Minimally Invasive Scoliosis Surgery Featuring George Picetti, III, M.D.

[titaniumed]

Thx Ballet Mom

Very Informative.... I never dreamed that I would watch a scoli surgery with Jerry Garcia’s “The Wheel” in the background, great music selection I must say.

Dr Decky trained under Dr Bradford at UCSF who pioneered my corpectomy procedure years ago....nice of him to make the videos, show the procedure and the hardware, which without, we would probably still be using Luque wires....

Dr Picetti is a great guy also. At the meetings in Sacramento, he takes the time to answer everyone’s questions.

Hd, that was nice of you to go over to the hospital during Elias surgery....I had to attend a GE Aviation conference. Extremely boring stuff.

Ed

[mariaf]

is it the medicine, or the money..??
4 weeks is expensive, and so much of what insurance will pay for is driven only by that!!

jess

Sadly, this is true Jess.

That is why the Shriners' philosophy is so unique in the medical world - the only thing they look at - and take into consideration as a factor when deciding on a treatment plan - is what is in the best interest of the patient...period.

[jrnyc]

i am so glad Shriners is there for the kids!

too bad adults don't have a place like that!
i'd be glad if we could just get insurance companies to pay for needed surgeries, without calling things "experimental" whenever they think they can get away with not paying for something!

jess

[Ballet Mom]

Here's a link to some info for Montreal. It's on page 15. http://webversion.staywellcustom.com...spring/canada/

and

Info for BC Children's
http://www.bcchf.ca/ckfinder/userfil...Spring2010.pdf

Thank you for posting these CAmomof2!

This is actually minimally invasive surgery with a posterior approach, two rods and the pedicle screws with only three keyhole incisions for access. So this would be a big improvement on the posterior approach if the longer term results hold up. As Jess says, this does appear to be the wave of the future. The insurance companies will have to get on board at some point.

This is not the same surgery as I'm looking at for my daughter though. What interests me about the anterior thoracoscopic surgery is the three levels that don't have to be fused, which increases the spine flexibility at the end. It remains to be seen what will happen to this particular minimally invasive surgery, however, it certainly is a good thing for the SRS' champion golfer who had this procedure done!

[Ballet Mom]

I'm in the "find the best surgeon you can find and do whatever they recommend" camp. Otherwise, I think that sometimes surgeons alter their methods to do what's popular, even if it's not the most effective thing.

When my mom had breast cancer (20 years ago), her surgeon told us we could choose whether we wanted a lumpectomy or a mastectomy - he presented it as if it was just a matter of preference. But, when we did some research, it turned out (again, at that time) that although the lumpectomy was very popular with patients, it was far less effective in assuring that the cancer wouldn't return. So, it became popular because patients wanted it, and chose the surgeons who performed it, and not because it was an even equivalent way of treating the disease.

I have zero information on whether the same dynamic is going on for minimally invasive - I don't think we've had enough years to evaluate it. But I think it's better to chose the best surgeon and let them choose the method.

That's usually good advice, however, if someone is interested in a spinal procedure that can be used to save some flexibility, it is pointless to take them to a surgeon that doesn't specialize in that type of surgery.

Fortunately, Dr. Newton is a surgeon I would take my daughter to in any case for a consultation. I like his training (Texas Scottish Rite), I like his research (the fusionless tethering, which may eventually take the place of vertebral stapling) and other SRS studies. I like that he believes bracing works in those kids who will consistently wear their brace, and I really like that EOS machine they've installed at Rady Children's. It is a bonus that one of his surgical interests is endoscopic surgery.

As to breast cancer patients having a choice between lumpectomy and mastectomy, I'm glad they have that choice. The great thing about now and twenty years ago is the internet. It is hard to communicate effectively in the short amount of time patients and doctors have together. I don't know anything about breast cancer, but in the space of one minute I was able to go to a site and have a total rundown of the benefits and risks between the two surgical options and what patients should consider in making this decision. It sounded very reasonable to me. I'm sorry it sounds like your mother drew the short straw. That's why I bring it up all the time. Medical risks are very real risks.

Another thing that would cause a choice for lumpectomy vs mastectomy is not due to popularity. Reconstructive surgery after mastectomy is tremendously expensive. I know a professor who had it done and she comments on the tremendous amount of money the insurance company was required to pay for the reconstruction. So basically, for most people who choose lumpectomy, they will be happy with their decision and so will the insurance companies. If one ends up with the short straw, they end up with a mastectomy anyway and continuing treatment and reconstruction. One has to make medical decisions very wisely, the internet is a great help.

The other issue is that everyone is assuming these posterior pedicle screw implants are the gold standard and there aren't surgeries better than it. Well, I have read a few surgeons in their studies raise a warning flag that the stiffness of the pedicle screw systems seems to be causing early deterioration of disks on either side of the fusion. So it really remains to be seen if this surgery is going to end up better than other systems, no matter the cheerleading that goes on in this forum. Yes, it achieves better cosmetic results, but will it lead to everyone needing continuing revision surgeries in the future? I'm not trying to scare anyone, I'm simply saying they don't know. And anyone who says they do know is not telling the truth. So it is possible that the anterior surgery with a more flexible construct may actually be the better surgery for those with moderate, flexible curves.

[Ballet Mom]

hi hdugger
i would expect to get at least 3 opinions on ANY major surgery for anything i ever may need done...
i am sorry there is a surgeon anywhere who didn't present all the pros and cons on breast cancer surgery! unfortunately, i think everyone needs to research any serious procedure they are facing...not all doctors think alike, no matter how ethical they may be....& since it is our own body and we will have to live with the results, we are the ones burdened with researching it all.....kinda "cant trust anyone completely" when it comes to major cutting and stitching, as it were....
i am very happy there are more and more choices coming in spinal surgery...i personally believe if the world is still here 50 years from now, spinal surgery will look a lot different than it does now...just my own speculation..

jess

I agree. Words of wisdom.

[Ballet Mom]

Dr Decky trained under Dr Bradford at UCSF who pioneered my corpectomy procedure years ago....nice of him to make the videos, show the procedure and the hardware, which without, we would probably still be using Luque wires....
Ed

Glad you enjoyed the video!

Dr. Deckey is a great surgeon, no doubt. He is one of the orthopedic surgeons who specializes in the spine, who is NOT a member of the SRS, that I would feel absolutely comfortable with performing my daughter's surgery (if she ends up needing it).

[Pooka1]

There are at least two former SRS surgeons in my area who, last I checked, are no longer listed on the SRS website after previously having been listed.

I have been stating that our surgeon is not an SRS member which is true but I don't know if he ever was. He may or may not have been given the Grand Central Station nature of SRS membership.

It was one of those former SRS surgeons who referred us to our surgeon while they were listed with SRS.

[Ballet Mom]

Hi hdugger,

I think perhaps you're misunderstanding what my intent is in planning a consult with a surgeon who specializes in the anterior endoscopic surgery. It isn't to demand that type of surgery for my daughter. It's to find out through his experience with that type of surgery, whether my daughter would even be a candidate, what he feels about the risks and benefits of that type of surgery, in what situtations he uses it and whether he would recommend it in my daughter's case. I find it hard to believe he's still specializing in endoscopic surgery simply because parents come in demanding it for their kids.

If she turned out to be a candidate, I'd have to find out if there was any way to finance the surgery, either by changing insurance companies if there are any that pay for that type of surgery, or talking to the surgeon about being able to pay just the difference in cost between the two different surgeries. Who knows if it could even be done? It's simply something to investigate.

My daughter has seen a lot of top scoliosis surgeons in So Cal. We're blessed to have a lot of great surgeons in California. I wouldn't hesitate to have any one of the surgeons we've been to perform any surgery my daughter might need (although I'd pick one that recommended a selective fusion over one that recommended fusing both curves, lol).

I totally agree that surgeons should be able to explain all the risks and benefits of surgery, unfortunately in those appointments lots of people are simply in shock and don't remember the conversation well or don't think to ask the right questions. That's why I think the internet is good, not to actually replace the surgeon.

I think it's great that your family was able to make the choice you felt was best for your mom. I probably would have made the other choice for myself. Thank goodness for informed choices! :-)

[LindaRacine]

There are at least two former SRS surgeons in my area who, last I checked, are no longer listed on the SRS website after previously having been listed.

I have been stating that our surgeon is not an SRS member which is true but I don't know if he ever was. He may or may not have been given the Grand Central Station nature of SRS membership.

It was one of those former SRS surgeons who referred us to our surgeon while they were listed with SRS.

Hi...

I'm not sure who you're referring to, but I think it's probably unfair to apply it to the entire SRS membership. As far as I know, all of the California surgeons I know (and that's quite a few), who were at one time members of the SRS, are still members. The only reason surgeons are forced to drop out is if their percentage of spinal deformity surgeries is reduced below the 20% of all surgeries level, and the surgeons actually call attention to it.

--Linda

--Linda

[Pooka1]

Okay I agree the remark was irrationally exuberant.

I am just trying to say that I just happen to know that two guys were were previously listed are not listed as of today. I don't recognize many names but two I do recognize fall off the list. One was our guy until he referred us to another surgeon. And maybe our surgeon used to be an SRS guy and the first guy still thought he was. Who knows.

I have no way of knowing if two guys in a few years is at all representative of the SRS guys as a group. I just find it amazing that two that I happen to be familiar with dropped off the list while I was looking. But you are saying it probably is not representative so I accept that.

[kennedy]

I watched that video on youtube a couple years ago