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Thread: Problems After Spinal Surgery - Crankshaft

  1. #1
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    Problems After Spinal Surgery - Crankshaft

    Hi folks,

    Well for all you who followed Elysia's progress prior to Surgery in Feb this year - you will be aware of how concerned I was at the time that she was being fused with a Risser 0. She had a compensatory curve in her lumbar of 23 degrees and we hoped by having this surgery on her Thoracic that the lumbar would sort itself out.

    Surgery was successful and she was fused T5-L1 with 5 ribs removed. June 08, 5 months after surgery and her x-ray looked beautiful.

    In the last few months - problems started. I noticed Elysia's hips out of line again and her chest development prominent on one side.

    Our x-rays last week and subsequent Dr appointment confirmed my fears. Her lumbar is now curving and her spine is crankshafting!

    At this stage we're back playing the scoli waiting game again and will see our surgeon in June 09 to see what is happening, but things don't look too promising. Elysia has only started menses and will have by all accounts another 2 years of growth.

    Our surgeon is suggesting that he may have to try removing her hooks (she did not have pedicle screws, all hooks as her pedicles were just too tiny for the screws and too risky to use) and inserting some screws through her fused spine to try de-rotate her and also to extend her fusion down into her lumbar region. Very scary stuff as this will be no text book scoli surgery but a more complicated and I presume more dangerous procedure.

    Am wondering if anyone has come across this before and what things I may need to be concerned about regarding a second surgery on my child.

    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.

  2. #2
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    OMG so sorry to hear that. Danielle as well had the thorasic done in the hopes that the lumbar was still flexable enough to straighten itself out. All is well so far just had surgery 4 weeks ago looking good. Although she has had her period for 2 1/2 years so hopefully that will be the difference. I can not imagine how you feel one surgery was enough poor thing. I will be thinking of you
    Catherine
    Mom of 14 year old Danielle
    T45 degree curve Feb 2008
    T47 degree curve May 2008
    T50 degree curve Sept 2008
    Surgery Nov 24th 2008
    Ontario, Canada

  3. #3
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    Oh geez, Del, I'm so sorry.

    I'm guessing it is a good thing that only hooks were used previously. It just seems like it would be easier to revise than with screws but I don't know that.

    I am so, so, SO tempted to email this question to our surgeon and report back but I don't think he will answer because it doesn't concern Savannah's case.

    Good luck. Maybe it will stabilize. Or maybe stapling or some other option besides extending the fusion right away is still an option.

    I'll be thinking of you.

    Best regards,
    sharon
    Last edited by Pooka1; 12-22-2008 at 08:09 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  4. #4
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    Quote Originally Posted by Pooka1 View Post

    I am so, so, SO tempted to email this question to our surgeon and report back but I don't think he will answer because it doesn't concern Savannah's case.

    Sharon, maybe it would be worth asking your surgeon anyway, perhaps as a hypothetical. You can always play ignorant, pretending you don't know and you've heard this is a possibility whether it's relevant to your daughter's case or not. I just think it would be interesting to hear what he'd say and the I guess the worst he could do is like you say, not respond, but at least you've tried.

    Cheers,
    Lisa

  5. #5
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    Quote Originally Posted by Kitty View Post
    Sharon, maybe it would be worth asking your surgeon anyway, perhaps as a hypothetical. You can always play ignorant, pretending you don't know and you've heard this is a possibility whether it's relevant to your daughter's case or not. I just think it would be interesting to hear what he'd say and the I guess the worst he could do is like you say, not respond, but at least you've tried.
    It's a good suggestion but unfortunately, I've already asked him about it because when we pulled the trigger on the surgery decision, Savannah's Risser was 0 or 1 (I can't recall exactly). He said crankshafting would not be an issue for Savannah but didn't say why.

    I'm thinking either he suspected her Risser would rise enough by surgery or he just thought some other aspect of the bones would not predispose her to crankshafting, or something else. I don't know. Just guessing.

    And again, he is batting 1000. At the 7.5 month checkup, her Risser had maxed out, her growth plates are closed, and she is done growing. And there was no change in the spine between a few days after surgery and 7.5 months.

    It may be the amount of bone mass. Savannah has all screws except two hooks on the upper left that I think are there to anchor the large de-rotation they did where screws might pull out. And after reading something Ti Ed wrote, I think they are there for some kyphosis correction also.
    Last edited by Pooka1; 12-22-2008 at 08:44 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Del--

    I'm so sorry to hear about this. My son was also fused at Risser 0. However, his fusion is already much longer than Elysia's. What is happening to her is something we all have or have had on our minds for our own children, and our hearts are with you. Please keep us posted.

    Mary Ellen

  7. #7
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    What is crank shafting? Is that when the curve progresses outside of the fused area? So does that mean she may require a longer fusion?

    I'm sorry that you have to deal with this.

    Karen
    ******************

  8. #8
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    Crankshafting is when the spine continues to grow after fusion. Because the growth is uneven front to back, it results in twists and curves of the spine. It is only an issue with a low Risser because at a high Risser, little grow can occur to distort the spine.

    I think that's close. Someone correct me if I'm wrong.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    http://www.pediatric-orthopedics.com...scoliosis.html

    About 2/3 of the way down (or just search the page for "crankshaft."

    Apparently, an anterior fusion is done to avoid crankshafting per a very cursory scan of this material.

    It sounds fixable but it required taking down the posterior fusion, doing an anterior procedure and then redoing the posterior.

    That's sounds like a revision I would want done by someone who has done several before.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #10
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    I'm confused. Is what Del is describing a new (or progression of the) curve in the unfused lumbar spine? Or is it curving of the fused portion of the spine in the anterior? It seems to me these are two different things. The first would result from (for whatever reason) not fusing low enough to begin with. The second would result from the anterior side of the fused section of spine growing, while the posterior side does not. Am I correct? Am I missing something? Can anyone clarify?

    Mary Ellen

  11. #11
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    My guess is you are correct... I think Del is saying Elysia has both issues, two different issues which may or may not affect each other. I think you can have crankshafting without curve progression and you can have curve progression (in unfused areas) without crankshafting.

    Anybody know if that is correct?
    Last edited by Pooka1; 12-22-2008 at 02:16 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #12
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    Decompensation (curving above or below the fused spine) and crankshafting are 2 different things, but compensatory decompensation can result from crankshafting (and become structural without correction).

    I don't think Elysia's issue is that she wasn't fused over a larger area, WNCMom ... it's that she was posteriorally fused (permanent fusion vs. expandable) at a Risser 0.

    Crankshafting is a very real possibility when that much potential growth remains.

    Hang in there, Del!

    Pam
    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

  13. #13
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    I believe this description may help clarify the phenomenon of crankshafting, which I copied from iscoliosis.com


    This is what happens when you have a posterior spinal fusion at a young physiologic age with significant growth remaining. The posterior fusion acts as a tether to growth on the posterior part of the spine, while the anterior part ( the side of the spine facing the lungs in the chest and the intestines in the abdomen) continues to grow. The result is that the spine spins around the posterior tether like a crankshaft, causing the scoliosis to recur even though the spine has already been fused.



    What I don't get is how they can separate front and back - I thought the spine just grew as one. And therefore if you've got rods anchoring the spine down, that should be that. But obviously it's not and my previous thinking on this was very naive, to say the least.


    Lisa

  14. #14
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    Lisa,

    As I understand this...

    Only the back of the spine is fused in a posterior approach. The front of the spine is neither fused with new bone nor anchored by the rods and so is free to continue to grow.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  15. #15
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    Lisa,

    Each vertebrae are a 3-dimensional object - front, back and sides. This is why scoliosis treatment is so complex - the vertebral bodies are complex. Add in the soft tissue surrounding the bone structure, and you have even more things to complicate matters. By fusing only the posterior portion (back side, closest to the skin on the back) you have risk of problems just like Elysia has developed. Her spine wants to grow vertically. The posterior part can't, since it's fused solid, but the anterior/front part still has growth potential/soft tissues to grow. If they grow too much, it can cause problems like crankshaft (rotation of the spine, asymmetry of the torso, even pseudoarthrosis (failed fusion)). This is not a common occurrence, but when its your child, it's a huge concern.

    Your comment about the rods anchoring the spine are true - the rods are anchoring the BACK (posterior) part of the spine but the rods are not influencing the front portion of the spine. With a Risser zero, this is a chance many parents and surgeons must take when agreeing to posterior-only surgery.

    HTH
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

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