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Thread: anterior vs posteror fusion

  1. #1
    Join Date
    Oct 2003
    Location
    new jersey
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    anterior vs posteror fusion

    Just wondering if anyone has any thoughts on the different types, anterior and posterior, of surgery. I would love to hear your experiences, information, any direction you can give. We are working with doctors to decide, bu twondered if anyone had feedback.

  2. #2
    Join Date
    Sep 2003
    Location
    Austin, TX
    Posts
    61
    Hi,

    Which approach to use depends on a variety of factors, and you really need to make this decision with your surgeon. To make some broad generalizations, however:

    - The posterior approach is generally used to correct moderate thoracic curves, whereas the anterior approach is generally better for correcting lumbar curves or very stiff curves anywhere in the spine.

    - The posterior approach is generally safer and has fewer surgical complications.

    - In the hands of a good surgeon, the level of correction attainable between the two approaches has narrowed over time to approximately equal, though the anterior approach may require fusing 1 or 2 fewer vertebrae in the lumbar region, which is usually worth the slightly higher risks of that approach.

    - The posterior approach leaves a larger scar.

    Dave

  3. #3
    Join Date
    Oct 2003
    Location
    new jersey
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    Dave,
    Thanks for your reply, but I guess what I'm hoping to get from this is info from people who have had the different approaches. We've had numerous MD appointments and conversations over the last few months, but I was hoping to hear from some actual patients. Being a medical professional, I have access to all of the textbook info I need, but I haven't heard the testimonials from patients... I've only spoken with one ''anterior'' and one ''posterior''... if anyone else has info, I'd love to hear from you.

  4. #4
    Join Date
    Oct 2003
    Location
    MO
    Posts
    2
    I, as an adult, had posterior only surgery in February of 1998. My surgery was successful. I have one long scar down my back from just above the top of my shoulder blades to my waist. The scar has faded very nicely over the past 5 years. It is pencil wide at the top and a thread wide at the bottom. I, also, have a scar over my right hip in the back from where they took the bone graft to fuse my spine. It is only about 3 inches long and about a pencil width wide. Some people deal with more pain and discomfort from the graft site than they do from the incision in the back. I have no discomfort today from either site. The only remaining problem I have today, and I'm not sure I would call it a problem, is that a large area over my left scapula is still mildly numb today. I can feel pressure to the area but I cannot feel anyone lightly touch my skin. I had to have 6 rib osteotomies on the concave side of my rib cage to gain a better correction. So I attribute the numbness to the doctor having had to peel back more muscle tissue to gain access to the ribs to cut them.

    So, posterior surgery was the experience I had to go through. Anterior surgery was never even discussed in my case. I had one complication develop after my surgery. Five days after my surgery I had to have a chest tube inserted for my left lung. I developed a pnumothorax (partial collapsed lung) which was believed to have been caused by one of the cut ribs irritating the lining of my lung, allowing pockets of air to develop between the lining and the lung. Because of that I had to remain in the hospital about 5 days longer than I would have.

    My recovery after surgery was quick according to the doctor. For a 38 year old, one would normally take 12 to 18 months to feel fully functional again. I was fully functional after 5 months and ready to play volleyball again.

  5. #5
    Join Date
    Sep 2003
    Location
    Austin, TX
    Posts
    61
    I, too, had a posterior-approach surgery and thoracoplasty last December. My surgeon achieved a 78% correction of my primary thoracic curve. I had no complications whatsoever and was released from the hospital 5 days after surgery.

    My recovery was relatively quick for a 30-year old; I was driving and taking 2 mile walks in less than 3 weeks. The only thing I can't do to this day is higher-impact activities like running, jumping, etc. It's getting better but still hurts a bit.

    My long scar is still fading, slowly. I also have some general numbness along the incision line and around the right scapula where some of my ribs were resected for thoracoplasty and a bone grafting source.

    Hope this is useful.

    Dave

  6. #6
    Join Date
    Nov 2003
    Location
    England
    Posts
    1
    I've had both types of surgery for a progressive lumbar scoliosis. Initially an anterior Zielke fusion, which reduced a 46*+ curve down to 18*, but which left me 'flat-backed' and which failed after a couple of years with a pseudarthrosis and subsequent increase in curve, and pain.

    This was stabilised with a posterior Harrington rod, and (touch wood!) has been fine since. I'm now 35 and 13 years post-op.

    The first op took longer to get over, with an impressive scar (plus hip graft scar site). The second was not so bad, though again, a long scar and hip graft site on other hip!

    I've since had a baby girl, with no problems, and am expecting another in Jan 2004. I think I now have fewer back problems than many of my contemporaries, though I wonder if that is because I had to learn good 'back habits' in my teens when coping with a Boston Brace. I try to never stress my back, and I don't walk long distances as that aggravates the somewhat flattened discs below the fusion in my lumbar spine.

    Hope this helps. Happy to elaborate if required.

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