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Thread: Spinal instrumentation Concepts and Biomechanics

  1. #1
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    Spinal instrumentation Concepts and Biomechanics

    I have to thank Sharon for posting the occasional Dr Hey vid.... One thing leads to another and presto! I found the goods! Courtesy of the Seattle Science Foundation.

    This vid will answer a few questions about our hardware....

    https://www.youtube.com/watch?v=q0-EdCJyfgA

    Some of this might be a little boring for some, make sure you get your popcorn.

    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

  2. #2
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    Okay I watched that entire video. Material science plus a touch of physical chemistry.

    These surgeons really have to know engineering in addition to medicine.

    Based on the comments I think I heard in the video, proximal junction kyphosis is the biggest problem with fusions. Getting the sagittal plane in balance is the grail. From the testimonials I have read over the years in this sandbox, that really does seem to be the case.
    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."

  3. #3
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    I agree with Pooka. That engineering is part of medicine but probably less predictable. I think my upper extremity specialist has an engineering degree also. Think about removing a part of the scapula and then transferring a muscle to do replace the job of one that failed.
    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

  4. #4
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    Yup, yup and yup....

    I have always wondered why not just go bigger if the rods break?....or build a stronger construct? We do need “some” movement for healing to happen. I read this someplace else many years ago....

    My rods were pre bent at the factory. I guarantee they use either jigs or CNC roller bending equipment, not hand benders at the factory... The bending and shaping is critical, and I agree that if a surgeon over bends, don’t try to correct, just throw the rods out and start over. Also, the rods almost always break at the screw heads.

    My sagittal plane situation was pretty darn good, it really didn’t change too much. The sagittal plane is more important than the actual scoliosis curves on outcomes. Kyphosis can really wreak havoc, along with PJK. This question needs to be answered.....Why does kyphosis happen? Why the breakdown on only the front of the endplate? Why is this location specific?

    Funny how different surgeons will have the option to tap or not tap. And some will under tap a turn like my surgeon did, (states this in my hospital report) for increased locking or tightening effect...It also seems now that almost all the screws now are titanium.....I am wondering if this is mostly due to a biofilm effect. ???

    He also answers the cross member question. I don’t have any, and read that its also not suggested for DDD patients.

    The pedicle has strong bone......its also tricky aligning and getting through without a breach.....which makes me think about the tethering procedure and how they avoid this by going through the side. Once again, its only one pothole in the road we have to steer around, and all surgery has its pros and cons.

    Seattle Science has some great videos......I will have to check out a few more. I watched all the Research Channel “scoliosis” videos years ago with Jens Chapman. I cant seem to find these anymore.....They shouldn’t let this material be lost, its such a shame. If its financial, then Zucky, Gates or Uncle Warren need to throw some or kick down in that direction. (smiley face)

    https://www.youtube.com/user/ResearchChannel/videos

    Time for coffee

    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

  5. #5
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    Ran out of popcorn....

    Thanks for posting, Ed but I ran out of popcorn about 10 minutes into the video.
    Susan
    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 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at 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 + prayer

  6. #6
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    Susan good to hear from you. I hope you are well. My popcorn supply needs replenishing.
    As a side note I think the muscle transfer worked. I am almost six months out and so far it is good. Still a little hard to do some movement but in time that may get better.
    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

  7. #7
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    Quote Originally Posted by jackieg412 View Post
    Susan good to hear from you. I hope you are well. My popcorn supply needs replenishing.
    As a side note I think the muscle transfer worked. I am almost six months out and so far it is good. Still a little hard to do some movement but in time that may get better.
    I have been following along and am very glad you are getting some relief.

    Do you know if your surgeon write it up as a case study in the literature? I am just wondering how ground breaking the surgery was.
    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."

  8. #8
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    Quote Originally Posted by susancook View Post
    Thanks for posting, Ed but I ran out of popcorn about 10 minutes into the video.
    Susan
    Susan, I don’t believe you.....

    Are you doing ok? Did you see my Panama stem cell thread?

    Jackie, good news on the muscle transfer....

    Is the winging over? Are you past the pain yet?

    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

  9. #9
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    Hi Ed, the scapula is in place now. The shoulder is still down a little but I am told it is my rib cage that is down. And there isn't anything that can change that.
    However that being said, the shoulder has much more stability with the winging under control. I just finished PT this week. Movement is easier and strength is coming. I will be 6 months in mid September. It can be painful because the muscles still go into a snit on occasion. I guess it is a spasm and very uncomfortable. I think I will always need to work on it. And Ed you know how much work it is. But I am really hopeful.
    Thanks for asking.
    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

  10. #10
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    Work? No way....(knowing smile)

    You talking shoulder or spine? The shoulder for me was 6 months. Scoliosis surgery in adults is a different book in a different library in a different state. Your shoulder and spine revisions are also in their own category.

    I had lumbar spasm’s after a ski competition many years ago. (before surgery) It felt like a sword pushing in and twisting, I was completely out of commission, flopping on the bed like a fish, begging neighbors for drugs on a Saturday. I think I bummed some vicoden which was like a plastic baseball bat to the medula. (in other words, weak)

    Try to take it easy if you spasm. Its hard to control, that’s for sure.

    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

  11. #11
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    I think both the spine and shoulder are a lot of work. My SPINE is doing ok. I just keep on keeping on. The shoulder is doing good but I haven't achieved all movement yet. I think that I can't sleep on it yet. I am not sure but it can account for the reason that one day it is moving well and the next day I can't lift it well.
    Now I had an injury in January, all I did was squat down quickly to pick up something and I felt a strong pull from my spine. It did grab my attention . Then I started having pain in the back of my thigh. Sitting is impossible. I changed some things I was doing and thought it was a pulled muscle. Then my lower leg and foot went numb. I took it easy as advised for 6 weeks. Here we are months later and no improvement. Went to PT had an X-Ray and then an MRI. Turns out I tore the hamstring partially. Two doctors can't come up with the reason for numbness. I was checked twice for reflexes and no reflexes in my lower left foot and leg. What can that mean? I have an EMG scheduled in September. Now what and why the change? What could I have done in this type of injury? I did not falll and nobody pushed me.
    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

  12. #12
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    Jackie

    Whenever we drag ourselves in like a cat that was just hit by a car, you always hear the words “What did you do?”

    “Oh....nothing doc”. (smiley face) “I don’t know what happened”.

    This has happened to me countless times.....(laying down on the floor, pulling myself in with one arm, with some blood trails, coming back from a mission)

    The life of an old scoliosis patient.....another day in paradise. We are in major pain, and we might submit a 3 on a 1-10 pain scale. Hey, were used to it.

    But your saying you cant sit down? That’s not good....Legs go numb while sitting down, or pain upon sitting? I had this before my surgeries.

    Our legs are most definitely connected to our spines or lower spines.....we know this and feel this through all our walks. As we age with scoliosis, our squatting and our bending movements are going to have to happen slower, that’s for sure. I have slowed down, and I’m being careful these days, probably due to my neck and new upper spine aching at T1. In my scoliosis surgical recovery, my arm and shoulder were broken, it slowed me down and was probably a good thing as far as the spine was concerned.

    Sounds like a nerve injury of some sort.....You can also have a soft tissue inflame on a nerve and get similar results. You would think this would have resolved itself by now?

    Be sure to let us know what happens

    Hang in there Jackie, you’re a tough one.

    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

  13. #13
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    Location
    illinois
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    Yes you are correct-we have to slow down. That being said I find it very hard to walk slow. It's like I have a pace that feels comfortable and that's it. Otherwise it is not right.
    I agree that I must have pulled something (muscle, tendon,ligament). The problem is it has been 8 months and the numbness. The EMG order is written up using the abbreviation--EHV-NRF. The neurologist office that will be doing it has to do it under those restrictions. I think it translates to extra high voltage, no reflexes. The change is concerning because I did have reflexes after surgery.
    I can't sit because of pain- but I do have a hamstring injury. It also goes numb. It goes extremity numb after walking up steps
    Last edited by jackieg412; 08-30-2016 at 02:49 PM.
    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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