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Thread: CA bound

  1. #61
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,557
    Melissa

    You will have to ask your surgeon what being fused to C2 will be like. Itís obvious that you will lose mobility, how much, I donít know.

    The belly cut will be used for the anterior. Some surgeons insist on anteriors as it helps guarantee a difficult fusion. The rods will then be repaired from the back side.
    Ed
    49 yr old male, now 59, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  2. #62
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791
    Quote Originally Posted by titaniumed View Post
    Melissa

    You will have to ask your surgeon what being fused to C2 will be like. Itís obvious that you will lose mobility, how much, I donít know.

    The belly cut will be used for the anterior. Some surgeons insist on anteriors as it helps guarantee a difficult fusion. The rods will then be repaired from the back side.
    Ed
    Thanks I have a appt with him the begining of july

  3. #63
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,802
    Quote Originally Posted by mbeckoff View Post
    What does being fused to C2 do to my mobility?

    Would I have 2 incisions or would the broken rod be fixed from the front?


    Melissa
    Hi...

    It will definitely have some affect on mobility, but you will still be able to turn your head. There are several other members who are fused T2-sacrum, so maybe one of them will comment.

    Yes, you'll need 2 incisions if Dr. Bederman decides that you need anterior fusion. The good news is that the incision will probably be small.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  4. #64
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791
    I am already fused T2-sacrum . He is fusing me to C2.

    What will that do to me?

    Melissa

  5. #65
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791

    Good day today

    I got some good meds from the pain doctor that will allow me to go on with my life of packing. I also went for a hearing test because my 16 year old son kept telling me that it was my fault that I did not understand him . Well, I have perfect hearing, at least something works. I finally heard from my run away 18 year old.We just had a normal phone conversation but it was nice to hear from her.

    Take care

    Melissa

  6. #66
    Join Date
    Oct 2008
    Location
    Sunshine Coast, Queensland, Australia
    Posts
    3,261
    Good to get some bits of good news from you Melissa. If you can continue with a warm relationship with your daughter, it's more likely you can be there for her when things in her current situation go pear-shaped, if that's what happens. Keeping the lines of communication open is always the best thing.

    Also very happy to hear you've been given some good pain relief after all this time. Excellent news!

    Definitely ask the surgeon about your flexibility being fused C2 to sacrum, expect some limitations but if it gives you the chance of a pain-free life, the loss of some flexibility will, I hope, be well worth it.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  7. #67
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,802
    Quote Originally Posted by LindaRacine View Post
    Hi...

    It will definitely have some affect on mobility, but you will still be able to turn your head. There are several other members who are fused T2-sacrum, so maybe one of them will comment.

    Yes, you'll need 2 incisions if Dr. Bederman decides that you need anterior fusion. The good news is that the incision will probably be small.

    Regards,
    Linda
    Sorry, typo. i meant C2-S1.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  8. #68
    Join Date
    Jun 2009
    Posts
    311
    Sorry about the daughter drama. . .just goes to show that scoliosis surgery or not, pain or not, hell or highwater or not. . .life carries on.

    Please be hopeful. Just having a non-union(s) fixed will make such a difference. My daily life now, compared to what it was in Dec through Feb 22. . .no comparison!! Help is on the way.
    Fused T-3 to L-3, Aug 25
    Hardware removal surgery, Nov 2, 2010
    Fused T-10 to L-2, osteotomy, Feb 22, 2011

  9. #69
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791
    Thanks everyone for your good wishes. I feel so much better now as my pain is tolerable with the drugs.

    Melissa

  10. #70
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791

    Arrow

    This is the latest from my new surgeon:

    Since I am now getting a lot of information and we can't go over it together I think its important to explain as we move forward. Your upper back/neck and the low back are 2 different problems but related. Essentially you had a triple major curve (one in the upper thoracic/cervicothoracic, a main thoracic, and a lumbar). You had the main thoracic and lumbar curves fused and corrected and the upper thoracic was not. Because you still were still somewhat unbalanced you had to tilt your head to the left to straighten your head. Some pre-existing narrowing in your neck from degeneration along with this new tilting caused the left arm pain to worsen which is why you had your neck surgery.

    The lower back with the broken rod is the more minor problem. There is some imbalance which is tilting you off to the left by around 4 or 5 degrees only and could be left if everything else was ok. The broken rod doesn't necessarily mean that there it has not healed -- sometimes your spine will fuse after a rod has broken. The op notes describe a very thorough fusion procedure. On your CT it looks like it is trying to fuse and you have had an attempted fusion in the back and front of your spine (all through the back). In general, the anterior fusion is more reliable than the posterior. On the other hand, at one year after surgery it doesn't look like its really solid either. It can take up to 2 years for it to fully heal. So I think the low back is a bit of a toss-op. If that was the only problem we could wait on it if you wanted to and see if it heals. Reasons for operating on the lumbar spine would be to improve the overall balance (which would improve your neck somewhat as well) and to get it to heal if in fact it is not fused and your back pain was from a delayed union or a nonunion. There is only minimal narrowing at the right L1-2 area but not a lot to warrant surgery alone unless you had significant right thigh/groin pain. This could all be done through the back (correction and re-fusion). If the spine was very unstable when we explore it you might also need an anterior surgery (through the belly to remove the grafts, redo the fusion and implant larger grafts) although I think the chance of needing this is low.

    Your neck is a different story and the bigger problem. You had a curve at the junction of your neck and upper back (cervico-thoracic junction). After your first operation on your spine the tilt on C7 was around 11 degrees and your head was offset relative to the middle of your pelvis by around 2cm. On your most recent films that tilt was now around 20 degrees and you are offset by 6cm -- in other words your head is falling away from your torso to the right side. The main problem is that you have a significant curve from C5-T3. Before the cervical fusion you used those motion segments (C5-6 and C6-7) to correct and bend back to straighten your head and that curve probably contributed to nerve pinching. That compensatory curve may also have been the reason for graft movement following the first cervical surgery but without looking at the pictures between those operations its hard to know. On your recent MRI it appears that there was an injury to the spinal cord but currently very little ongoing compression. There isn't much to further decompress. I'm not sure that the prognosis for spinal cord recovery is great but the emg may give us more information. The fusion now from C5-7 has transferred the compensatory curve up above C5 and that is insufficient for balancing your head over your hips because you can't bend at those levels now. If you are having significant neck pain and feel very unbalanced (which you look like on xray) then we would need to correct this curve -- which has some implications. Clearly, we would have to include the levels between the neck surgery and the top of your scoliosis fusion (C7-T1, T1-2, and T2-3) and we would also back up the fusion that was performed in the front (C5-7). Unfortunately stopping in the middle of the neck (at C5) has a high rate of failure with such a long fusion below. The most reliable place to end is C2 to avoid a failure of the fixation. This will leave you with about 50% of your flexion/extension and lateral rotation (from the base of the skull to C2). Unfortunately in order to correct the curve a fusion is the only option so you end up trading motion for balance -- the only question is where to stop (C2 or C5) which has trade-offs. The correction would be down between C7 and T3 with osteotomies.

    If we operated on your neck it probably makes most sense just to replace the broken rod at the same time and get some more correction in the lumbar spine. We can wait on the anterior surgery. If you wanted to do this in smaller pieces I would suggest we do the neck first, then the lumbar spine, then, if necessary the anterior lumbar.

    My overall recommendation at this point would be to remove the old hardware in the lumbar spine, explore the fusion, place new hardware where necessary from C2 to the pelvis with cobalt rods, fuse posteriorly from C2-T3 with osteotomies at C7-T1, T1-2, T2-3, and re-do the posterior fusion in the lumbar spine.
    Possible anterior lumbar fusion if very unstable.
    Obviously, this is a large operation with significant risks not that different from your prior surgery. Main risks are to your spinal cord and nerves, nonunion, infection, persistent imbalance, hardware failure and all the medical risks. Your motion will also be quite limited -- you will have around 50% of neck rotation and up/down bending. All your lower bending will take place at your hip joints.


    Melissa

  11. #71
    Join Date
    Oct 2008
    Location
    Sunshine Coast, Queensland, Australia
    Posts
    3,261
    It's jaw-dropping isn't it?

    What are you inclined to do? If it was me, I think I would go for his recommendation. To a lay-person, he sounds thorough and seems to have a good grasp on what's going on. What's this EMG he speaks about, is this a test you're still to have?

    I feel for you making this decision. But I also feel that it gives you hope. Even with better pain control, can you go on living this way? At least he's offering you his recommendation. It's a matter of weighing up all the risks (again) with the future movement restrictions if you go for it, with how you are now. Best of luck, Melissa.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  12. #72
    Join Date
    Jun 2009
    Posts
    311
    Melissa, thank you so much for posting his letter. Dr. Bederman sounds amazing! It was kind of him to send you a lengthy, detailed letter (including the "maybes") so you have all of the specifics in writing (as opposed to trying to remember all of that from conversation).

    I'm glad that you have good pain coverage now. . .it would be hard to think it all through, and come to a decision, while in unrelenting pain.

    Big decisions! Hopefully this is one of those situations that clarity comes in a lightbulb moment, and then you just know what it is that you want to do.
    Fused T-3 to L-3, Aug 25
    Hardware removal surgery, Nov 2, 2010
    Fused T-10 to L-2, osteotomy, Feb 22, 2011

  13. #73
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791
    The EMG is a nerve test that I need to have before surgery. He is very thorough and that makes me more secure in my decision to have him operate. While I am here in NC, he is sending me to Dr Hey in Raleigh for his professional opinion. So I really am getting 2 doctors opinions.

    Thanks for the good wishes about my daughter. I did see her today . It just get me upset when I think about leaving her here in NC 2300 miles away from me. I have never not celebrated her birthday with her and this year will be the first.It also happened so quickly . If I had more time to take in this information, I would be better off.

    Melissa

  14. #74
    Join Date
    Mar 2008
    Location
    New Bern, NC
    Posts
    1,445
    Hi Melissa,
    I'm glad you got to see your daughter. It is very hard to move so far away from your children, but you have to do what is best for you and in the long run, it will be best for them also. We got to see our son and grandsons last week when we flew to RI and Mass and it is so bittersweet. Our son will go for months without contacting us and it really hurts. It has taken me a long time to be able to sleep nights without worrying half the night.
    I had an appointment with Dr. Rand and I still have issues with nerve pain and neck pain. Dr. Rand suggested a nerve block in the SI joint for the nerve pain, so I asked him where in NC I could go for that and he suggested Dr. Hey as well. Let me know what you think of him.
    We are all pulling for you Melissa.
    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.

  15. #75
    Join Date
    Dec 2009
    Location
    NC
    Posts
    791
    Thanks Sally. I will let you know about Dr Hey but I have to say that I am so impressed with Dr.Bederman. He called me today and spoke with me over 30 minutes about different options for the surgery. I do not know if that is common but it never happened with my other surgeon.

    God blessed me with Dr Bederman.

    Melissa

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