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  • Cotrel-Dubousset instrumentation issues

    Hi everyone...I'm new, and I wasn't quite sure where to post this one. I hope I'm in the right area. I'm not due for surgery, but I did have some questions I was hoping SOMEONE would finally be able to answer. For the background:

    I was diagnosed with scoliosis when I was 8. Apparently at the time I didn't need a brace, but a year later I did, so I was fitted for a Milwaukee brace as well as a pad on my lower right side and a strap on my upper left side (to try to control the curves). Did the usual, wore it for 23 hours a day for a year. It didn't maintain the curves, so when I was 11 I was set up for surgery. They didn't want to do the surgery because I hadn't hit my first stage of growth yet, but he (the Dr.) said that if they waited a couple years, I would be in serious trouble based on the fast progression. So they did the surgery and used Cotrel-Dubousset instrumentation: 2 stainless steel rods on the top curve and one on the bottom. The bottom rod had a 3 inch tail on it that they didn't see as a problem considering I was quite chubby. For a few years after surgery, everything was fine until I was about 15-16 and I was losing feeling in my extremeties and anytime I did anything that would shock my ribs (such as coughing or sneezing) an incredible burning pain would completely engulf my back (seriously felt like I was on fire). I went back to Shriners where they had me point to where exactly the most pain was, and it was at the bottom. They taped a dime to my back (where I had pointed) and did a series of x-rays and discovered that between the tail of the rod and the dime there wasn't any space. The rod was literally coming through my skin. They also discovered that the bottom hook was pulling away from my spine and had bent. So I had a second surgery to remove that 3 inch piece of metal. After that, all was well. Except for the numbness (I was told that would eventually go away). Moving forward....

    Now I'm 25 and for the past few years things have been getting progressively worse. Still have the numbness in extremeties, especially in select fingers and toes. The biggest issues now are that if I reach my arm behind my head and touch between my shoulder blades (where most of the pain is) and push a little bit, there is a lot of "crunching". This extends from between my shoulder blades up to the top of the scar (and is itself quite painful). The second problem (which, to me, is the biggest) is I feel like there are several very powerful hands squeezing my spine, running exactly through the same area where my rods are. If I move even a tiny bit I can "feel" my rods attached to my spine. I haven't felt anything remotely like this since I sat up for the first time after my first surgery. I've also started experiencing my "hot back syndrome" mentioned earlier (this is more recent...probably the past several months). Another thing is my sternum (which should be solid) has been...popping or cracking...I suppose those terms should define it. I've noticed that, instead of being relatively flat like it used to be, there is now a faint ridge or bump running vertically. It's very faint, but it's definitely there, and it wasn't before all of this spine squeezing, body twisting thing started.

    Now that all of that has been said, I've been to the doctor (as well as the ER for severe pain extending from between my shoulder blades to the center of my chest...thought I was having a heart attack) on several occassions....only one time have x-rays been done, and that was because of severe chest pain. I've been told over and over again that my spine is fine (been told by the ER doctors, which I will admit, in this area, are lacking in intelligence...I have to wonder how they even made it through medical school sometimes)...or rather, it LOOKS fine. I've mentioned the "crunching" and the burning and they had no idea what it was and decided to give me some pain medication instead of investigating further. I've talked with my regular physician about it...she too offered pain medication, muscle relaxers, etc... and suggested that it's probably stress related. I'm at a complete loss. I honestly don't know what to do at this point. I can't go back to Shriners because I'm too old and the orthopaedic surgeon here won't see me because I've already had a spinal fusion (very small town). I'm becoming incredibly worried...not only because of the effect the pain has on me emotionally, but it's also affecting my career. Lets face it, you can't paint if your hands are numb (okay, some people can...). But really...I don't know where else to turn. I have no idea what to do. I've researched the internet and the library and every other resource I have available for information relevant to problems with C-D instrumentation, and nothing has come up. Except for this website So....I apologize for the novel, but if anyone has ANY idea what's going on or if this is normal (I was told I'll have pain for the rest of my life, but I'm quite sure this is far exceeding my original doctor's definition) I would truly, truly appreciate some advice. I quit taking the pain medication because I'm not a fan of medication period...pain is supposed to let you know when something isn't right, not be covered up so things can worsen.

    So, just for those who don't want to read a novel here's the list:

    *squeezing/pressure running length of instrumentation
    *feeling like my spine is twisting/rotating
    *changes in sternum
    *numbness
    *breathlessness
    *back on fire (sounds like the name of a band, but it isn't...as far as I know...would still make a good name though )
    *crunchiness/popping
    *one I forgot to mention: severe joint pain...if there's a joint, there's some pain (I've been told I have arthritis, mainly in my left hip because of one leg being 2 inches longer than the other...fun party trick...I suppose arth. goes along with the territory)
    *Oooo, another one I forgot to mention...ribs slipping out of place and pushed back in via the husband, both in my back and in my front..this one I haven't been able to figure out yet.

    Okay, I'm done. I think. I'm also absentminded so I'm quite sure I forgot something...as the Arnolds so eloquently put it, "I'll be back."

    Thanks in advance!!!

    -Etoile
    Last edited by Etoile; 04-25-2006, 10:54 PM.

  • #2
    Oh yeah...here's the one I forgot. A scraping sensation against my rib hump from my scapula. This is a new one. I just remembered because I moved....and it scraped.

    K...on with it!

    Comment


    • #3
      Hi Etoile...

      You need to be seen by a scoliosis specialist with a lot of experience in treating patients with prior fusions. Where are you located?

      Regards,
      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

      Comment


      • #4
        By the way, I've seen thousands of scoliosis xrays, and don't think I've ever seen anyone with 3 extra inches of rod! That's gotta be some pretty big malpractice! I've heard of people have discomfort from the implants when there's an extra 1/2"!

        --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

        Comment


        • #5
          Hi Linda Thank you for replying.

          I live in Pennsylvania...roughly 30 minutes from the New York state border. I've searched for specialists and decided that it was best to contact the surgeon who assisted in my first surgery (Dr. Cortina) which was done in Erie. I called his office (he works in conjunction with Shriners hospital) and the secretary told me that he no longer practices "back surgeries" as she put it. She was unable to give me any more information than that. That was about a year ago. I've not called since...my brief conversation with her threw me off and kind of made me give up. Then when I called the ortho in town, his secretary told me that he doesn't treat patients with previous spinal fusions....just patients who have scoliosis but haven't been treated. That confused me a bit....quite a bit.

          I clicked on the link you had posted somewhere in this forum (I can't remember the specific thread) relating to a list of specialists. The closest I could find was in Erie and coincidentally he was the doctor that perfomed my second surgery; Dr. Sanders. Unfortunately he has moved from his own practice to take over the position of Chief of Staff at Shriners...the former COF was Dr. Frankovitch (who assisted in my first surgery)...however he's retired....so basically I feel like I'm running in a circle and not making any progress. I was hoping that if I saw the doctors that were involved in the surgeries then maybe something could be done since they already know the background.

          I had considered calling Shriners and asking if they could send my records to me (along with the last x-ray taken by them), that way I would have the information at my disposal and maybe that would help get things moving. But I don't know if they do that. They were supposed to send some records to my regular physician, but she never received them. Soooooo....yeah. I don't know where to go from here.

          As far as the 3 inch bonus package, my sugery lasted 9 hours. I would think that in 9 hours time, someone would find a couple minutes to remove that tail. They didn't think it was necessary at the time. Is it really malpractice? I mean, I understand that in regular hospital situations, it would be considered that, but because we went to Shriners, it was free.

          The more I read on here, the more I see that people were given choices as to whether or not they wanted the surgery. I wasn't offered that choice. It was a must-do. Maybe it had something to do with my age? Not that I'm complaining about it....I certainly am glad that I did go through that/those experience(s).....it made me who I am. I just wish I was more informed, I guess. I would be grateful if someone would have clued me in on what to expect several years down the line. I can't find anything online about C-D instrumentation, except for rave reviews and definitions and such.

          Sorry if there are any misspellings in this post....I've not been to bed yet My nerves are shot for the most part, trying to figure out what to do. I think, since I'm awake, I'll give Shriners a call and see what can be done as far as information being sent to me. I would really like to see what was never told to me.

          Comment


          • #6
            Oh yeah...here's the one I forgot. A scraping sensation against my rib hump from my scapula. This is a new one. I just remembered because I moved....and it scraped.


            I had that exact sensation and it was very painful. I actually had a "right scapular resection" where part of my scapular was removed and there was a very large (dr. said size of an apple) burser sac against the chestwall, which also was removed. As he explained it ........... every time I would lift my arm up and down, it would rub against my rib cage causing the inflamation. I could hear the crunching sound and it felt like it was getting "caught" on my rib cage. Recovery was tollerable - pt to get the arm moving again and I do not have that feeling at all. If I can help you further, please let me know.
            Good luck. LYNN
            1981 Surgery with Harrington Rod; fused from T2 to L3 - Dr.Keim (at 26 years old)
            2000 Partial Rod Removal
            2001 Right Scapular Resection
            12/07/2010 Surgical stabilization L3 through sacrum with revision harrington rod instrumentation, interbody fusion and pre-sacral fusion L5-S1 - Dr. Boachie (at 56 years old)
            06/11/14 - Posterior cervical fusion C3 - T3 (Mountaineer System) due to severely arthritic joints - Dr. Patrick O'Leary (at age 59)

            Comment


            • #7
              Hi Etoile...

              It would be malpractice in my opinion, but I don't know whether or not you'd find a doctor to be your expert witness, or whether you'd get a jury to agree with me.

              I'm not a medical professional, but I don't think your C-D implants are specifically the problem. I'm guessing that it's more how they were implanted. For the most part C-D implants have been very stable. Again, I'm not a medical professional, but from what you describe, I suspect you might get some pain relief from having the implants removed.

              I'd like to encourage you to call Shriners. It should only take one phone call to find out if a) they have your records/xrays and b) if you can get copies.

              I'd also encourage you to make an appointment with one of the New York surgeons who are known for their treatment of patients with prior fusions. Here are the names that I hear most:

              Oheneba Boachie (this would probably be your best choice, but he does not participate in insurance plans)
              Thomas Errico
              Jean-Pierre Farcy
              Baron Lonner
              Michaell Neuwirth
              Frank Schwab

              Regards,
              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

              Comment


              • #8
                Hi Etoile,

                Beautiful name, I see that you know some French(I'm French Canadian). Welcome to the forum, and sorry about your pain.

                About the crunchiness(popping); I had the same happen to me and it was only a year after my rod broke and the screws from that side loosened that they saw a TINY crack in my Titanium rod(after all that year that I suspected it was broken b/c of the "crunching" and grinding, as I called it, but they didn't believe me ), and so it could be that you have some hardware that is loose or broken, and sometimes X rays don't see all that could be broken-only a good inspection while surgery could solve that problem. I had surgery to replace the rods and screws and add fusion this last December for that. I also had a bursitis type of pain years ago after I had my first surgery, it was located in my right/upper thoracic side(between shoulder blades), and again I had surgery to remove a hook b/c the pain was getting too much, and that surgery was pretty "easy", compared to the other ones.

                I don't know what is wrong with you, but just wanted to share some of my experiences since you decribed some pains that resembled mine. About the back on fire, I used to open the freezer door to put my back there and get relief, before this last surgery....It sounds silly but all the inflammation caused me to go nuts and that helped Hey, you do what you gotta do when you have pain...

                Good luck, and try to find a new ortho that specializes in adult scoliosis.
                35 y/old female from Montreal, Canada
                Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
                Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
                Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
                Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

                Comment


                • #9
                  malpractice

                  Not sure if it really a malpractice issue because maybe your spine shortened or an area of non-fusion occurred allowing part of the spine to shorten/re-curve allowing the bottom hardware to loosen and protrude.

                  You are entitled to your all your medical records. Sometimes, after many years, they are disposed of because it costs money to store stuff.

                  They did NOT have my old records at Hospital for Special Surgery(from 1956) when I went for my revision there in 2002. They did have my original medical record number and my childhood address.

                  Same thing with a scoliosis doctor I consulted 6 years before my surgery(Dr. Keim); he retired and Dr. Thomas Errico took over his practice but no records of mine were saved.
                  Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
                  Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

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