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Inserting rods percutaneously

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  • Inserting rods percutaneously

    I've just done a search here and nothing came up when I typed in the word "percutaneous".

    My surgery is scheduled for Monday, December 7th. I will be having rods added from T5 to L3. My doctor wants to try to insert the rods percutaneously. He says instead of one big incision down the middle of my back, he will make multiple small incisions slightly to the sides of my original back surgery scar. He says this should make recovery easier, and reduce the risk of infection.

    I'm wondering if anyone else has had rod insertion done this way?

  • #2
    Newer procedure...

    I believe this is a "newer" minimally invasive procedure. I saw Dr. Lonner in New York, a well respected surgeon here, and he would perform part of my surgery that way as well.

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    • #3
      Hi..

      This is definitely a new procedure, and there's no research on it yet. I've spoken to a few surgeons about this technique, and they both expressed concern that there could be issues of non-fusion.

      Dr. Anand's technique involves fusion from the front, thorascopically, and then fusion from the back, percutaneously. You can see pictures here:

      http://www.infospine.net/treatment-s...s-surgery.html

      The picture on the left at the bottom, shows the percutaneous approach.

      --Linda
      Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
      ---------------------------------------------------------------------------------------------------------------------------------------------------
      Surgery 2/10/93 A/P fusion T4-L3
      Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

      Comment


      • #4
        Percutaneous

        In medicine we mean percutaneous as going through the skin. This can mean an injection, a needle, or anything else, for that matter, that punctures the skin.
        Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
        Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

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        • #5
          My doc says he will access the vertebrae though the side, using the traditional, wide open approach. He plans on doing only the back surgery percutaneously.

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          • #6
            Originally posted by ShannoninPDX View Post
            My doc says he will access the vertebrae though the side, using the traditional, wide open approach. He plans on doing only the back surgery percutaneously.
            Hi, Shannon ...

            In trying to envision what you're describing, I'm a little confused. Let me see if I can lay out my thoughts where they make sense ...

            Normally, if a surgeon makes a lateral (or anterior) incision, it's to gain access to the front of the spine for disc removal. With your scenario I have no idea if the lateral approach is for the same purpose - or if you even still have all your discs.

            Anyway, aside from that, I had my surgery photographed - and seeing how they placed my hardware makes it difficult for me to wrap my mind around the percutaneous rod insertion.

            It's clear in my photos that my surgeon definitely required open access to lay the foundation for my rods (i.e., the pedicle screw constructs), and also to sculpt the rods in situ. Once all that was done, (not tiny) set plugs were placed to secure everything. While I understand your situation is (probably quite a bit) different, I can't understand how they plan to:

            A) install the hardware to hold the rods,

            B) accurately place rods inserted through the skin, especially when they go under the erector spinae, and

            C) securely anchor them without open access.

            Maybe it's possible your surgeon plans to use some existing framework of laminar clips (or whatever they used for your initial fusion): I'm not sure, however, how they know that framework is solid in light of the complications you've had.

            The biggest puzzlement for me, I think, is how they're going to lock down the rods. I mean, they can't just stick them through the skin and call the job finished, you know?

            Although I can't really visualize how, does he intend to gain access to the rods (and secure them) from the anterior/lateral approach?
            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

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            • #7
              I'm reading some stuff on it now, and it's a little more clear ... but wow ... that's a lot to accomplish without an open posterior approach.

              Wonder if they anticipate less resistance correcting your curve vs. a "normal" one (and I only mean "normal sans injury")? I just keep thinking about the pics of 4 hands cranking on me with the big rod benders ... and the tremendous force it took to bring me closer to 0°.
              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

              Comment


              • #8
                Interesting ...

                Well ... after all my confusion, I think I get it.

                There's actually quite a bit out there on the AxiaLIF technique, and there's even surgery video on the Trans1 site. If anyone wants to view, it's on trans1.com: I'll refrain from posting the link here lest anyone accidentally walk into it. Personally, I don't find it disturbing - but some might.

                Also, I see now it isn't intended as a technique to replace methods that allow for moderate to extreme correction, or long segment fusions. It does sound like it has potential promise for people unable to undergo traditional surgery and/or those at high risk with an open approach.

                Shannon, I wish you the best.

                Regards,
                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

                Comment


                • #9
                  Side incision...

                  Dr. Lonner told me he would perform the side incision with the new minimally invasive approach, but go into the back the standard way. Does anyone know anything about that approach? Thanks, Joy

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                  • #10
                    Originally posted by joyfull View Post
                    Dr. Lonner told me he would perform the side incision with the new minimally invasive approach, but go into the back the standard way. Does anyone know anything about that approach? Thanks, Joy
                    Joy, are you asking for info on the XLIF anterior approach - or the traditional open posterior approach?

                    Regards,
                    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

                    Comment


                    • #11
                      Hi Shannon

                      I always thought of the word "percutaneous" as the constant process of making coffee down at work. Oh well. LOL
                      Good luck next week.


                      Pam

                      Thanx for posting about AxiaLIF. Hard for some of us inquisitive scoli types to ignore, especially when the word "disturbing" is used to describe a video. Of course, being a horror movie fan, I felt like Danny in "The Shining" when he was told to stay out of room 237.

                      Ohhhweeeooo.......Dum,dum,dum,dum. (Thats the movie score)

                      It looks great for L5-S1. One level.....

                      Hard for a scoli to get exited, but still very interesting. Some do this as outpatient, which is incredible.

                      Ed
                      49 yr old male, now 63, the new 64...
                      Pre surgery curves T70,L70
                      ALIF/PSA 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

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                      • #12
                        I believe dr lonner may be referring to the way dr anand is doing minimally invasive in CA...is that correct?

                        jess

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                        • #13
                          I had the XLIF procedure done earlier this year, to extend my fusion one level as the disc at the bottom of my fusion had worn out (L3-L4). I also had pedicle screws placed for extra stability via a posterior incision. I can't imagine how the XLIF on its own could be usefully used for a scoliosis correction, but it was fabulous for sorting out the problem I had and recovery was very, very fast despite the additional posterior procedure

                          I have previously had an open anterior release followed by posterior fusion done on both of my curves (left thoracic at the age of 10, right lumbar at the age of 18) so I well know how hard a full anterior procedure can be! I haven't met anyone else who has had an anterior release done on both sides of a double curve, so I'd be interested to hear from anyone who has.

                          TXmarinemom, thanks for that link....I'll definitely have a look....I got my own surgeon to take photos during my surgery because I think it's all fascinating

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                          • #14
                            for aging fusions

                            Wow! If I am understanding this correctly, this is a surgical technique that holds great promise for the large group of us who may need additional surgery as we age, due to various problems eminating from the base of our fusion. Being much less invasive, it would be better tolerated by an aging body. It could be used to extend an existing fusion. Is that a reasonable conclusion?
                            1966 fusion in Buffalo of 11 thoracic vertebrae, with Harrington rod

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                            • #15
                              Julie, it's probably fair to say that. It's usually an anterior-only fusion technique that is used on its own for degenerative disc problems in people without scoliosis though. If you have scoliosis, the uneven loads on your lumbar vertebrae mean that having a traditional posterior fusion procedure will probably be recommended too, in order to keep everything stable.

                              I have sizeable scars from this last surgery, despite it being "minimally invasive", but they did re-use the existing incision sites so I haven't ended up with any new scars. The fact that they didn't need to cut through as much of the psoas muscle as they usually do really made it easier to recover though.

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