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Thread: Finding a surgeon

  1. #16
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    Quote Originally Posted by susancook View Post
    DLIF? OLIF? Why are they better than ALIF?
    Hi Susan...

    I don't know of any research yet, but DLIFs and OLIFs are similar to XLIFs. I think there are probably a lot of reasons I don't know about, but two I can think of immediately are 1) no risk of retrograde ejaculation for men and 2) approach from the side means that it's easier to access the spine, especially in heavier people.

    --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

  2. #17
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    Quote Originally Posted by LindaRacine View Post
    No, while some surgeons do a lot of them, many don't do any at all. I think Boachie and Lenke have both stated that they never do them any more. TLIFs do essentially the same thing, but I thin that pseudarthrosis rates may be a bit higher in TLIFs. XLIFs are becoming a lot more common, though they can't be done at L5-S1. The newest technology is DLIFs and OLIFs.

    --Linda
    I knew about Dr Lenke not doing ALIF’s, but didn’t know about Dr Boachie.... I did see some material on DLIF, similar to XLIF, but didn’t pursue the material.......XLIF has many advantages....No pedicle screw breach being the 1st thing since its done from the side....Operating through portals spares the large openings...Etc

    Decisions and thoughts on scoliosis surgery are not easy....There are multitudes of decision making and testimonial threads here, (use search)

    Selection on surgical method should be left up to the surgeon. There is no way a layman can decide, but we should be informed.

    I always enjoyed going to scoliosis meetings....Bent, if there is one in your area, attending would be a good idea.

    “Can I see your x-ray?” (smiley face)

    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

  3. #18
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    Oregon
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    I'm really curious if Lenke doesn't do ALIF what does he do to revise broken rods from from pseudoarthrosis (a topic kinda near and dear to my heart) and how does he deal with L5-S1.? I had a PLIF done at L4-5 along with PSF T8-sacrum during my first surgery in 2010, the XLIF's at L2-3 and L3-4 with the first broken rod revision, then an open ALIF at L5-S1 last September for the 2nd broken rod revision. God I hope that does the trick!!

    I read up a little on DLIF and OLIF yesterday and one major advantage is the surgeon can stand upright in a comfortable posture rather than the awkward, ergonomically incorrect position apparently required for some of the other approaches to interbody fusions. I can dig up the article if anyone is interested.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  4. #19
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    Quote Originally Posted by leahdragonfly View Post
    I'm really curious if Lenke doesn't do ALIF what does he do to revise broken rods from from pseudoarthrosis (a topic kinda near and dear to my heart) and how does he deal with L5-S1.? I had a PLIF done at L4-5 along with PSF T8-sacrum during my first surgery in 2010, the XLIF's at L2-3 and L3-4 with the first broken rod revision, then an open ALIF at L5-S1 last September for the 2nd broken rod revision. God I hope that does the trick!!

    I read up a little on DLIF and OLIF yesterday and one major advantage is the surgeon can stand upright in a comfortable posture rather than the awkward, ergonomically incorrect position apparently required for some of the other approaches to interbody fusions. I can dig up the article if anyone is interested.
    Hi Gayle...

    I'm not sure I follow in terms of the broken rods, since that's always done posteriorally. I think Lenke routinely does TLIFs, but I could be wrong.

    --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

  5. #20
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    Jan 2008
    Location
    Oregon
    Posts
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    Revisions for pseudoarthrosis

    Hi Linda, I thought it was pretty standard when there is a pseudoarthrosis to revise posteriorly as well as fuse the anterior column, both from my own experiences as well as reading. I remember reading along the lines of "if you have pseudoarthrosis you have to go in and do something different rather than just repeating the original surgical plan." That was what I meant about Lenke not doing ALIF's ever. From my readings, I would be less than thrilled at the idea of just refusing posteriorly and hoping it fused!
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  6. #21
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    Quote Originally Posted by leahdragonfly View Post
    Hi Linda, I thought it was pretty standard when there is a pseudoarthrosis to revise posteriorly as well as fuse the anterior column, both from my own experiences as well as reading.
    Yes, most people get anterior support in this instance, it's just not always ALIF.
    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

  7. #22
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    Jan 2016
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    13

    X-ray

    Quote Originally Posted by titaniumed View Post
    I knew about Dr Lenke not doing ALIF’s, but didn’t know about Dr Boachie.... I did see some material on DLIF, similar to XLIF, but didn’t pursue the material.......XLIF has many advantages....No pedicle screw breach being the 1st thing since its done from the side....Operating through portals spares the large openings...Etc

    Decisions and thoughts on scoliosis surgery are not easy....There are multitudes of decision making and testimonial threads here, (use search)

    Selection on surgical method should be left up to the surgeon. There is no way a layman can decide, but we should be informed.

    I always enjoyed going to scoliosis meetings....Bent, if there is one in your area, attending would be a good idea.

    “Can I see your x-ray?” (smiley face)

    Ed
    I don't have a copy of my most recent (and most telling) x-rays. I'm not aware of any scoliosis meetings in my area. This is the only resource I have found. I am beginning to think I am in no man's land when it comes to scoliosis. I saw a neurosurgeon recommended by an orthopaedic surgeon who was recommended by a nurse I work with. No dice. He does not do the surgery and is recommending me to go to Indianapolis, and if not there, to the Cleveland Clinic. He was very nice, and appreciated the seriousness of my condition, but indicated that as long as I can still function, any surgeon would be wary about doing such a major surgery. I am still working, although I am miserable when I get home, and don't do much but sit in the evenings. I can go to Indianapolis, but the surgeon he recommended is a neurosurgeon, and I'm not seeing much to indicate he is a scoliosis surgeon. I'll continue looking...

  8. #23
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    Quote Originally Posted by bentRN View Post
    I don't have a copy of my most recent (and most telling) x-rays. I'm not aware of any scoliosis meetings in my area. This is the only resource I have found. I am beginning to think I am in no man's land when it comes to scoliosis. I saw a neurosurgeon recommended by an orthopaedic surgeon who was recommended by a nurse I work with. No dice. He does not do the surgery and is recommending me to go to Indianapolis, and if not there, to the Cleveland Clinic. He was very nice, and appreciated the seriousness of my condition, but indicated that as long as I can still function, any surgeon would be wary about doing such a major surgery. I am still working, although I am miserable when I get home, and don't do much but sit in the evenings. I can go to Indianapolis, but the surgeon he recommended is a neurosurgeon, and I'm not seeing much to indicate he is a scoliosis surgeon. I'll continue looking...
    BentRN,
    Welcome! This is the only source or outlet that I have, too. I was told by my insurance company, coincidentally affiliated with the main hospital I go to, that many scoliosis surgeons are neurosurgeons. I wanted to see the doctor I had been seeing out of my HMO, so I looked up EVERY orthopedic surgeon in their hospital to "prove" that they had no one qualified to touch me. Their answer was that this was handled by the neurosurgery department. So then I saw the head of neurosurgery and he referred me to who I wanted to see because none of them were trained in long spinal fusions.

    I would recommend calling the neurosurgery department where you've been referred and ask them if they do scoliosis surgeries there on ADULTS. The reason I say that is because "my" hospital did them on children until the doctor hurt her shoulder so badly she couldn't do them anymore. But they never did them on adults because, as the chief of neurosurgery told me, adults are less flexible and more complicated often needing cages, osteotomies, laminectomies, etc. along with having stiffer and more brittle bones.

    "My" hospital was listed as one of the nation's top 50 hospitals in 2015. With that kind of reputation I am shocked that they don't offer this kind of surgery. They've done multibillion dollar equipment purchases and remodeling over the last three years or so. You would think that would attract some scoliosis specialists. I know the demand is high and the number of scoliosis surgeons are few where I live. But I'm in the hub of some of the nation's best surgeons and they must all be happy where they are...??? I just don't have access to them because I'm on an HMO.

    I'm going to guess that you are in Indiana from your comments. I don't think I've seen any SRS doctors listed for that state. So if you do have surgeons, you will have to do some detective work. The state where I live lists two. Out of those two, one must be a ghost doctor because I could never find him or reach him at the number they have for him. So, basically, we have one. There are others that aren't listed, but they work at the same facility as the "one" and are trained by him. That's the gist I get, anyway. My DIL saw the other one, not listed on the SRS, that trained under the big guy. So you may have some, but like I said you'll have to hunt them down. TiEd went to a STELLAR surgeon in Reno, NV that put him back together. His doctor wasn't listed on the SRS. Ask him about it.

    It would be nice to have a scoliosis, or even a back patient support group within 50 miles of home. I'd definitely go. It just seems like it's taboo or something. People don't like or seem to want to talk about it. I KNOW I'm not the only person in my small town with scoliosis. I see at least a few walking around! It just seems to be a sore subject (pun not intended) to talk about it. I was in a cardiac rehab group where I met a fellow scoli. I mentioned to her that I had heart problems that I didn't know if it was aggravated by my scoliosis or not, just to see if she would talk about her scoliosis. She did, briefly. She said she was born with it and had her upper back fused, which I had NO idea because it was noticeable in her lumbar. But I never mentioned that, not wanting her to feel self-conscious that I even noticed at all. It was short and sweet. No offer of advice or how she felt...nothing. That was the last time I tried to reach out to someone. My biggest support is my DIL who was fused when she was 16 and now my son just up and decided to move them to Florida! So now she's gone. :'-(

    I don't know why people feel like it's so taboo. I had a cousin by marriage who's lived her life plagued by congenital scoliosis. She doesn't like to talk about it. It's just really weird how people don't want to talk about it. Maybe WE are the weird ones? But you will find EVERYONE here willing to share experiences and give support. Sometimes the forum seems dead at times. But it usually picks back up. We are on what seems to me to be kind of a slow streak. It's always nice to welcome new members!

    Anyway, welcome again!
    Rohrer01
    Last edited by rohrer01; 03-29-2016 at 07:37 PM.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  9. #24
    Join Date
    Jan 2016
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    13
    Quote Originally Posted by rohrer01 View Post
    BentRN,
    Welcome! This is the only source or outlet that I have, too. I was told by my insurance company, coincidentally affiliated with the main hospital I go to, that many scoliosis surgeons are neurosurgeons. I wanted to see the doctor I had been seeing out of my HMO, so I looked up EVERY orthopedic surgeon in their hospital to "prove" that they had no one qualified to touch me. Their answer was that this was handled by the neurosurgery department. So then I saw the head of neurosurgery and he referred me to who I wanted to see because none of them were trained in long spinal fusions.

    I would recommend calling the neurosurgery department where you've been referred and ask them if they do scoliosis surgeries there on ADULTS. The reason I say that is because "my" hospital did them on children until the doctor hurt her shoulder so badly she couldn't do them anymore. But they never did them on adults because, as the chief of neurosurgery told me, adults are less flexible and more complicated often needing cages, osteotomies, laminectomies, etc. along with having stiffer and more brittle bones.

    "My" hospital was listed as one of the nation's top 50 hospitals in 2015. With that kind of reputation I am shocked that they don't offer this kind of surgery. They've done multibillion dollar equipment purchases and remodeling over the last three years or so. You would think that would attract some scoliosis specialists. I know the demand is high and the number of scoliosis surgeons are few where I live. But I'm in the hub of some of the nation's best surgeons and they must all be happy where they are...??? I just don't have access to them because I'm on an HMO.

    I'm going to guess that you are in Indiana from your comments. I don't think I've seen any SRS doctors listed for that state. So if you do have surgeons, you will have to do some detective work. The state where I live lists two. Out of those two, one must be a ghost doctor because I could never find him or reach him at the number they have for him. So, basically, we have one. There are others that aren't listed, but they work at the same facility as the "one" and are trained by him. That's the gist I get, anyway. My DIL saw the other one, not listed on the SRS, that trained under the big guy. So you may have some, but like I said you'll have to hunt them down. TiEd went to a STELLAR surgeon in Reno, NV that put him back together. His doctor wasn't listed on the SRS. Ask him about it.

    It would be nice to have a scoliosis, or even a back patient support group within 50 miles of home. I'd definitely go. It just seems like it's taboo or something. People don't like or seem to want to talk about it. I KNOW I'm not the only person in my small town with scoliosis. I see at least a few walking around! It just seems to be a sore subject (pun not intended) to talk about it. I was in a cardiac rehab group where I met a fellow scoli. I mentioned to her that I had heart problems that I didn't know if it was aggravated by my scoliosis or not, just to see if she would talk about her scoliosis. She did, briefly. She said she was born with it and had her upper back fused, which I had NO idea because it was noticeable in her lumbar. But I never mentioned that, not wanting her to feel self-conscious that I even noticed at all. It was short and sweet. No offer of advice or how she felt...nothing. That was the last time I tried to reach out to someone. My biggest support is my DIL who was fused when she was 16 and now my son just up and decided to move them to Florida! So now she's gone. :'-(

    I don't know why people feel like it's so taboo. I had a cousin by marriage who's lived her life plagued by congenital scoliosis. She doesn't like to talk about it. It's just really weird how people don't want to talk about it. Maybe WE are the weird ones? But you will find EVERYONE here willing to share experiences and give support. Sometimes the forum seems dead at times. But it usually picks back up. We are on what seems to me to be kind of a slow streak. It's always nice to welcome new members!

    Anyway, welcome again!
    Rohrer01
    Thanks for the welcome and your thoughts! Actually I live in Ohio. I will just keep looking. It seems there is a Neurosurgeon in Cincinnati who might have some experience, and he may end up being the guy. It seems I may have to put this off for a while.

  10. #25
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    reno,nevada
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    Quote Originally Posted by bentRN View Post
    He was very nice, and appreciated the seriousness of my condition, but indicated that as long as I can still function, any surgeon would be wary about doing such a major surgery.
    There is a lot of truth in this. These are serious surgeries that do have their complications.....My surgeon asked me multiple times why I waited so long. I didn’t think I needed to answer....

    The problem is that if you don’t see someone who is “actually capable”, you will never know.......If my surgeon didn’t come to town, I would have traveled down to UCSF in San Francisco for some sort of answer. I needed an answer. Doing the “doctor tour” with all the wrong doctors, which many of us do at some point, is tiresome.

    I had multiple meetings with my surgeon and heard all sorts of complication related stuff, bla, bla, bla. And it does get absorbed in time, but if you are in serious pain, I think you deserve to hear the words “It will help”. You don’t want to specifically ask this, it has to happen on its own. Sigh....In other words, no swaying, best to keep quiet and don’t sway any surgical decision.

    Many here have flown to have surgeries done, its doable. Not terribly convenient, but doable. Picking or hiring your initial surgeon is important. If the right person doesn’t fall out of the sky, I think its worth seeking him out and traveling.

    None of this stuff is easy....we know that. Your not alone here, there are many posters here, both that have done well, and have not. Nobody should tell you to have surgery, but its not something to ignore if you are in pain.

    I think that seeing some of the heavies, the extreme of extreme, like a 180 degree kyphosis patient with head at knees, and extreme Gibbus deformity patients get repaired and seeing them mention that they were in heaven after surgery or surgeries, had a profound effect on my decision. I thought, “they made it”. Its possible. Dr Boachie was featured of the Discovery program “Surgery saved my life” many years ago, and he operated on this kid that was really bad, and he made it. I watched this program 10 times before my surgeries. It installed hope.

    I also needed to hear from at least one patient, “Get it done”. Otherwise I never would have put the effort into seeing my specialist....

    It was worth it.

    If you are thinking of giving up, I would at least get a set of full x-rays made from anyone, they have to be full, get them burned to disc. Front and side. This way you can e-mail them. Dr Pashman in Los Angeles does look for a small fee, He is credible. You can e-mail to Linda Racine and have one of the scoliosis surgeons at UCSF take a look. You can get a full set from a radiology company, some will discount for cash payment. There are ways. If you do eventually decide on surgery, they will shoot their own set of x-rays.

    http://espine.com/

    http://espine.com/spinal-balance/

    http://espine.com/scoliosis/adult-scoliosis-cases/

    If you want to talk with any of us on the phone, just send a PM. There are many here including myself that will be more than happy to talk to you about things...

    Hang in there

    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

  11. #26
    Join Date
    Mar 2010
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    2,755
    Quote Originally Posted by bentRN View Post
    Thanks for the welcome and your thoughts! Actually I live in Ohio. I will just keep looking. It seems there is a Neurosurgeon in Cincinnati who might have some experience, and he may end up being the guy. It seems I may have to put this off for a while.
    I would call his office and ask if he handles scoliosis cases and if so, how many surgeries he does per year. It's important that you have a guy/gal that does them often. They are more likely to be able to quickly handle problems that may arise mid-surgery or foresee the best outcome by knowing how long to fuse and what type of fusion would be best for your case. If he only does one a month or less, run away! Have you looked on the SRS link to see if there are any member doctors near enough to you that you could consult with?

    Are you limited by an HMO like I am? If so, that's a REAL bummer. I have had the head of neurosurgery where I live say I needed to have corrective surgery, especially because of the neck involvement, MY doctor who I've been seeing for about 15 years become wishy-washy telling me it was up to me when I was ready, then shutting me down when I was finally "ready", and another doctor in NC say I needed surgery because I have progression even though I'm under 50 degrees. But my neurosurgeon cow-towed to the opinion of my wishy-washy surgeon, who is the ONLY one my insurance company will pay for. They won't even let me get a second opinion, which is written right in my certificate of coverage. They say he was my second opinion and my neurosurgeon who is not qualified to do the surgery was my first opinion. Say what? I hate dealing with insurance companies!

    All the best,
    Rohrer01
    Last edited by rohrer01; 03-31-2016 at 07:20 PM. Reason: added thoughts
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  12. #27
    Join Date
    Jun 2011
    Location
    Southern CA
    Posts
    2,224
    Get an excellent surgeon. That is so important.
    My NC surgeon messed me up badly, and my CA surgeon had to fix me. I am very fortunate to have located him when I did.
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  13. #28
    Join Date
    Jan 2016
    Posts
    13

    traveling for surgery

    Ok, so let's go with traveling. How's that work? I go to NY for a visit or so, then I schedule the surgery. I stay (the night before?) I have the surgery. I stay in the hospital (one week? Two weeks?) Then what?

  14. #29
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,550
    Hey Bent!

    I traveled from Portland, Oregon to San Fran, CA for my first surgery since my son was there and I could stay with his family postop for 6 weeks, then travel back to Oregon. There is another awesome surgeon in Portland that I had seen 4 times before going to see Dr. Hu, but at that time we lived in the country about 1 hour away from the hospital and I had limited support for recovery, so SF seemed like a better choice.

    Here's what I did:

    Made an appt with Dr. Hu in SF for an initial consult and had all of my xrays/CT/MRI/notes from prev MDs sent to her. I liked her a lot and then scheduled my 2 day surgery with her.

    Went down to SF [12 hour drive] a few days early, went to the hospital and was fitted with a brace, had an appointment with her the day before surgery to ask additional questions.

    Had 2 days of surgery, stayed in hospital x 1 week. Went to nearby inpatient "intensive" very imp that you do intensive which is 3 hours of therapy a day. I was 65 at the time and it was a challenge, esp the first 2 days to do 3 hours. Stayed at Rehab inpatient for 2 weeks and learned everything to make me semi-independent.

    Went to my son's home to rest until the 6 week visit w/ Dr. Hu, then we drove back to Oregon in 2 days. Some people go to a recommended rest place for a few days before going home from the hospital or rehab.

    So......my thoughts and recommendations:

    1] Have the best doctor possible. One that does lots of adult deformity scoliosis spine surgery. Maybe best someone that a few people on here recommend.

    2] If you are over 60 [unless maybe you run marathons....] go to "Intensive Rehab Inpatient" [not skilled nursing facility] for 1-2 weeks to learn to walk, turn well in bed, get out of bed, bath, do hygiene, rest a little, etc.

    3] Ask your doctor's advice nurse about where to stay before and after surgery as far as a residence. Every hospital/doctor has a recommendation.

    4] Go a few days before your surgery to get settled. Bring someone with you.

    5] When you decide on your doctor, ask on the forum who saw him/her for surgery. Where did they stay? How did they manage? Problems? Advice? Could I have your phone number to call for questions? etc

    6] I suggest driving for surgery unless it is >12 hours or so away.

    Good luck. If you want to talk with me on how I managed in SF, send me a PM and we can hook up by phone.

    You can do this!
    Susan

    PS: In spite of all of the problems that I have had since my first surgery, I do not regret having my scoliosis surgery. Before I had surgery, I could walk about 1/2 block and then was in so much pain that I needed to sit down. I asked both surgeons that I consulted, "What would happen if I did not have the surgery?" and both said that I would be permanently in a wheelchair within 5 years or so.
    Last edited by susancook; 04-06-2016 at 03:27 PM.
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  15. #30
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    770
    Susan is really a trooper. But do remember you need someone to follow up with. And expect some problems. If you expect problems you won't be disappointed when it happens. Make sure to interview some one near you. You may need their help.
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

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