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Thread: Revision surgery with Dr. Arlet

  1. #1
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    Question Revision surgery with Dr. Arlet

    Hello,

    This is the first time posting here. I have a revision surgery set with Dr. Vincent Arlet on 07/17. This will be from T4-L2. I am 26 and had my first surgery when I was 12 years old. My curve is now at 65 degrees to the left thoracic and with a prominent rib hump when bending over. The curvature is expected to increase at 1 degree per year and therefore I would like to put this behind me while I'm young, healthy and in relatively good shape.

    My questions is does anyone know of anyone having surgery done with Dr. Arlet? From my research he seems to be well appraised but I have not seen much mention of him on this site.

    Also from experience does anyone know what sort of curvature correction I may receive along with any reduction in the rib hump? Dr. Arlet advised there could be a 40% correction but I am not sure that is feasible. He also mentioned there could be a reduction in the rib hump but did not want to perform a thoracoplasty.

    Any thoughts or feedback would be great.

  2. #2
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    Welcome to the forum, nice to see younger folks posting...

    I am not understanding, what levels did you have fused when you were 12? and what will be revised? Do you have any x-rays you could post?

    Its impossible to say what curve correction you will have, in general, adult corrections are usually in the neighborhood of 50%

    I was told I could be fused "as is" since many questions get answered after they get in. Expecting no correction as the worst outcome prepared me and when the nurse brought my x-rays in to see, I was pleasantly surprised with what I saw and I am quite happy...I still have a small thoracic hump, this being corrected by the de-rotational abilities of modern hardware systems. Thoracoplasty is a rare thing here in the states....there are not many members here that have had thoracotomy done. I have read that open thoracotomy is especially painful, and for pain, its in first place. Its something I would have trouble begging for. Our surgeries are hard enough as it is.

    There were a few posts about Dr Arlet a few years ago......from what I am seeing, he looks like he has been on the scene for many many years....

    How much pain are you in?

    Ed
    49 yr old male, now 58, the new 53...
    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. #3
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    Hey Ed,

    I am not sure exactly what levels were fused previously. Basically Dr. Arlet will be fusing more levels to hopefully correct some of the curve and then prevent it from curving in the future.

    I'm in pretty good shape , I go to the gym 3-5 days per week, I lift weights and do cardio when I am at the gym. I would say my pain is sparatic but it has never stopped me from going to work or being out and about.

    My main reasoning for moving forward would be to prevent the curve from getting worse and to hopefully increase the cosmetics of my back / rib hump. Dr. Arlet himself appears to know what he is doing but hasn't been to transparent in explaining what to expect and what not. I could just be having last minute jitters knowing that I'm going from a pretty active and social lifestyle to the opposite.

  4. #4
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    Hi.

    I had the same question that Ed had about what operation you had when you were 12. I am not clear on why that didn't stabilize your curve unless you have adding on or something where you have other curves that weren't fused originally that are progressing.

    Knowledge is power and you deserve to know exactly what was done and what will be done. If you ask Arlet he will tell you. I suspect you are not sure what to ask to I am going to throw questions out there you can use if you want...

    1. What levels were previously fused?

    2. Why do I need a second operation? Did other curves develop or did my original fusion not take?

    3. Are you removing hardware? If you want it ask him for it. He will likely give it to you.

    4. Am I a candidate for vertebral body tethering either of the original curve or any new curve? Tethering is an experimental technique that is showing promise. It is better than fusion in sparing motion... it preserves front to back motion but you will still lose some side to side and twisting.


    Revisions are generally easier than original surgeries per the testimonials I have heard.

    Assuming nothing else is going on, with a T4-L2 fusion I suspect you will have no restrictions on physical activity beyond bungee jumping and such. Both my daughters are fused T4-L1 and have no restrictions other than bungee jumping. They claim they feel normal and the one I asked didn't even realize she didn't have a normal range of motion bending side to side. People don't bend through the thorax much so her ROM is less than an unfused person but not much less. I think it will be similar to you. Even with tethering the bending to the side is restricted because of the tether. The tether mainly preserves front to back bending per that one study I saw.

    Good luck. At 26 I suspect you will recover like a teenager which means weeks versus months before you feel better.
    Last edited by Pooka1; 07-07-2017 at 12:09 PM.
    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."

  5. #5
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    So I was able to look at my records online and the prior surgery was a fusion from t8-t11 with the use of a Harrington rod. The X-ray noted scoliosis from t6-l2 which would seem to make sense as to why the surgery will be t4-l2. Do you know what type of rods are used now ? From my readings on here it appears the Harrington rod is obsolete so to speak.

    Thanks !

  6. #6
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    Yes you will receive a modern segmental construct. Because you are not being fused too far into the lumbar, trying tethering may not be worth it. Most people don't bend very much through the thorax to the point that my daughter who has a fused thorax didn't realize she had lower ROM than unfused people until I showed her me bending to the side. Most people don't bend to the side which is which she didn't realize it.
    Last edited by Pooka1; 07-07-2017 at 11:34 AM.
    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."

  7. #7
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    I just need to decide if it is worth going through. I am pretty active as far as going to the gym , walking , riding a motorcycle. We obviously won't know the correction until after the fact but the cons of not going through with it would be continued curvature of the spine and less likely of a good result as I get older. I'm afraid at the thought of losing what I have now but the fear of being worse off down the road scares me just as much.

  8. #8
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    Quote Originally Posted by Optimist View Post
    I just need to decide if it is worth going through. I am pretty active as far as going to the gym , walking , riding a motorcycle. We obviously won't know the correction until after the fact but the cons of not going through with it would be continued curvature of the spine and less likely of a good result as I get older. I'm afraid at the thought of losing what I have now but the fear of being worse off down the road scares me just as much.
    I question whether you will feel less ROM between now and a slightly longer fusion. It may be almost the same because you will still have most of your lumbar.

    I posted an article in another thread on the pros and cons of fusion in young adulthood versus as a teenager which may interest you.

    As I understand this, the straighter you can get your spine, the less you are taxing the discs in the unfused spine below the fusion and the less chance you will need to have your fusion extended into your lumbar. That is a big reason to get this fixed sooner rather than later in my opinion. Ask Arlet about this issue.

    The modern instrumentation allows A LOT of de-rotation. My one daughter was highly rotated and the surgeon was able to remove at least 90% of that. It was shocking. I predict if Arlet does that maneuver, you may not have much of a rib hump or at least one that is barely noticeable like my daughter.
    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."

  9. #9
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    Sharon ,

    Thank you for your input, it's helped a lot. I've met with Arlet a few times over the last two years and to put it "frankly" his bed side manner isn't the best along with the fact he is originally from France there tends to be a bit of a language barrier so it's tough to understand what he is saying / doing.

    I've done some research and he appears to be a great surgeon. He goes overseas twice a year to perform these fusions in poorer countries free of charge. He invented scolisoft which is a database that all spine surgeons use now to see prior outcomes of similar surgeries. So I don't have a hesitation that he doesn't know what he is doing but I would think he would have had more reviews on this forumn since he has been in the game for 20 plus years.

  10. #10
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    Yeah I have heard of Arlet from reading this forum. I think he is certainly experienced which is what matters. I don't know why there are not more testimonials about him.

    I am not aware of any upside to delaying your revision. If you delay, your curve might get stiffer and you won't get as good a correction in that case. Also, the sooner and more you straighten your thorax the more straightening of you lumbar will be driven which might save you from needing an extension. Plus you will get at least some derotation and you will see a cosmetic improvement I assume.
    Last edited by Pooka1; 07-07-2017 at 02:54 PM.
    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."

  11. #11
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    It might clear things up if you got a second opinion from another surgeon. That would be a good idea since you are dealing with a revision.
    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."

  12. #12
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    Do you know of anyone that went back to school or work to a sedentary job quickly? My goal would be to back in a few weeks.

  13. #13
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    Quote Originally Posted by Optimist View Post
    Do you know of anyone that went back to school or work to a sedentary job quickly? My goal would be to back in a few weeks.
    If you were a teenager, based on both my daughters, I would say probably you could. There were both back in school full time by 4 weeks post op. While I think your recovery would be closer to a teenager than a middle aged person, if you are still on opiod painkillers you will not be allowed to drive as far as I know. But working a desk job by a month may be doable and probably will be given what good shape you are in. That will help you a lot in the recovery.

    What does Arlet say?
    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."

  14. #14
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    Arlet said as long as I can tolerate the pain and am not on narcotcis he said whenever I feel up to it I can go back to work. He said there would be no additional risk to the fusion by sitting all day rather it is what I can tolerate or not.

  15. #15
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    Quote Originally Posted by Optimist View Post
    Arlet said as long as I can tolerate the pain and am not on narcotcis he said whenever I feel up to it I can go back to work. He said there would be no additional risk to the fusion by sitting all day rather it is what I can tolerate or not.
    That's close to what my daughters were told. Our (pediatric) surgeon said most patients are back in school between 3 and 4 weeks post op. You won't be 100% but I think you might be able to do a desk job with some breaks.
    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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