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Thread: Why Two Surgeries???

  1. #1
    Join Date
    Feb 2007
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    251

    Why Two Surgeries???

    Hi

    I am wondering why some of you have to have surgery on two different days when they are doing Anterior and Posterior? Why are they not performed on the same day? My Dr. said he would do both the A & P during the same surgery.

    Just Wondering,
    Patty

  2. #2
    Join Date
    Sep 2003
    Location
    NJ
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    1,291

    Why 2 surgeries?

    It depends on the patient's age, general health and what needs to be done. The safety of the patient is what determines this. In my case each stage took 6 hours; would you want your doctor standing for 12 hours? Also, the longer one is under the more risks can occur.
    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

  3. #3
    Join Date
    Dec 2006
    Location
    San Diego, CA
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    82
    Dear Patty,

    My doctor generally does separate anterior and posterior fusions because each one takes around 6 or 7 hours. He says that he has learned from experience that it's not a good idea for someone to be under general anesthesia for longer than 9 or 10 hours max. He is focused on the prevention of complications. I'm grateful that he is patient focused, and I trust him due to his impressive credentials and reputation. He is Dr. Akbarnia. He practices in San Diego.

    Take care,

    Brynn

  4. #4
    Join Date
    Feb 2007
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    251
    Thanks Brynn and Karen,

    May I ask what was done during each surgery?

    I was told the total time would only be 6 - 8 hours.

    Thanks,
    Patty

  5. #5
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    Sep 2003
    Location
    Northern California
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    Hi...

    I had both of mine in the same day, in about 11-1/2 hours. If I had to do it over again, I would have had them staged. It was tough on me, and it was tough on the surgeon.

    --Linda

  6. #6
    Join Date
    Dec 2006
    Location
    San Diego, CA
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    Dear Patty,

    The first surgery is an anterior fusion. The surgeon goes in through the side, using minimally-invasive small incisions (at least in the kind my doctor does). Then he removes the discs from the vertebrae he is fusing, placing metal "cages" between them ("biomechanical spacer implants") and packing these with bone graphs. My doctor is using artificial bone for this (BMP allographs). These will grow together and fuse as the patient heals. During the posterior fusion, the surgeon goes in through the back and puts in rods, with more bone graphs. My doctor uses bone from the patient, mixed with BMP graphs. My understanding of why two surgeries are performed is that this increases the likelihood of the fusions "taking" and lasting a long time.

    My surgeon, Dr. Akbarnia, explains the various types of fusion surgeries in the Treatment section of his website: www.sandiego-spine.com. Linda Racine also has information about these on her website, where you can link with sites that even show actual surgeries (if you are up for that.....) and give descriptions. Her website is: www.scoliosislinks.com.

    I hope this helps and isn't too much information.......

    Take care,

    Brynn

  7. #7
    Join Date
    Sep 2003
    Location
    Northern California
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    6,337
    Quote Originally Posted by brynnski
    The first surgery is an anterior fusion. The surgeon goes in through the side, using minimally-invasive small incisions (at least in the kind my doctor does). Then he removes the discs from the vertebrae he is fusing, placing metal "cages" between them ("biomechanical spacer implants") and packing these with bone graphs. My doctor is using artificial bone for this (BMP allographs). These will grow together and fuse as the patient heals. During the posterior fusion, the surgeon goes in through the back and puts in rods, with more bone graphs. My doctor uses bone from the patient, mixed with BMP graphs. My understanding of why two surgeries are performed is that this increases the likelihood of the fusions "taking" and lasting a long time.
    Hi...

    While this is the most common type of two stage scoliosis surgery, there are other scenarios. Some have posterior surgery first, followed by anterior surgery. And, many surgeons are still doing a larger, open approach for the anterior surgery.

    The most common reason for two stage surgeries is to free up an inflexible spine (by removing discs), so that a better correction can be attained.

    Regards,
    Linda

  8. #8
    Join Date
    May 2005
    Location
    Wheeling, WV
    Posts
    1,105
    Hi Patty,

    For me the anterior surgery consisted of removing 5 discs, a rib and some hip that lasted about 5 1/2 hours. The second posterior surgery involved the realignment and placement of the rods and screws that took about 9 1/2 hours for me.

    I assume it depends on how long the fusion is. I personally, didn't want anyone to operate on me for 15 hours straight.

    We all have scoliosis, but to different "degrees"!!! None of us are the same, as far as what our backs look like, or what procedures the doctor's we choose take.

    I really think if having surgery is the decision you have made, and you have have choosen a surgeon you trust, you have to go with their decision on how to do it.

    Shari

  9. #9
    Join Date
    Feb 2007
    Posts
    251
    Thanks, for the replys,

    I understood my Dr. to say he would do the Anterior to remove 3 discs and I believe he said that would give more flexibility in the spine for the posterior. He said he would be placing the robs from T4 - L4. I think he said this would take 6-8 hours.

    What I'm wondering now is by removing the bottom 3 discs does that make both curves more flexible or just the bottom? I was told that my bottom curve is very flexible and the top curve is very stiff.

    When I go back in April for a pre op I already have 3 pages of questions...

  10. #10
    Join Date
    Sep 2005
    Posts
    97

    Hi Patty..

    Who is your doctor?

    Quote Originally Posted by sccrm08
    Thanks, for the replys,

    I understood my Dr. to say he would do the Anterior to remove 3 discs and I believe he said that would give more flexibility in the spine for the posterior. He said he would be placing the robs from T4 - L4. I think he said this would take 6-8 hours.

    What I'm wondering now is by removing the bottom 3 discs does that make both curves more flexible or just the bottom? I was told that my bottom curve is very flexible and the top curve is very stiff.

    When I go back in April for a pre op I already have 3 pages of questions...

  11. #11
    Join Date
    Aug 2006
    Posts
    32
    Quote Originally Posted by Shari
    I assume it depends on how long the fusion is. I personally, didn't want anyone to operate on me for 15 hours straight.
    Shari
    Dr. Boachie-Adjei said he draws the line at twelve hours for the combined anterior-posterior. My guess is that both the fatigue of the surgeons and the effect on the patient are limits.

    Believe it or not, Dr. B does one of these combined operations every Tuesday when he is on his normal schedule. It is routine for him. He took a break of about an hour and a half between the stages as my wife was prepared for the posterior, came and talked to me, and probably had lunch. All in a days work.

  12. #12
    Join Date
    Feb 2007
    Posts
    251
    Hi Ken,

    The surgeon is DR Bains at Oakland Medical Center.

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