thoracic curves...but that is a different situation....

also...mine would not be teeny tiny cuts...the doctors themselves call them "smaller"..not "tiny" ..they are smaller than traditional surgery...but certainly not teeny tiny by any means...where is this stuff coming from?...i talked to 2 of Dr Anand's patients in CA as well...

jess

[sarah105]

Jess,
I don't know a ton about minimally invasive, but I think the confusion comes from the fact that there are really two types of minimally invasive surgery. The thoracic kind has been around for a while. I/my parents discussed it with my surgeon when I was 14ish. (I wasn't a candidate because my primary curve was too low.) The thorasic kind uses several smaller incisions and looks like it requires a deflated lung. It is a video assissted procedure.

http://www.scoliosisassociates.com/s...n=practice1010

The one you are talking about looks like it is minimally invasive for people with lumbar curves that would require A/P approach. I'm not sure, but it doesn't seem less invasive for curves like mine that only require posterior. I only needed one incision, so it seems like this approach would have been more invasive for me since it involves going in twice (I doubt I would have been a candidate anyway since my curves were higher up).

I think more people have heard of the first type (thorasic) and they assume thats what you are talking about when you say minimally invasive. I think less people are aware of the newer lumbar option.

[jrnyc]

hey sarah
yes, i am referring to the newer available minimally invasive for lumbar..i know thoracic minimal has been around for years and years...we were waiting...some of us...for lumbar to catch up!

i flew 6,000 miles (round trip) to discuss lumbar minimally invasive with Dr Anand...a well known proponent for lumbar minimal...and i asked every question in the book...then spoke to 2 of his patients...both over age 60....when i tell you i asked every question, i'm not kidding...i paid cash for the consult...i got my monies worth! i wasnt going all that way (airfare, hotel, cabs, etc!!) and not get answers! and i got them...wasnt any "teeny tiny" discussion either...the incisions are just smaller, shorter...and the surgery is less rough on the patient...if it goes right...neither of the surgeons i talked about this with said anything about their exhaustion, either....i assume they arrange things ahead of time...and my planned A/P of 10 plus hours wouldnt have been a walk in the park for any surgeon...so how much worse would minimal be than 10 plus hours...!?

i know thoracic is different than lumbar surgery...i am glad that your surgery went well and that you could get on with things in good health!

jess