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Thank you to those who commented on my book. I always appreciate the feedback!
Regarding Renee’s last post, I completely understand your hesitation to want anything other than a tried-and-true procedure performed on your son. If I were in your situation, I may do the same. Dr. Akbarnia, by the way, is very well regarded.
To reiterate a point in my previous post, though, this procedure really isn’t “new.” Dr. Gaines and several other surgeons have been performing it for at least three years, in hundreds of cases, and more importantly the bone-on-bone procedure involves smaller surgical procedures that have been performed thousands of times over. What’s really new is the application of some of these techniques to treating scoliosis, specifically.
For those unfamiliar with Dr. Gaines’ technique, let me outline the basics:
1. The anterior approach (from the side) is used. The advantage here is better access to the vertebral discs, and a less noticeable scar after surgery (because it is partially masked by your arm). The disadvantage is that a rib may need to be removed and a lung deflated – this is generally more risky than a standard posterior (from the back) approach.
2. The surgeon will only operate on a small number of vertebrae around the apex (peak) of your curve. On your x-ray, you will see 1 or 2 vertebrae that appear to be the most out of alignment. This is the apex. Several vertebrae above and below this level will also be out of alignment, by decreasing amounts the farther away you move from the apex. Most surgeons operate on (fuse and instrument) all or most of these misaligned vertebrae. In b-o-b, only the apex and 1-3 vertebrae each above and below the apex will be addressed. The other vertebrae will fall into alignment.
3. The discs in this small group of vertebrae will be completely removed. In traditional posterior surgeries, the discs are usually left in-place and fused over with bone grafts. In this technique, there are no bone grafts. With the discs removed, the vertebrae will be squeezed together so that they sit on top of each other. This is what “bone on bone” refers to. Without the discs in the way, a generally higher level of correction is achievable because the vertebrae can be brought into tighter alignment. Your body will grow new bone over the small gaps and fuse on its own.
4. Instruments (rods or cages) are placed above the vertebrae to stabilize them while healing. Very strong pedicle screws with two screws per unit are generally used to affix the rods to the vertebrae.
5. After surgery, an epidural catheter is placed directly into the spine for pain control. The catheter provides a steady flow of a narcotic. Dr. Gaines claims this is far more effective than an IV or oral narcotics. Time in the hospital is 5-14 days, which is higher than the more typical 5-8 days for more traditional surgeries.
6. A brace is usually prescribed for 6-8 weeks. Most surgeons do not prescribe a brace for their patients after more traditional surgeries.
I hope this helps!
Dave Wolpert
Regarding Renee’s last post, I completely understand your hesitation to want anything other than a tried-and-true procedure performed on your son. If I were in your situation, I may do the same. Dr. Akbarnia, by the way, is very well regarded.
To reiterate a point in my previous post, though, this procedure really isn’t “new.” Dr. Gaines and several other surgeons have been performing it for at least three years, in hundreds of cases, and more importantly the bone-on-bone procedure involves smaller surgical procedures that have been performed thousands of times over. What’s really new is the application of some of these techniques to treating scoliosis, specifically.
For those unfamiliar with Dr. Gaines’ technique, let me outline the basics:
1. The anterior approach (from the side) is used. The advantage here is better access to the vertebral discs, and a less noticeable scar after surgery (because it is partially masked by your arm). The disadvantage is that a rib may need to be removed and a lung deflated – this is generally more risky than a standard posterior (from the back) approach.
2. The surgeon will only operate on a small number of vertebrae around the apex (peak) of your curve. On your x-ray, you will see 1 or 2 vertebrae that appear to be the most out of alignment. This is the apex. Several vertebrae above and below this level will also be out of alignment, by decreasing amounts the farther away you move from the apex. Most surgeons operate on (fuse and instrument) all or most of these misaligned vertebrae. In b-o-b, only the apex and 1-3 vertebrae each above and below the apex will be addressed. The other vertebrae will fall into alignment.
3. The discs in this small group of vertebrae will be completely removed. In traditional posterior surgeries, the discs are usually left in-place and fused over with bone grafts. In this technique, there are no bone grafts. With the discs removed, the vertebrae will be squeezed together so that they sit on top of each other. This is what “bone on bone” refers to. Without the discs in the way, a generally higher level of correction is achievable because the vertebrae can be brought into tighter alignment. Your body will grow new bone over the small gaps and fuse on its own.
4. Instruments (rods or cages) are placed above the vertebrae to stabilize them while healing. Very strong pedicle screws with two screws per unit are generally used to affix the rods to the vertebrae.
5. After surgery, an epidural catheter is placed directly into the spine for pain control. The catheter provides a steady flow of a narcotic. Dr. Gaines claims this is far more effective than an IV or oral narcotics. Time in the hospital is 5-14 days, which is higher than the more typical 5-8 days for more traditional surgeries.
6. A brace is usually prescribed for 6-8 weeks. Most surgeons do not prescribe a brace for their patients after more traditional surgeries.
I hope this helps!
Dave Wolpert
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