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Thread: Types of revision surgery

  1. #1
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    Apr 2004
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    Massachusetts
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    Types of revision surgery

    I'd like to hear from any of you who have a large fusion from the 70's or earlier and have had revision surgery. I was fused from T4 to L4 in 1974 at Children's Hospital Boston.

    The disc in L4/L5 is bad and L5/S1 as well although not as severe. I also have spinal stenosis. I am considering surgery. One plan presented is to add on a new rod and just fuse the spine the rest of the way to the sacrum. This would leave the old fusion alone and essentially just extend it.

    Another plan involves cutting into the old fusion to create a lordotic curve. The reason of course that the two lower levels are now bad is because of the way they did the fusions way back when. They overcorrected and I have no natural curve. I hesitate though to cut out pieces of that old fusion. I've talked to a patient who had that successfully done.

    I have 2 second opinions lined up for the first week in Oct. Any comments from people who have had additions put on to a large fusion?
    M.

  2. #2
    Join Date
    Apr 2004
    Location
    new jersey
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    Hi,
    Age can have an influence on your decision ; and in my opinion if U R going 2 have surgery , than do it the right way. I believe correcting the lordotic curves is a smart move.
    CONNIE


    Surgery June 28th 2004
    fused T4 -L3
    Hip graft
    Grown 1 1/2 inches
    25/o upper T 15/o
    53/o T 15/o
    37/o L 6/o
    Dr. Micheal Nuewirth
    New York City

    August 6, 2004
    Pulmonary Embolism
    complication from surgery

    January 2007 currently
    increasing pain at the T4/5
    point irratation heardwear

  3. #3
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    Sep 2003
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    Northern California
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    Hi M...

    Have you been diagnosed as having flatback? If it were me, and assuming that flatback had been diagnosed, I would opt for the more extensive surgery.

    I have some references on my website that might be of some assistance to you:

    http://www.scoliosislinks.com/FlatbackontheInternet.htm

    Also, there's a YahooGroups list for people with flatback:

    http://health.groups.yahoo.com/group...ioFlatbackers/

    Good luck with your decision.

    Regards,
    Linda

  4. #4
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    Dinwiddie,VA
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    Hi, I had my surgery in 1989 and another just this past March to have a piece removedat the very end. I also have the same 2 discs as you do that are bad and have possible nerve damage to my hip and right leg. They are not sure what is causing the pain the discs or nerve damage. Do you experience leg and hip pain as well? My pain management doctor says he doesn't recommend having the rod extended to that area. He has been doing many injections but they don't seem to work either. Maybe we both can get some answers. Take care!

  5. #5
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    Apr 2004
    Location
    Massachusetts
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    thanks to all for the replies. The web links Linda suggested are great. I have some studying to do!!! I have two more appointments for second opinions coming up the first week of Oct. Many times the whole deal is knowing what questions to ask. I didn't ask the first doctor if I have flatback syndrome. I am 46 years old. I have tried the injections (which helped for a while) and I have done physical therapy 4 times with different therapists. So I think I have pretty much exhausted my other options. My pain centers on the lower back and some pain radiates to the hip and the outside part of the left ankle. I don't have any upper back pain. I'm grateful for the forum. Information is key to decision making.
    M.

  6. #6
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    Jul 2004
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    Dinwiddie,VA
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    You are quite welcome. Age I don't think matters when you are in pain 24/7. I'm only 33. please let me know what you find out with your second opinions. Just maybe they will help me out as well. Thank you!

  7. #7
    Join Date
    Apr 2004
    Location
    new jersey
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    hi,

    It retrospect, age does make a difference..U did not give your age...U could have been 75 or older..In a case like that ; a massive extensive surgery would not be in your interest...or if U are very young....your decisions of surgery can be different...but now that we know your age LOL...you can make the best discision to help you live a very long . long and active life...good luck and hope you get some pain free days!!!!!
    CONNIE


    Surgery June 28th 2004
    fused T4 -L3
    Hip graft
    Grown 1 1/2 inches
    25/o upper T 15/o
    53/o T 15/o
    37/o L 6/o
    Dr. Micheal Nuewirth
    New York City

    August 6, 2004
    Pulmonary Embolism
    complication from surgery

    January 2007 currently
    increasing pain at the T4/5
    point irratation heardwear

  8. #8
    Join Date
    Jul 2004
    Location
    Northern California
    Posts
    255
    Hi there,

    Just a note, you might have read a post of mine elsewhere so sorry for repetition. Sorry to hear about your pain. I have experienced similar pain caused by degenerative disk around L4 (low back, hip, knee and ankle etc). After trying many other things, including the injections, my MD prescribed low-dose anti-depressants for the pain. They cut the pain level in half (from about 7-8 on a pain scale to about 3-4) in about a week or two. This might be worth considering if you need to wait for surgery or even for its own sake.

    All the best for the next few weeks.
    Laura

  9. #9
    Join Date
    Apr 2004
    Location
    Massachusetts
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    HI

    I'm back again with more questions about data on revision surgery. Linda: your links were excellent. The article by Keith Bridwell that showed two types of osteotomies was very helpful. Where can I research data on osteotomy outcomes? I noticed a new post from a patient from Ireland with the same question: What is the complication rate for these osteotomies and what is the outcome data?

    I had one second opinion today from an ortho. surgeon who advised against the osteotomy. He said the complication rate is 30-50%
    My old fusion stops at L4 (T4-L4) and he says that 70% of the back's lordosis is between levles L4 and S1. He says I've lost a little curve in the L2-L4 area (particularly L3) but is that worth messing with in view of the complications of this surgery? That's his point of view. I have another second opinion on WEds. of this week. Is there any place to search for current data on osteotomy success and risks?
    M.

  10. #10
    Join Date
    Oct 2004
    Location
    massachusetts
    Posts
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    M....Just trying to keep up to speed...in sept you wrote
    "I had one second opinion today from an ortho. surgeon who advised against the osteotomy. He said the complication rate is 30-50%
    My old fusion stops at L4 (T4-L4) and he says that 70% of the back's lordosis is between levles L4 and S1. He says I've lost a little curve in the L2-L4 area (particularly L3) but is that worth messing with in view of the complications of this surgery?

    I am also fused to L-4 and in the final days of deciding on who to do surgury with...I have two opinions but I have never heard it put as you have been told. In fact, both are proposing osteotomies...

    Question is, can you share who told you this, and did you hear anything new on your third opinion? Thanks...cam

  11. #11
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    Sep 2003
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    Northern California
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    Hi Daddy's Girl...

    Sorry, I didn't read your most recent post until today. I have abstracts for a bunch of outcome studies on my website:

    http://www.scoliosislinks.com/Outcomes.htm

    Also, you can do your own PubMed search here:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

    Since osteotomies can be done in various parts of the body, I suggest that you use SPINE OSTOTOMY OUTCOME as your search words.

    Regards,
    Linda

  12. #12
    Join Date
    Apr 2004
    Location
    Massachusetts
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    Hi

    I just came back on the board today and noticed a message from cammaltby. Also, thank you Linda. I will reply here to both. I am in the Boston area. I saw Dr. Howard Martin who is an orthopedist and an excellent doctor but advised against the osteotomy. I had also seen Dr. Eric Woodard (neurosurgeon)whose plan did not include an osteotomy. I have decided to do the osteotomy with Dr. Paul Glazer (ortho Beth Israel Hosp). I will have surgery Nov 29. I thought his point of view made more sense. It will be a Smith Peterson Osteotomy. The whole plan is rather complex. He will extend the present fusion to S1 (anterior approach) He will then do a posterior approach and cut off the end of the present fusion and do the osteotomy etc. He is breaking it up into two surgeries taking place the same week. It was one of the most difficult decisions I have ever made. PubMed was helpful. Two articles proved useful: Complications and Predictive Factors for the Successful Treatment of Flatback Deformity. Booth et al (Spine Vol 24, N. 16 pp1712-1720 1999) and Functional Outcome and Radiograhic Correction after Spinal Osteotomy (Ahn et al (SpineVol 27 n12 pp 1303-1311 2002) I also read Prevention and Management of Iatrogenic Flatback Deformity by Potter et al ( The Journal of Bone and JOint Surgery, 2004

    To be honest -- I am scared. I am holding on emotionally but the stress is getting to me anticipating this surgery and recovery. It is like life is happening but I am removed from it. I know that this is going to be OK and that it will be healing for me but at the same time it is a big deal.
    M.

  13. #13
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    Oct 2004
    Location
    massachusetts
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    M. & Linda....thanks for the reply.....I will look up the info but I am confident that the docs I am speaking with are aware of the limitations of the osteotomies.....or the reasons for doing them.

    I just wanted to verify that there wasn't new information coming out....I can certainly see why a surgeon that wasn't doing this kind or surgury often would no, or should not undertake it.

    And of course that is why Linda is constantly reminding us to verify that our surgeon have the kind of experience a revision requires....it's more that just a good "scoli" surgeon, at least that is what I have come to believe. I am not surprised that the most experienced revision surgeon you consulted is going to do one!

    M. It sounds like you are about three months ahead of me in the process and in some ways I wish it was me and I was going to get this behind me. At this point with the holidays upon us I won't schedule until Jan/feb. Nonetheless I know the feeling of anticipation and nervousness. Now that energy is directed toward choosing the doctor....but after that.....it will be may sleepless nights I am sure!

    I live out on Nantucket and have seen Dr. Rand in Boston and Dr Boachie in NYC. Both are proposing the same surgery as you are undergoing....the main difference is Rand does a two stage and Boachie does the whole encilada in one day....assuming the patient can pass the physical. At 48 I am thinking I could.

    One thing that I think is interesting is that if you read the Adult "First Timers" postings. alot of them have had anterior posterior surgery....and come through it very well. And they don't seem to have as much anxiety about their decision to go ahead. I suspect, for us, we feel a bit untrusting about the whole thing since we were sold a bill of goods by the medical profession before. The reality, however, is that generally our chances for a decent outcome are as good as theirs....at least that is the way I read it.

    So, enjoy Thanksgiving and expect the best. Before you know it you will be like many other posters....on with your life and off this board! Thanks for the information and the very best wishes.. Cam





    I

  14. #14
    Join Date
    Sep 2004
    Location
    north Georgia
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    Hi Daddysgirl, I haven't checked in to this forum for a while, but I happened to read your posting. I am in a similar situation, physically. I would be very interested to hear how the surgery goes, as would everyone else, I'm sure.
    My thoughts are with you,
    Camille

  15. #15
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    Aug 2005
    Location
    Valley Forge,PA
    Posts
    10
    Quote Originally Posted by daddy's girl
    I'd like to hear from any of you who have a large fusion from the 70's or earlier and have had revision surgery. I was fused from T4 to L4 in 1974 at Children's Hospital Boston.

    The disc in L4/L5 is bad and L5/S1 as well although not as severe. I also have spinal stenosis. I am considering surgery. One plan presented is to add on a new rod and just fuse the spine the rest of the way to the sacrum. This would leave the old fusion alone and essentially just extend it.

    Another plan involves cutting into the old fusion to create a lordotic curve. The reason of course that the two lower levels are now bad is because of the way they did the fusions way back when. They overcorrected and I have no natural curve. I hesitate though to cut out pieces of that old fusion. I've talked to a patient who had that successfully done.

    I have 2 second opinions lined up for the first week in Oct. Any comments from people who have had additions put on to a large fusion?
    I had a fusion in Boston Childrens in 1972. I AM facing the first situation you described,extended fusion . I can hardy walk. The pain from my sciatica is diabilitating. I am suppose to have the surgery soon.Mary Parris

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