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Thread: pre-op testing

  1. #1
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    Jun 2004
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    Boston, MA
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    pre-op testing

    Should there be concerns if your surgeon only order ct scan, and bending x-rays, and he's not ordering other pre-op tests as "i am young and healthy" - i am almost 40 yrs old.

  2. #2
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    Apr 2007
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    Sydney - Australia
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    Hey Mish - that question could have been written by me 7 weeks ago for Elysia.

    After reading online about ALL the tests, a friend in another state here in Australia actually telling me all the tests his daughter just had for her Scoli surgery - I was just as SURPRISED as you are as to just the MRI and bending x-rays. (And mind you those bending x-rays had been done almost 8 months earlier - they weren't even current ones!!!!)

    I asked about blood tests?? reply - in hospital day before surgery. Test for spinal cord monitoring for base line???? reply - no only when she's under as it hurts. Donate blood??? - reply - no we use cell-saver. Ahhhhh - it was at this point that I came to the obvious conclusion that no two scoli patients, surgeries or doctors had the same requirements or methods and just go with the flow.

    So maybe to put yourself at ease - ask the question to him - why not???

    It was all rather strange to me at the time as well but in the end I just put my faith in our surgeon that he knew what he was doing.

    So whilst Elysia was a 13 year old child - it was the same for her as you!

    Good luck - when's the surgery??

    Cheers
    Del
    Elysia 16 in Feb 2010
    Sydney - Australia
    Feb 2008 Fused T5-L1 and 5 ribs removed.
    Dec 2009 - Crankshafting
    Dec 10 - Revision surgery...3 vertebrae taken down, hooks removed, at T11-L1 - screws inserted, fusion extended down to
    L3 using Pedicle screws, some rib removed to try to derotate. Praying for things to settle.

  3. #3
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    Oklahoma City, OK
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    Quote Originally Posted by mish
    Should there be concerns if your surgeon only order ct scan, and bending x-rays, and he's not ordering other pre-op tests as "i am young and healthy" - i am almost 40 yrs old.
    Hi mish,
    I began seeing my scolio surgeon in August and since then, I've had an MRI on all 3 spinal regions, bone density scan, myelogram, CT scan and before my surgery in mid-June I will also have to see a cardiologist and pulmonologist. I'm assuming there will be a variety of blood tests much closer to the surgery date.

    Honestly, I'd be concerned and I would definately take Del's advice and ask your surgeon 'Why Not?" You and I are pretty close to the same age (I'm 45), and while I'd be flattered by being considered young, I'd be much more comfortable knowing my doc had as much info as possible pre-op.

    Good luck and keep us posted.
    Becky, 46 years old
    Diagnosed at 13 with mild scoliosis
    Ignored until 448/07
    Left thoracic 49* T5-T11
    Right thorocolumbar 60* T11-L4
    Surgery Monday, June 9, 2008 Oklahoma Spine Hospital
    Fused T-10 to L-5
    14 titanium pedicle screws
    Corrected to approx. 10* YEA!!!
    Email

  4. #4
    Join Date
    Nov 2003
    Location
    PA
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    360
    Hi mish,

    I'm glad you asked this question. My doctor didn't mention any pre-op testing either except x-rays. Maybe he'll address this at my next appointment in a couple of weeks. I'm guessing that it wouldn't hurt to ask for an EKG and lung function test if you're concerned (I'm definitely going to ask to have those done even if he doesn't think I need them).

    Shell
    Chemist, 30

    1998- 18 degrees
    2003- 33 degrees
    2005- 37 degrees
    2006- 44 degrees
    May 2007- 47 degrees
    December 2007 - 50 degrees X-ray

    Surgery May 27, 2008
    Fused T1 to L2
    Curve corrected to 15 degrees X-ray

  5. #5
    Join Date
    Oct 2007
    Location
    Indiana
    Posts
    1,978

    variation...

    Yup, this is another of those where they all seem different... I needed to get surgical clearance from my family doctor about a month before my surgery. Then, at my pre-op appointment at the hospital (different than my pre-op appt. with my surgeon) I had a few tests done... spine x-rays, chest x-rays, blood work, urinalysis, EKG, vitals, etc. I don't remember it real well, but I know there was a hospital doctor that gave me an exam and took my medical history. My MRI (complete spine) was from about 5 months before-- and no CT scan or other major testing.

    mish--if you have concerns about this, then please let your doctor know. Just say you're a little worried or concerned about whether your body is up to handling the surgery, and could you have (whatever tests) done to make sure you're fit, so you'll have peace of mind...

    All of these surgeries are major-- but the extent of the fusion factors in, with really long fusions and any other "extras" being done -- making for a LONG time in the operating room. I believe there is more stress on us the longer we are under anesthesia.

    Best wishes on this adventure!
    67 and plugging along...
    2007 52 w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15
    CMT (type 2) DX in 2014, progressing
    NEW 10/2018 x-rays show spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  6. #6
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    Houston, TX
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    Quote Originally Posted by mish
    Should there be concerns if your surgeon only order ct scan, and bending x-rays, and he's not ordering other pre-op tests as "i am young and healthy" - i am almost 40 yrs old.
    Hi, Mish ...

    About 3-4 weeks before my surgery I did my autologous donation and then headed to Methodist Hospital for my pre-op.

    I'm also "almost 40" (not that it bothers me, I'm just wondering when the *hell* that happened!) ... my birthday's in July.

    I'd already had cervical and lumbar MRIs (to check for degeneration above and below the planned fusion area) back in Dec. '07 (when I decided to have surgery), so those weren't part of pre-op.

    Same with x-rays. I had a series done in Dec. '07. We knew my curve was stable, so this wasn't even an issue. It had never progressed in adulthood.

    Actually, all my pre-op involved was:

    • at least 1000 questions about my medical history (you know you've had toooooooo many surgeries when you routinely write "see back of page -->" or simply write "ask me."); and
    • normal instruction on NPO, meds to stop 10 days before surgery, and what meds to NOT take the morning of surgery (for instance, my Adderal XR was not necessary - LOL!); and
    • a consult Anesthesia to devise an aggressive, effective pain management plan (I have an abnormally high tolerance to pain meds); and
    • discussion of necessary pre-op antibiotics (I required oral Bactrim for a week prior to surgery, and IV Vancomycin during/after surgery due to a history of MRSA infection; and
    • giving up 3 more big tubes of blood after I'd already just donated a pint. Thank goodness I'd force hydrated the days prior in anticipation (I donate blood regularly, and if I don't do this it takes *forever* to bleed!)


    That was it.

    Regards,
    Pam
    Last edited by txmarinemom; 03-28-2008 at 09:44 AM. Reason: .. oops - Del reminded me of something!
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  7. #7
    Join Date
    Nov 2007
    Location
    Big Bear, CA
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    290
    At 46 my pre op consisted of a spine xray, chest xray, minor blood work, meeting with anesthesia, meeting with hospital intake people, ekg and short medical history meeting. I had done an MRI (I think, but it could have been a CT scan) a few months prior. No blood donation on my part. I had already stopped my meds a few months prior to prepare for surgery, so that wasn't an issue.
    Geish
    47 years old, dx at 13
    +30* to the right, +60* to the left, +30* to the right
    Surgery 12-13-07 - fusion from T4 to sacrum.


    http://www.scoliosis.org/forum/attac...tachmentid=267 Pre surgery
    http://www.scoliosis.org/forum/attac...tachmentid=268 Post surgery
    http://i156.photobucket.com/albums/t...s/DSC01091.jpg Xray from the side
    http://i156.photobucket.com/albums/t...1089-1-1-1.jpg Xray from the back

  8. #8
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    Mar 2008
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    New Bern, NC
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    loves to skate

    Hi Mish,
    I see you are from Boston. Who is doing your surgery and how extensive is it? I would think that some blood tests would be in order, a CBC to make sure you are not anemic, a baseline Chemistry profile and a Type and Antibody screening in case you need blood transfusions. If you have never had a blood transfusion or children, then the Antibody screen wouldn't be necessary until and if you needed a transfusion after the surgery. Maybe he is planning on doing blood work the day of surgery. A cell saver was used in my surgery 4 months ago and I still needed transfusions in addition to the two units from the call saver. Of course, I was 67 at the time of my surgery, but in very good health. When in doubt, it is always better to ask the Doctor why certains tests are not ordered. I also had the bending xrays, an EKG, and a urine analysis.
    Good luck, Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  9. #9
    Join Date
    Jun 2004
    Location
    Boston, MA
    Posts
    51
    Thank you everyone for responding. I am a bit concern, but to say he's not doing pre-op is invalid. I am having pulmonary function test, CT Scan, bending x-rays, and also banking 3 units of blood, but when i asked about 'other' pre-op tests, he said there won't be any, because i am 'young and healthy'. I remember others who posted in this forum discussed other pre-op tests, and that got me concern.

    The EKG, urine test, blood work, meeting the with anesthesia - were these done on the morning of the surgery?

    Loves to skate - my curve is slight over 100 degrees, since i haven't had the Scan done, he's guessing it might be T-3 (or higher) to the sacru. Fortunately, i have no pain, which is why i put surgery on the back burner. However, recently, i have a slew of problems (bloating, shortness of breath, heart palpitation ect) and thought they are scoliosis related. The pulmonary specialist confirmed i've lost some lung volume (compare to the one he did in 2004).
    To be honest, the thought of surgery bring me to tears. I don't have high tolerance for pain, and recovery will be difficult as i also have Polio. My Dr. is Paul Glazer, at the Beth Isreal Deconess.

  10. #10
    Join Date
    Nov 2007
    Location
    Big Bear, CA
    Posts
    290
    Quote Originally Posted by mish

    The EKG, urine test, blood work, meeting the with anesthesia - were these done on the morning of the surgery?
    I had all of my pre op taken care 2-3 weeks prior to surgery. I had just enough time to donate 2 units of blood, but it would have required 2 more trips out to LA to do the donating, so I opted to not donate my own blood. A round trip for me would take 4-5 hours barring any traffic and it just wasn't worth it to me. My drive home from the hospital after surgery was 4 1/2 hours with traffic and weather.
    Geish
    47 years old, dx at 13
    +30* to the right, +60* to the left, +30* to the right
    Surgery 12-13-07 - fusion from T4 to sacrum.


    http://www.scoliosis.org/forum/attac...tachmentid=267 Pre surgery
    http://www.scoliosis.org/forum/attac...tachmentid=268 Post surgery
    http://i156.photobucket.com/albums/t...s/DSC01091.jpg Xray from the side
    http://i156.photobucket.com/albums/t...1089-1-1-1.jpg Xray from the back

  11. #11
    Join Date
    Aug 2007
    Location
    Auckland, New Zealand
    Posts
    185
    I had x-rays, and bloods. That's all! I never visited the hospital and got shown around, no ward visits, nothing! When I was a teen I had a MRI, but not since then. I came out fine! Not too traumatised!
    1994 curve at age 13, 70 degrees, untreated
    2000 Anterior fusion with instrumentation T9-L2, corrected to 36 degrees, 14 degree angle between fused and un-fused thoracic spine.
    2007 26 degrees junctional scoliosis
    Revision surgery, 6th December 2007 T4 to L3, Posterior approach.
    msandham.blogspot.com

  12. #12
    Join Date
    Mar 2008
    Location
    New Bern, NC
    Posts
    1,445

    loves to skate

    Hi Mish,
    All my pre-op testing was done 6 days before surgery. I wasn't able to donate my own blood as I came down with a nasty cold 4 weeks before surgery. I would imagine if you pass the questionaire for donating your own blood and the hemaglobin test, then you are not anemic, so one less thing to worry about. The Deaconess Hospital has a good reputation so you should be OK. Your Doctor probably has information about you from your primary care physician so try not to worry. You will be carefully monitered during surgery.
    I hope this helps a bit. Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  13. #13
    Join Date
    Mar 2008
    Posts
    74
    Thanks, Mish, for initiating this great discussion! When I had my first fusion, I was 43, and had the same pre-ops you are describing, minus the pulmonary function tests. I didn't meet with Anesthesia till the morning of surgery, as I recall. This surgery took only 3 1/2 hrs.

    Now that I am 49, and will have a revision on April 8, it is a whole different ball game...myelogram, CT, Cardiolite stress test, pulmonary function, bone scan, and enough bloodwork for 6 people! This surgery is expected to take 6-8 hours, so I am sure that's partly the reason for the work-up. It is good to read about what tests everyone's had so far.

  14. #14
    Join Date
    Oct 2005
    Location
    Chicago north suburb
    Posts
    772
    Hi Trish,

    May I ask why you require a revision six years after your original surgery? The prospect of having to undergo multiple surgeries remains my greatest fear about scoliosis surgery.

    Chris

  15. #15
    Join Date
    Mar 2008
    Posts
    74
    Sure, Chris. It's a good question...I'll PM you so as not to hijack Mish's thread.
    Posterior fusion T5-L1 May 5, 2003-age 43
    Posterior revision, thoracotomy,fusion T2-L2 April 8, 2008-age 49
    Fusion extension C1-L2 evacuation left pulmonary effusion May 9, 2008, age 49
    www.buggfamily.blogspot.com

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