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Thread: What is revision?

  1. #1
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    What is revision?

    Sorry for the newbie question, but I had my surgery in 1983 (T2-L4) when I was 12, and haven't been following the field at all.

    I've read that people are having their rods removed? Can you do that? My Luque rods are inside my spine, so I'm guessing I'm stuck with mine.

    So can someone tell me about revision, so I can at least understand what you're all talking about.

    Thank you,

    Brad

  2. #2
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    Hi Qikdraw! Welcome to the forum! Briefly, I believe revision surgery is any surgery that is necessary after the initial spinal fusion surgery. It could be to remove hardware (and usually the rods are attached to the spine by screws or hooks, etc.-- and so can be removed if need be); or for additional (improved?) correction-- maybe something needs "tweaking" and isn't quite right. Also, additional procedures may be done due to a balance problem, stenosis, degenerative disc disease, etc. Revision could also be for adding on to the original fusion (above or below the present fusion) or to re-do the fusion due to pseudarthrosis (failed fusion); or for any other reason that more work needs to be done. I hope that helps! Maybe someone else has more (or better) thoughts on this as well.
    66 and still heartbroken...
    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
    2014 DXd w/CMT (type 2)

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

  3. #3
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    Ah thank you, for the welcome and the info!

    degenerative disc disease
    Is there anything that can be done with this yet? Can they replace discs yet? Like with a piece of rubberised foam or something? I'm pretty sure this is what I have and would like to see it fixed.

    Brad

  4. #4
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    Replacement disc

    Brad.

    I was told that for individuals who have a fused spine, a replacement disc is not an option. The forces that would be placed on it are too great and they will break. It is only approved for single level (maybe 2 levels) replacement for people who have never had a prior fusion.

    I am having a revision because of degenerative disc disease. My fusion will be extended from L3 to S1.

    p

  5. #5
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    Quote Originally Posted by PNUTTRO
    Brad.

    I was told that for individuals who have a fused spine, a replacement disc is not an option. The forces that would be placed on it are too great and they will break. It is only approved for single level (maybe 2 levels) replacement for people who have never had a prior fusion.

    I am having a revision because of degenerative disc disease. My fusion will be extended from L3 to S1.

    p
    Well that is not very good news. If I extend my fusion I'll lose a lot more mobility than I have now. I really do not want to do that if I can avoid it. You're sure they just can't stick a piece of rubber in there?

    Brad

  6. #6
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    Well, if you ask nicely. . .

  7. #7
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    Quote Originally Posted by PNUTTRO
    Well, if you ask nicely. . .
    LOL!!!!

    Post of the month!!!!!!!!!!!!!

  8. #8
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    I was told that I may have degenerative discs, but that they could do nothing for me at this time because they would have to fuse my only two open vertebrae at the bottom of my spine causing me to be immobile. So for now they are taking out the hardware and refusing a spot that didn't fuse the first time and hoping I don't have any disc problems. So I think at this time the only solution to bad discs is fusion. But maybe someday they will come up with some rubber

  9. #9
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    Actually that is not the case. It wasn't until my 3rd spine surgery (and third set of hardware) that I had almost all of my lumbar disks removed and replaced with 8 titanium mesh cages (L2-L5 disks replaced). With that surgery it was a total (3-stage) spine revision surgery (T5-Sacrum) (posterior/anterior/posterior) with several osteotomies and titanium mesh cages to stabilize the spine and give me a lordosis because of failed spine surgeries and flatback syndrome. Along with the cages of course was the rods, etc. The cages were inserted anteriorly and filled with bone from several ribs, etc since I could not have any more bone taken from my hips because of previous surgeries. There is no way that these cages break. They replace the disks that were once there to stabilize. They are there for life.

    1981-Harrington/Luque instrumentation T9-L5 for 30 degree thoracolumbar curve.
    1990-Revision surgery-Broken hardware/flatback deformity/pseudoarthrosis-Cotrel Dubousett instrumentation with extension into sacrum.
    1995-Revision surgery-Severe flatback deformity/kyphosis-Moss Miami instrumentation (T5-sacrum) with titanium cages (back/front/back procedure), thoracoplasty, total reconstruction with osteotomies. (surgeon did surgery while coming down with chicken pox and developed encephalitis with brain damage, etc during 14 hr surgery)
    2005-Car accident-spinal cord injury/myelopathy from top of rods/hooks at T5. Decompression surgery to remove hardware, with exception of cages. Permanent damage.
    2008-5th surgery pending for severe stenosis in cervical spine, as well as lumbar spine because of prior surgeries.



    Quote Originally Posted by PNUTTRO
    Brad.

    I was told that for individuals who have a fused spine, a replacement disc is not an option. The forces that would be placed on it are too great and they will break. It is only approved for single level (maybe 2 levels) replacement for people who have never had a prior fusion.

    I am having a revision because of degenerative disc disease. My fusion will be extended from L3 to S1.

    p
    Last edited by Shelgrl66; 07-12-2008 at 03:21 AM.

  10. #10
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    Quote Originally Posted by Shelgrl66
    1981-Harrington/Luque instrumentation T9-L5 for 30 degree thoracolumbar curve.
    1990-Revision surgery-Broken hardware/flatback deformity/pseudoarthrosis-Cotrel Dubousett instrumentation with extension into sacrum.
    1995-Revision surgery-Severe flatback deformity/kyphosis-Moss Miami instrumentation (T5-sacrum) with titanium cages (back/front/back procedure), thoracoplasty, total reconstruction with osteotomies. (surgeon did surgery while coming down with chicken pox and developed encephalitis with brain damage, etc during 14 hr surgery)
    2005-Car accident-spinal cord injury/myelopathy from top of rods/hooks at T5. Decompression surgery to remove hardware, with exception of cages. Permanent damage.
    2008-5th surgery pending for severe stenosis in cervical spine, as well as lumbar spine because of prior surgeries.

    Am told that this will be how I will have to live the rest of my life-in and out of hospitals. So far 28 yrs and counting. Word of advice...leave surgery as your VERY LAST OPTION...in other words if it means being paralyzed or death, but do not take surgery lightly. It is NOT going to *take away pain*. It only creates MORE pain and problems. Most everyone has scoliosis to some degree. THIS life is NOT fun folks! I would rather be dealing with just the scoliosis.
    "Most everyone has scoliosis to some degree."???

    No, Shelgrl ... they don't. Scoliosis is a curvature over 10, and the stats say only 2-3% of the population has it. Please cite your sources (pretty much for all you said - outside your own experiences you infer are common).

    I can't ignore this negativity any more. You obviously had some issues (but then again look at Harrington/Luque, C-D, Moss-Miami ... EARLY instrumentation - mostly shyte hardware, long term ... 1st and 2nd generation), and just plain bad luck. And you blame your surgeons ... but you kept going back. (I see you have removed the surgeons names now. Wasn't it 3 with Shufflebarger and 2 with Shelokov? Correct me if I'm wrong. If you thought they were SO jacked up, why keep seeing them?)

    YES, surgery's a last resort, but I will NOT let your circumstances indicate some norm for newbies. It is NOT the norm (to anyone lurking).

    I'm sorry you had issues, but you need to put them in perspective HERE. I do NOT have more pain post-op (I have MUCH less). Nor do most I know.

    Also, I'm very experienced in elevated intracranial pressure (mine was 5-7 times normal for 45 days due to unexplained communicating hydrocephalus - you can see my VP shunt - never revised, still in place after 29 years - in my x-rays), so that's neither here nor there.

    Best regards,
    Pam
    Last edited by txmarinemom; 07-11-2008 at 02:35 AM.
    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


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  11. #11
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    Quote Originally Posted by Shelgrl66
    Am told that this will be how I will have to live the rest of my life-in and out of hospitals. So far 28 yrs and counting. Word of advice...leave surgery as your VERY LAST OPTION...in other words if it means being paralyzed or death, but do not take surgery lightly. It is NOT going to *take away pain*. It only creates MORE pain and problems. Most everyone has scoliosis to some degree. THIS life is NOT fun folks! I would rather be dealing with just the scoliosis.
    Shelgrl66, I am so sorry for all you've got through, you've definitely had more than your share of bad luck. But like txmarinemom, I am worried that others reading this may think your outcome is the only one possible after surgery and that just isn't the case.

    I ended up having surgery at age 14 after having upper back pain for several months and was starting to have some issues with my lungs. I was pain free after that surgery for many years and led a very active life - team sports, cycling, running. I have a Harrington rod, so it's not the newest instrumentation. I herniated my L5/S1 in 1999 by lifting something too heavy the wrong way, but after several months of physiotherapy, I was back playing sports and leading my active life pain free. Unfortunately, I've herniated it again, but physiotherapy is starting to kick in and I'm confident I'll be back to my old self soon (and I am pretty much pain free right now - just trying to regain my flexibility).

    If I hadn't had the surgery when I did, I would have some serious lung issues now. By having the surgery, I pretty much regained my original lung capacity which has led to me having an active life. The surgery also completely eliminated my upper back pain - the only pain I have dealt with in the past 18 year is when I herniated that disc in my lower back.

    Shelgrl66 - I really hope they find a solution to your back problems and pain. It seems so unfair to have to live like that and I can understand you wanting to give others a warning about surgery. I just wanted to balance that with the other side of the coin. Take care.

    - Sarah
    - 39 years old
    - At age 14, curve progressed from 45 degrees to 62 degrees in two months.
    - Surgery in 1990 at the Children's Hospital of Eastern Ontario (CHEO) with Dr. Letts. Fused T5 to L2. Corrected to about 30 degrees.
    - Harrington rod
    - Herniated disc - L5/S1 - January 2008. Summer 2009 - close to making a full recovery.
    - New mommy as of February 2011
    - Second child - September 2013
    - Staying relatively painfree through physio exercises!

  12. #12
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    I have problems with disc segeneration above and below my fusion. They are letting the discs dissolve on thei own and treating the pain in the mean time. I was told that the 3 in my thorasic area are in "no man's land" as in no man in their right mind would risk operating there because of having to move the heart and lungs. I have had a couple of nerve ablations to stop the radiating pain around my ribs. As for the disc at the base of my spine, it is fusing on its own.
    T12- L5 fusion 1975 - Rochester, NY
    2002 removal of bottom of rod and extra fusion
    3/1/11 C5-C6 disc replacement
    Daughter - T7 - L3 fusion 2004

  13. #13
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    Artificial disc

    Quote Originally Posted by Shelgrl66
    Actually that is not the case. It wasn't until my 3rd spine surgery (and third set of hardware) that I had almost all of my lumbar disks removed and replaced with 8 titanium mesh cages.
    Shelgrl66. I'm sorry if I wasn't clear. I thought that the question was regarding an artificial disc, one that is placed between the vertebrea and moves like a natural disc. These are contraindicated in people with a fused spine.

    Technology may improve over the next 10-15 years that could make it available later. I just couldn't wait that long.

    pc

    PS TXmarinemom--I realize the use of vague verbs.
    Last edited by PNUTTRO; 07-11-2008 at 04:19 PM.

  14. #14
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    txmarinemom:

    There are many people out there that have scoliosis that do not even know it. They go undiagnosed for the most part because schools don't even pick it up. Many people do have a curvature to some degree, as noone's spine is totally straight. 10 degrees isn't actually much and wouldn't really even show up unless you had an xray. I was even told by many neurosurgeons and the fact that only 10 percent actually ever needed the surgery in the first place. That's NOT to say that yours or anyone else's surgery was not needed. I get outraged, however, when these scoli doctors are taking in these teenagers and giving them surgeries when so many are not needed, especially without trying other alternatives. Let me tell you, I was not with just ANY surgeon..as he was the top 3 in the world at the time. He is known all over. He also helped invent the CD and Moss-Miami instrumentation. I also found out the other side to all this and found out how they scheduled people as if they were having hair appts. (that's not to say they're all like that) There was a conversation that I can't get into on here that the RN herself told me about. After decades of research I found out the other side to all this, hence why I stress to others that they should also see a neurosurgeon before any of these surgeries. You only hear the good side before you have these surgeries. They tell you that the hardware can never break or become dislodged, etc. Totally false. They also don't tell you what can happen if you are involved in a car accident with hardware or like myself, someone hitting me from behind. He told me I could do anything I wanted to, including having children no problem. (that's another story) People need to hear both sides and do more research, as there is PLENTY of information available nowadays. I don't care if my hardware isn't the newest in technology to some areas, as believe it or not, these were all new at one time (some not that long ago and still used) and over time they will find out problems with what is out there now. Some of the people that had surgeries back before me are doing better than some of those that have had newer procedures, as back then they weren't taking people in for these procedures as if they were making cars on the assembly line.

    As for your question in regards to WHY I continued to go to him, well let me tell you that there WERE NO other options, as noone else would take me and take over what another surgeon has messed up. They basically told me all these years that I am either *too complex* and I was told they don't want to get involved. I can't even go to the emergency room if I have a problem because they don't know what they are looking at. The liability is also not something anyone wants to take on. I was basically STUCK going back. I am still to this day having a hard time finding someone and I could go paralyzed from leaving it once again. When I was in my car accident in June 05, because I had to search all over again, the surgery wasn't done until Nov 05 and then the damage was irreversible. I was also taken by this other guy because it was my car insurance policy versus my health insurance, which no specialists took. This is the reality of the other side. Try walking over bent in an L and noone doing anything for you. There was a 5 yr span in between the 2nd and 3rd surgery because that was how long I had searched until I couldn't take it any more and went back out of desperation. Because of the searching however, it caused damage to my lungs. It wasn't my fault that I was put in this position. I'm not the only one out there that is going through this and am tired of the discrimination put on me and others because we weren't a success story. We have JUST as much right to speak as the next person. Not only are we discriminated against in the healthcare field, but also by employers and insurance companies. You have to either go without care, which I had so as to not lose my job. When I was married, my ex had lost his job because of using his insurance for this, and most recently while on intermittent FMLA because of my problems, I was also let go. I never saw Shelokov, nor do I know who he is. I also want to know why it is that you are turning this around as if I'm the bad guy here, much like that of an abused spouse. Again, there are plenty of people like myself out there..I know people across the country like this going through the same thing, as you meet many people after 28 yrs of *dealing* and pretending to everyone that you are ok or else you get people talking to you as you have to me. I am happy that you are doing well and haven't had to go through these kinds of experiences, but many think that by having a surgery that they will all of a sudden have no more pain. Parents are also thinking that because someone has this big title and does 200-300 of these surgeries a year, that that is a wonderful surgeon. That isn't always the case. Please check out their past malpractice suits as well.

    You asked the question so-to-speak and of course it's not going to be all positive, happy and sugar-coated, and I've left out quite a bit. I met many people from the Scoliosis Association and other organizations that had even gone through 7, 10 or more surgeries and still going BECAUSE they had so many surgeries. I wouldn't call that a success. Our bodies are just not meant to withstand all this. Trust me, after that many surgeries, your pain does not go away. If I was a parent with a child with scoliosis and had the possibility of a future surgery, I WOULD WANT to know both sides first. We have a right to know this.
    Last edited by Shelgrl66; 07-12-2008 at 03:51 AM.

  15. #15
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    Thank you, Sarah. I totally understand where you're coming from in regards to others reading, etc. Of course not everyone has this type of outcome, which is great. Every case is different in regards to what hardware is used, what levels, etc. In my case, an initial revision surgery had to be performed because of the history of the Harrington/Luque hardware on long fusions extending into most of the lumbar, creating the flatback deformity, broken hardware, etc. There are thousands out there across the globe. Having children did not help either.

    I also have found that there are far too many scoliosis surgeries going on or have gone on that were quite unnecessary or rather do not try other alternatives before doing so. Having a neurosurgeon's opinion is most helpful before having these surgeries as they understand far beyond the curve and the spine itself. I'm sure in your case surgery WAS needed and I'm glad that it helped in your situation. I hope all works out for you regarding the pain you are having and I thank you for being so understanding. We should all be there for each other instead of fighting against each other.

    Take care,
    Shel

    Quote Originally Posted by SIsForSarah
    Shelgrl66, I am so sorry for all you've got through, you've definitely had more than your share of bad luck. But like txmarinemom, I am worried that others reading this may think your outcome is the only one possible after surgery and that just isn't the case.

    I ended up having surgery at age 14 after having upper back pain for several months and was starting to have some issues with my lungs. I was pain free after that surgery for many years and led a very active life - team sports, cycling, running. I have a Harrington rod, so it's not the newest instrumentation. I herniated my L5/S1 in 1999 by lifting something too heavy the wrong way, but after several months of physiotherapy, I was back playing sports and leading my active life pain free. Unfortunately, I've herniated it again, but physiotherapy is starting to kick in and I'm confident I'll be back to my old self soon (and I am pretty much pain free right now - just trying to regain my flexibility).

    If I hadn't had the surgery when I did, I would have some serious lung issues now. By having the surgery, I pretty much regained my original lung capacity which has led to me having an active life. The surgery also completely eliminated my upper back pain - the only pain I have dealt with in the past 18 year is when I herniated that disc in my lower back.

    Shelgrl66 - I really hope they find a solution to your back problems and pain. It seems so unfair to have to live like that and I can understand you wanting to give others a warning about surgery. I just wanted to balance that with the other side of the coin. Take care.

    - Sarah

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