Page 1 of 2 12 LastLast
Results 1 to 15 of 25

Thread: Instrumentation

  1. #1
    Join Date
    Sep 2008
    Posts
    336

    Question Instrumentation

    I know there are various kinds of instrumentation used. Any ideas on pros/cons or how surgeons decide on what to use?

    Getting my questions lined up for next week's apt.

    Marian

  2. #2
    Join Date
    Apr 2007
    Location
    Seattle, WA
    Posts
    385
    Our surgeon chose stainless steel. He said one reason was that it was less likely to break than titanium (although it is heavier) and I've read about that too. I was leaning toward wanting titanium because of its greater flexibility and lighter weight but since Alexander still, presumably, has a lot of growing to do, I was okay going with the strength of stainless.
    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.

  3. #3
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    Hi Marian...

    I think surgeons mostly use what they're trained on, although they may pick up expertise with new implants with good results that are new to the market.

    I don't think there's any way that we (consumers) can tell what might be the best implants for our surgeries. Instead, I think the best thing we can do is find a surgeon with a lot of experience, and good references, and then trust that they'll use the appropriate implants.

    By the way, I think there are sometimes issues with insurance companies. That is, some insurance companies, will limit the amount allowed, so the surgeon may be forced to use less expensive implants.

    Regards,
    Linda

  4. #4
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    I have 6mm Vitalllium rods (a propreitary Stryker XIA system - cobalt, chromium, moly - CoChMo) alloy I've yet to see anyone else post they have this XIA (and it was placed just over a year ago). My x-braces and screws are titanium.

    It's lighter than 316 SS (or 316L SS) by far, and stronger/lighter than titanium (Ed, I'm counting on you to back up my safety factors. Hanson told me I'd most likely never snap a rod living my life as I do ;-).

    The same SS system would have weighed > 1 lb.

    Hanson estimates mine at 6 oz - T4 to L1.

    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

  5. #5
    Join Date
    Sep 2008
    Posts
    336
    Thanks for the input!

    Does the type of material make any difference in terms of infection rate either right after surgery or after?

    I was also wondering about the differences between things like Cotrel Dubosset, Moss Miami, etc.

    Keep 'em coming!

    Marian

  6. #6
    Join Date
    Jun 2008
    Location
    Mississippi
    Posts
    126
    Hi Marian,

    My daughters surgeon chose to use titanium because of her needing future MRI's. I am not absolutely sure why but I don't think you can have an MRI with stainless steel rods (maybe because of the magnet). Anyway, when he mentioned that it could interfere, we chose titanium since with her past tethered cord she has to have it checked by MRI every few years. I think we would have chose that anyway since your never know when you may need an MRI for something. It may be something to ask your doctor about. Just a thought. Wish I could explain it better but I am sure the surgeon will know exactly why.

    Sharon

  7. #7
    Join Date
    Jun 2008
    Location
    Mississippi
    Posts
    126
    Hi again,

    I googled what I said about the MRI and steel. It has to do with the magnetic heating of the steel. I found several places explaining it when I typed it in my search bar. Sorry, I am not really sure how to add a link on here. I need to figure that out I guess. Hope this helps.

    Sharon

  8. #8
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,534

    metallurgy class 101

    I agree with Linda's statement.

    The fact that hardware breaks upon pseudoarthrosis is a testament to the forces we put our backs under. With the leverage that the fused sections of the spine have above and below a non-union, just about anything can break, with the repetitive see-saw motion. A successful fusion is key here. Successful fusions have been done with Luque wires.

    One of the factors we face in metalworking, is a thing call inclusions.( I'm forgetting all this stuff ) LOL

    http://www.matter.org.uk/glossary/index.asp?dbid=210
    http://www.matter.org.uk/steelmatter...ess/5_1_2.html

    I'm sure they x-ray all the hardware to look for flaws, but that is no guarantee of 100% integrity.

    Titanium has excellent anti-corrosive properties, non ferromagnetic for use in MRIs and osseointegration. Now Pam knows why her screws were made of Ti. It is not selected for its lightness for implants.

    http://en.wikipedia.org/wiki/Titanium
    http://en.wikipedia.org/wiki/Osseointegration


    Making steel is just like cooking in the kitchen. A group of ingredients added and heated up. They will let the batch cool off into an ingot, and possibly do a vacuum arc remelt(VAR) or electroslag remelt(ESR)to remove impurities, then roll it into a bar, like using a rolling pin when you bake.

    http://en.wikipedia.org/wiki/Vacuum_arc_remelting
    http://en.wikipedia.org/wiki/Electroslag_remelting

    Medical grade stainless steels or any groups of medical grade metals or alloys go through a strict set of manufacturing parameters. BTW, we do make the best steels here in the United States. I specify only domestic made materials period.

    Exam next week folks.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  9. #9
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757

    Ed ...

    You think I can wait for a pop quiz next week? Laff. You *seriously* underestimate my ADHD.

    ... and Vitallium rods? VERY MRI-able ... even more so than Ti. Your view, por favor?

    I know why my screws were made of Ti. High shear resistance, MRI-ability ... and, LOL, compatibility with CoChMo. They don't make Vitallium screws for medical grade use ... ;-)

    Regards,
    Pam
    Last edited by txmarinemom; 02-18-2009 at 11:02 PM.
    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

  10. #10
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    Quote Originally Posted by smileyskl View Post
    Hi Marian,

    My daughters surgeon chose to use titanium because of her needing future MRI's. I am not absolutely sure why but I don't think you can have an MRI with stainless steel rods (maybe because of the magnet). Anyway, when he mentioned that it could interfere, we chose titanium since with her past tethered cord she has to have it checked by MRI every few years. I think we would have chose that anyway since your never know when you may need an MRI for something. It may be something to ask your doctor about. Just a thought. Wish I could explain it better but I am sure the surgeon will know exactly why.

    Sharon
    Hi Sharon....

    It's perfectly safe to have an MRI with stainless steel implants. However, the stainless steel makes the MRI unreadable in the area directly around the implants.

    Regards,
    Linda

  11. #11
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    Quote Originally Posted by pmsmom View Post
    Thanks for the input!

    Does the type of material make any difference in terms of infection rate either right after surgery or after?

    I was also wondering about the differences between things like Cotrel Dubosset, Moss Miami, etc.

    Keep 'em coming!

    Marian
    Hi Marian...

    The differences between posterior spinal implant systems used for scoliosis are pretty subtle. Almost all of these systems are considered "universal." That is, they all pretty much accomplish the same thing.

    I've never heard that there are any differences in infection rates between the various metal implants, and I can't imagine why there would be.

    Regards,
    Linda

  12. #12
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,534
    LOL. Pam, that was fast! I figured this thread to be quiet.

    One of the things that my surgeon was concerned with was the backing out of my screws. I guess that has been a problem otherwise Synthes wouldn't have a non-linear lead and pitch on the threads of the screw. The combination of the increasing torque to 15NM and the osseous integration or direct attachment of titanium oxide permanently fusing to the bone is the cats meow I guess. That and maybe a little gift from the hardware people?

    No test, that was just a catalyst.

    Oh no, I think Im burning pizza in my oven! roughing it tonight

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  13. #13
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Any Galvanic action going on between any of these metals and alloys?? Would it matter? Maybe it would make folks clairvoyant or something.
    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."

  14. #14
    Join Date
    Oct 2006
    Posts
    132
    I just feel like a bad mom. I didn't even ask what TYPE of metal they are using. I just figured it was standard and they use, whatever it is they usually use in spinal fusions. Similar to when we got her braces on her teeth, we used the basic ones that were recommended for her teeth. Didn't really think to ask about other kinds.

    They *might* have told me but when we found out she was having surgery, they were shoving a bunch of papers at us at the same time as they showed us x-rays of previous people and a model of how it was done. Since, I had already done my research, I 1/2 paid attention since I knew the basic concept.

    HMM....maybe I should ask when we go for our pre-op appt. next Friday.
    Becky
    Mom to DD (15) with S 48*+ curve
    Had her surgery March 9, 2009

  15. #15
    Join Date
    Sep 2008
    Posts
    336
    Hey, Becky,

    Don't feel like a bad mom. Is there an echo in here?

    I couldn't even communicate the information to the surgeon til I started throwing out terms like "Moss Miami", etc.

    He did say that he uses something called "Isola".

    Marian

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •