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Problems After Spinal Surgery - Crankshaft

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  • #16
    I've been gone for a while and am therefore a little late responding but wanted to add this: When Alexander's surgery was suggested, I was very concerned about the possibility of crankshafting occurring because of his young age (esp. because boys may have up to 10 years of future growth following a fusion at age 12). Three out of four of the surgeons we interviewed strongly recommended only a posterior fusion. They all insisted that the risk of crankshaft phenomenon was so small as to be barely there anymore with the new instrumentation. They said that the pedicle screws went in so deeply that they effectively prevented the crankshaft from being able to occur.

    Maybe because Elysia's surgeon was only able to use hooks and not screws, she was at a higher risk for what, prior to pedicle screws, was a fairly common phenomenon with young fusion patients.

    Regardless of the cause though, I am so sorry that Elysia may need surgery again. I really hope that her lumbar curve stabilizes on its own and the crankshaft mellows out too. I still approach each follow-up appointment practically holding my breath while we await the x-ray result so I can relate to what you're going through with this (6+ years of watching, waiting, bracing).

    Best Wishes,
    Laurie

    Mother of Alexander & Zachary:
    Alex is 16 years old and in the 11th grade. He has congenital scoliosis due to a hemivertebrae at T10. Wore a TLSO brace for 3 1/2 years. Pre-op curves were T45 & L65; curves post-op are approx. T31 & L34. Had a posterior spinal fusion from T8 to L3 on 7/12/07 at age 12. Doing great now in so many ways, but still working on improving posture.
    Zach is 13 years old and very energetic.

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    • #17
      Carmel,
      Thanks for that, but unfortunately I still don't get it
      I have had a close look at the spinal cord and it joins front and back, there are no separate segments, so i still don't understand how if the posterior is anchored down with rods, then the front can still curve, unless it's pulling the rods with it, in which case what's the point of having the rods, if they're not going to hold a curve, whether that curve is moving front or back...and further to this, if it's the front of the spine that curves, why not just place the rods in front, or does that not make a difference?????

      LIsa
      Mum to Tahlia, aged 15. Fused from T2 - L3, 18/11/08.

      Comment


      • #18
        Originally posted by laurieg6 View Post
        (snip)They all insisted that the risk of crankshaft phenomenon was so small as to be barely there anymore with the new instrumentation. They said that the pedicle screws went in so deeply that they effectively prevented the crankshaft from being able to occur.
        Okay that makes sense. I didn't know why our surgeon was able to rule out crankshafting even when Savannah had a very low Risser. I think he knew he was able to us mostly screws with her and therefore crankshafting would be highly unlikely.
        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."

        Comment


        • #19
          Originally posted by Kitty View Post
          Carmel,
          Thanks for that, but unfortunately I still don't get it
          I have had a close look at the spinal cord and it joins front and back, there are no separate segments, so i still don't understand how if the posterior is anchored down with rods, then the front can still curve, unless it's pulling the rods with it, in which case what's the point of having the rods, if they're not going to hold a curve, whether that curve is moving front or back...and further to this, if it's the front of the spine that curves, why not just place the rods in front, or does that not make a difference?????

          LIsa
          Imagine a balloon half blown up between two boards. You put a vise clamp on one end which keeps the distance between the two boards at that side constant. Then you blow up the balloon some more. The balloon will expand at the unclamped side and push the boards apart there.

          The vertebra are the boards and the balloon represents growth at the top and both of each vertebrae which continue to grow at the non-clamped side because nothing is stopping it. The balloon/vertebrae don't continue to grow at the clamped/fused back part because the pressure of the fusion holding the vertebrae together doesn't allow it.

          Anterior fusion is harder as I understand it and they collapse a lung. I don't think they can put rods on the anterior side... I think they put shorter segments on the side of the spine (and still call it anterior for some reason).

          The fact that the spine crankshafts and doesn't just break the fusion in multiple areas tells you the rods/screws/fusion tend to hold very well. It's also why 95% of kids don't need any physical restrictions after fusion surgery.
          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."

          Comment


          • #20
            Originally posted by Pooka1 View Post
            Imagine a balloon half blown up between two boards. You put a vise clamp on one end which keeps the distance between the two boards at that side constant. Then you blow up the balloon some more. The balloon will expand at the unclamped side and push the boards apart there.

            The vertebra are the boards and the balloon represents growth at the top and both of each vertebrae which continue to grow at the non-clamped side because nothing is stopping it. The balloon/vertebrae don't continue to grow at the clamped/fused back part because the pressure of the fusion holding the vertebrae together doesn't allow it.

            Anterior fusion is harder as I understand it and they collapse a lung. I don't think they can put rods on the anterior side... I think they put shorter segments on the side of the spine (and still call it anterior for some reason).

            The fact that the spine crankshafts and doesn't just break the fusion in multiple areas tells you the rods/screws/fusion tend to hold very well. It's also why 95% of kids don't need any physical restrictions after fusion surgery.
            ?????? Sorry, I still don't understand. It still does not make sense to me that the rods can't hold the spine in place (whterther front, back, side or whatever).

            Mum to Tahlia, aged 15. Fused from T2 - L3, 18/11/08.

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            • #21
              Several surgeons explain crankshaft

              http://www.iscoliosis.com/faq.html?i...=What%20is%20a
              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."

              Comment


              • #22
                sharon, that is the site i quoted in my earlier post, but they DO NOT explain the inability of the rods to prevent the crankshafting.
                Mum to Tahlia, aged 15. Fused from T2 - L3, 18/11/08.

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                • #23
                  Back in 1986 (at the age of 10) I had an anterior release and fusion followed by a posterior fusion with a Harrington Rod implanted two weeks later, to correct my thoracic curve. This was done to prevent crankshaft phenomenon, and my thoracic spine has been rock solid and stable ever since.

                  I'm very surprised to hear that younger children don't routinely have anterior procedures in order to prevent crankshaft. If the growth plates aren't affected then the front of the vertebrae can continue to grow despite the fact that the backs are tethered - it's simple really. Mine were removed so the fronts of the vertebra fused together as well as the backs, and my thoracic vertebra look quite small on x-rays because they're the same size that they were when I was 10.

                  NB I did spend 6 months in a post-surgical plaster cast and then 6 months in a TLSO which must have aided the uninstrumented anterior fusion process. These days I guess that anterior instrumentation would negate the need for this.

                  Comment


                  • #24
                    Originally posted by Kitty View Post
                    sharon, that is the site i quoted in my earlier post, but they DO NOT explain the inability of the rods to prevent the crankshafting.
                    Oh sorry. My memory is not what it used to be.

                    sharon
                    Last edited by Pooka1; 12-26-2008, 06:18 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."

                    Comment


                    • #25
                      Thanks everyone for the input!!! Been a little while since I checked back in.

                      But after exhaustive research into crankshaft - YES - it is definately happened because Elysia was Risser 0 at time of surgery and surgeon was unable to use the new Pedicle screws and had to use hooks because her pedicles were just too small.

                      The million dollar question is why the heck doesn't pedicle size show up on X-rays, cat scans, MRI's - he obviously did not know that he would come across this problem prior to having her opened up on the operating table. Perhaps the best thing to have done would have been to close up and come back another day and perform the double surgery of Anterior Release and then the Posterior fusion.

                      Very depressing to watch this re-run of the last 18 months of our lives - not to mention poor Elysia and how this all will affect her, but I guess we'll all live through it again.

                      But - not to put anyone off from having the surgery - just one of those things to be sure and investigate thoroughly with your childs surgeon if they are Risser 0 or 1 before agreeing to the surgery and then everything should be fine for them.

                      I'll check back in after our next appointment in June and fill the forum in on what Elysia's progress is then.

                      Cheers and regards to everyone
                      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.

                      Comment


                      • #26
                        Del,

                        Are you saying the surgeon didn't know ahead of time that he couldn't use screws?

                        I thought they can get very accurate sizes of thing from the radiographs these days using an x-ray opaque standard scale but maybe I'm wrong.

                        Wishing you and Elysia the best.

                        sharon
                        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."

                        Comment


                        • #27
                          Oh Del! Somehow, I missed this before. My heart goes out to you and Elysia. What a dreadful shock, just when you thought it was all behind you.

                          Immi's surgeon has always said he wants her to be as near to maturity as possible before he operates - she's still a dot so it looks like we'll have a few more years of Spinecor (hopefully). What has happened to Elysia will definately keep me asking questions.

                          Thinking of you!

                          Laura xx
                          Last edited by RugbyLaura; 01-19-2009, 08:04 AM.
                          UK based Mum of Imogen, 38 degree curve at 9 years old. SpineCor since 15/6/07, 31 degrees in brace.
                          10th December 07 - 27 degrees, 23rd June 08 - 26 degrees, Feb 09 - 24 degrees, Aug 09 - 35 degrees, Jul 10 - 47 degrees, Dec 10 - 50+ degrees.
                          Surgery due to take place early December 2011 at the RNOH, England.

                          Comment


                          • #28
                            Originally posted by RugbyLaura View Post
                            (snip) she's still a dot [...]
                            Made me chuckle.
                            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."

                            Comment


                            • #29
                              Dell- I was really sorry to read your post too. Keep us up to date on what goes on. Hugs, Susie
                              71 and plugging along... but having some problems
                              2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
                              5/4/07 posterior 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
                              10/2018 x-rays - 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

                              Comment


                              • #30
                                Yep that's right Sharon!! He Obviously had no idea!!! I want to ask him at our next appointment why pedicle size doesn't show up on x-rays - but what's the point now??? Or perhaps it DOES show up but he didn't think to check it - maybe he's never come across very tiny pedicles before!!!!

                                Plus I know that there is surgical techniques in the states that allow surgeon's to use special instrumentation to allow for tiny pedicles - Dr Betz at Shriners does this! I've seen it on his website.

                                Thanks everyone for your good wishes and prayers - Just when we thought it was safe to go back in the water!!!!!


                                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.

                                Comment

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