Decisions--2nd opinion very different than first

[leahdragonfly]

Hi Gayle

In your saggital view, your plumb line is pretty far back. It looks as if from T2 hanging down, you are about 4 inches back at your pelvis.

What has the Doc who wants to just fuse the problem area said about this? Will this increase?
Ed

Hi Ed,

I asked about the saggital plane, too, and the conservative doc said I was well-balanced in the saggital plane since I'm not leaning forward. He didn't seem to notice how much I am actually back, as you noticed. I think we both know the answer, this does not get better, but I will ask specifically. The other thing worrying me about the smaller surgery is the considerable amount of lumbar arthritis I have. This would be completely unaddressed in the smaller two-level anterior fusion. I am tempted by the smaller surgery, but don't want to be short-sighted about how it will affect my spine and balance in the future. The long fusion, T10-pelvis, would address everything, but is a much longer surgery and recovery, along with a loss of flexibility.

I have an MRI in a few weeks, and then will have another appt the next day to discuss the results. I hope it will add valuable info to my decision.

Gayle

[LindaRacine]

Hi Gayle...

I don't think negative sagittal balance has anywhere near the same lethality of positive sagittal balance. Although we see it (radiographically) occasionally, I don't recall ever hearing of anyone being treated specifically for it.

In an effort to strive for avoiding a positive sagittal balance, surgeons not infrequently give patients a negative sagittal balance. I have a friend who has it from her revision surgery about 8-10 years ago, and who is completely pain free. The only reason she is aware of it is that she feels weird if she doesn't have a pillow in her lumbar area when she sits.

Regards,
Linda

[leahdragonfly]

negative saggital balance

Hi Linda,

That is very interesting info and good to know. I do wonder about this, it is the cause of my mid and upper back muscles being very tight and fatigued by the end of the day.

When I walk I lean forward unless I make myself consciously stand up perfectly straight. I would hate to have this get worse after surgery.

I also have to remember to ask, if I have a fusion to T10, where I am completely hypokyphotic, does this give me a higher chance of PJK/degeneration above the fusion?

[LindaRacine]

Hi...

It's interesting that you lean forward. I'm guessing that's from your low back pain. (I do the same thing.) It definitely wouldn't be because of the negative sagittal balance which, if anything, would cause you to lean back.

--Linda

[titaniumed]

The negative balance would be great for powder skiing since we have to sit back.

Dr Menmuir constructed mine perfect. I think it was all that talk of skiing that did it! Gayle, tell them you’re an avid skier!

The docs have to really pay attention to balance in both planes. I have read that it isn't easy to do. Dr Menmuir used a "Jackson table" in my surgery.
http://www.mizuhosi.com/jacksonSpine.cfm

I think that having the right tools for the job is essential. I didn’t ask if he was going to use one of these tables, but maybe it’s a valid question.

Its important for operating rooms to be high tech. I don’t know if one can assume that every scoliosis surgeon would demand only the best. I'm sure they do, but can you bet on it? Does every hospital have the best stuff now???? Is a hospital tour acceptable?
Ed

[jrnyc]

wow, TiEd...i never heard of a Jackson Table.....guess i wouldn't have occasion to hear of it...
but he didn't bend you during surgery, did he?
did you ever ask him what he used it for in your particular case?
i'd love to see the pix!

on hurricane watch...
jess

[titaniumed]

Jess
The Jackson table can be moved and helps adjust heights in specific areas that are needed in these surgeries.... A great tool.

I found this info out from my extensive hospital reports. I'm sure I was adjusted on the table during my surgery. They can rotate also, like a rotisserie. This feature is for the barbeque sauce. I have a Ronco, and cook to perfection every time.... worth every penny! LOL

I asked for pics when I was being staged right before I was rolled in, but they knocked me out before I got an answer... Seriously. My vascular Doc told me that they were going to have a long busy day. So no pics.

Tomorrow night it will be windy in NYC. Looks like the eye will scrape Hatteras. Will the "Low" pressure trigger pain? Hurricanes have the lowest pressure.
Ed