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  • anterior release/posterior fusion

    would like to hear from any parent(s) regarding your child's experience with anterior release/posterior fusion.

    Renee

  • #2
    Hi Renee...

    This is something that is rarely, if ever, done on kids. I'd be curious who is recommending it.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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    • #3
      Hi Linda,

      I hope I'm describing it correctly. It will be done by Dr. Newton at Childrens' Hosp. San Diego. For the anterior approach I believe he is proposing removing the disks btwn the last 3 vertebrae to be fused, and preparing that (front) area for fusion, then doing the posterior fusion. Pretty sure this is what he said. I was prepared to hear about the need for posterior fusion, but was floored (and mind started spinning) when he started talking about the anterior approach. He said no need for any rib removal, 3 small incisions betwn ribs and will require a chest tube. Does any of this make sense to you?
      also wanted to add that my son is 12 1/2, latest (Nov.) measurement was 55T. Last measurement was 42 deg. in May '10, I believe rib hump measured around 20, growth plates still wide open...
      Last edited by flowerpower; 12-04-2010, 12:16 AM.

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      • #4
        Originally posted by flowerpower View Post
        Hi Linda,

        I hope I'm describing it correctly. It will be done by Dr. Newton at Childrens' Hosp. San Diego. For the anterior approach I believe he is proposing removing the disks btwn the last 3 vertebrae to be fused, and preparing that (front) area for fusion, then doing the posterior fusion. Pretty sure this is what he said. I was prepared to hear about the need for posterior fusion, but was floored (and mind started spinning) when he started talking about the anterior approach. He said no need for any rib removal, 3 small incisions betwn ribs and will require a chest tube. Does any of this make sense to you?
        also wanted to add that my son is 12 1/2, latest (Nov.) measurement was 55T. Last measurement was 42 deg. in May '10, I believe rib hump measured around 20, growth plates still wide open...
        Hi....

        Yup, that's what it sounds like. You need to ask why he thinks the anterior release is necessary. This type of surgery is done frequently in adults, because the spine becomes so stiff that it's difficult to get a lot of correction by only doing posterior surgery. Kid's spines, however, are rarely stiff. Did Dr. Newton do bending xrays?

        --Linda
        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
        ---------------------------------------------------------------------------------------------------------------------------------------------------
        Surgery 2/10/93 A/P fusion T4-L3
        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

        Comment


        • #5
          Actually Linda, he did not do bending x-rays this time, so good point, will have to question him more on this. Vince did have his x-ray done with the new EOS machine (which does take very good x-rays btw). Anyhow, I believe Dr. Newton's reasons for anterior approach are (not necessary in this order): Vince has a large thoracic curve (fusion will be from t4-L1), the rib hump/rotation is significant and also with Risser 0/growth plates open & still much growing to do, he believes this approach will avoid crankshafting.

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          • #6
            Excellent thread

            I hope Elisa (Spiny Mouse) is reading this thread. There is some good information here that she can use to ask questions when her son is seen at Shriners next month.

            Good luck Flowerpower. Newton is impressive. I think he is arguably one of the very top pediatric guys.
            Sharon, mother of identical twin girls with scoliosis

            No island of sanity.

            Question: What do you call alternative medicine that works?
            Answer: Medicine


            "We are all African."

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            • #7
              thanks Sharon, I am grateful that we were sent to Dr. Newton and I highly recommend him to anyone. He and his staff really seem to consider the whole well being of the child also, not just the treatment itself. My oldest son had posterior fusion 5 years ago and so far has had no problems (he will have his 5yr. post-op in a couple of weeks). Breaks my heart to have another child go through this, but at least I know he is in good hands.
              Good wishes to Elisa also. If your situation is similar and you have questions, or would like information on Dr. Newton, I can try to answer.

              Renee

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              • #8
                Hi Renee,

                I have had an anterior release/posterior fusion done twice, once for each of my curves. This is very unusual, but I wasn't a typical case - I had Infantile Idiopathic Scoliosis, which is a lot rarer than Adolescent Idiopathic Scoli. I had my thoracic curve fused when I was ten, but they left my lumbar curve for as long as possible in order to let me grow more, so I had that fused when I was 18. Both curves were very stiff (I needed halo traction to help pull out my thoracic curve after having the anterior release, and before having the posterior fusion).

                My experience probably isn't very useful to you but I just wanted to reassure you that I came through both surgeries with no problems at all In the UK, where I live, it seems a lot more common for teenagers to have the two stage procedure (as it's known), especially if they have larger curves. They don't seem to have a harder recovery than the kids who just have a one stage fusion.

                Best wishes to you and your child Renee. Sharon, I'll direct Elisa to this thread

                Toni xx

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                • #9
                  Originally posted by flowerpower View Post
                  much growing to do, he believes this approach will avoid crankshafting.
                  Bingo! That's the reason.
                  Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                  ---------------------------------------------------------------------------------------------------------------------------------------------------
                  Surgery 2/10/93 A/P fusion T4-L3
                  Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                  Comment


                  • #10
                    Thanks for sharing Toni, and really, any bit of information helps. Glad to hear that the 2 stage procedure wasn't any harder on you. That is one of my concerns with my son. Also a bit worried about the chest tube - I've heard of some kids having complications, but, according to the surgical coordinator, it is more common with children that have other medical issues in addition to scoliosis.
                    I am curious about the halo traction...was this part of the surgical plan to begin with or was this something the dr. felt was needed once they were "in" doing the anterior portion of your surgery? How long did you have the halo traction & what was the time frame between the anterior & posterior surgeries? Just trying to prepare for any possible scenarios...my son's surgeries will take place in the same day, will be about 8 1/2 hrs. from what we were told

                    Renee

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                    • #11
                      The halo was planned in advance, they knew they needed to do it as my curve was so stiff. But, I had a very severe curve from infanthood (it was already well over 60 degrees when I was first diagnosed at 6 months old) and this was back in 1986, when techniques weren't as good as they are now. It is very, very rare for anyone to need to have halo traction during scoliosis treatment these days, especially adolescents. Today the instrumentation is capable of derotating the spine, which corrects the curve far more efficiently than the older types of rods used to do.

                      My experience probably isn't very relevant to what your son will experience, but I just wanted to illustrate that the two stage procedure isn't something that causes significantly more problems in the longterm than a one stage posterior fusion does

                      Comment


                      • #12
                        thanks again Toni, for sharing. It is very helpful to me as I try to learn what to expect (or what I may be able to rule out). So the fact that your experience may not be totally relevant to Vincent's, is actually irrelevant ;^)

                        Renee

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                        • #13
                          Originally posted by flowerpower View Post
                          Actually Linda, he did not do bending x-rays this time, so good point, will have to question him more on this. Vince did have his x-ray done with the new EOS machine (which does take very good x-rays btw). Anyhow, I believe Dr. Newton's reasons for anterior approach are (not necessary in this order): Vince has a large thoracic curve (fusion will be from t4-L1), the rib hump/rotation is significant and also with Risser 0/growth plates open & still much growing to do, he believes this approach will avoid crankshafting.
                          Hi Renee, I too have a son with a significant curve(s) as well as a very noticeable right rib hump. I was wondering how old your son is as well as how tall he is. My son is fourteen and is about 5' 7" or 8" and he'd be a few inches taller I'm sure if his spine was straighter. I'm curious to find out how much growing my son has left to do and whether they'll wait for that or recommend surgery asap as he's a severe case.

                          Thanks for directing me to this thread Pooka and Toni.
                          Son 14 y/o diagnosed January 20th. 2011 with 110* Curve
                          Halo Traction & 1st. surgery on March 22nd. 2011
                          Spinal Fusion on April 19th. 2011

                          Dr. Krajbich @ Shriners Childrens Hospital, Portland Oregon



                          http://tinyurl.com/Elias-Before
                          http://tinyurl.com/Elias-After

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                          • #14
                            Hi Renee

                            I remember talking to Patricks surgeon about anterior surgery becasue of the size of his curve and his lack of maturity but he felt in his case it wasn't necessary. In hindsight maybe I should have explored it more because Patrick's spine did in fact crankshaft. Despite that his instrumentation is solid and stable and has not moved or twisted at all. I think the twist was absorbed by the ribs as his ribhump has very much returned. So I can't answer any of your questions on anterior surgery. But I will say that Patrick was put into traction during his surgery which is a normal practise for his surgeon as far as I know. He had no pain whatsoever from the traction and the marks on his legs have virtually disappeared.
                            I wish for your son that they could wait on the surgery until he has matured a bit more but with progression its a tough call. Our surgeon did try to put it off as long as posible but at 78 degrees it was time to go ahead.
                            By the way how is your older son doing?

                            Ramona
                            mom of Patrick, age 15 at time of surgery
                            diagnosed July 2006 curves T58 L 38

                            Nov. 2006 curves T72 L38
                            also lordoscoliosis

                            feb.2007 curves T79 L43

                            Surgery May 16 2007
                            fused T4 to L1

                            Comment


                            • #15
                              Originally posted by Elisa View Post
                              I too have a son with a significant curve(s) as well as a very noticeable right rib hump. I was wondering how old your son is as well as how tall he is. My son is fourteen and is about 5' 7" or 8" and he'd be a few inches taller I'm sure if his spine was straighter. I'm curious to find out how much growing my son has left to do and whether they'll wait for that or recommend surgery asap as he's a severe case.
                              Hi Elisa,

                              Son that is going to have surgery is 12 1/2 and approx. 5'1". My older son that had surgery was same age and about the same height as your son. We did notice an increase in height post-surgery but he did lose a little growth in the fused portion of spine. I posted this in another thread but will post again here: the way our dr. explained, the vertebrae grow approx. 1mm per year. So each vertebrae that is fused will lose 1mm per year of remaining growth. For example, dr. estimated that Vince still has about 4 years left of growing, which means a loss of about 4mm growth per vertebrae fused and he will have 9 vertebrae fused = an over all loss of about 36mm growth/height.
                              The plan usually is to let them grow as much as possible, but looking at the pics posted of your son's x-rays, I wouldn't be surprised if surgery was recommended sooner rather than later.

                              Renee
                              Last edited by flowerpower; 12-07-2010, 05:35 PM.

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