The "Art" of Dr. Lenke

[titaniumed]

Hi Sherie

Those are some nice looking post x-rays on Sheena. It almost looks like her lower is larger than 62, and looks like Dr Lenke took the angle off her plumb line. Without the x-ray markings, it looks like she was about 75 plus degrees prior to surgery. ??? Anyway, looks pretty good. Hope she is well.

I just cannot get over his wait time! Sheena waited 8 months, Rita 12 months, and now Joy for summer of 2011 is 18 months. Might be best to get on his waiting list, even without scoliosis.
Just in case. LOL

Sharon

Without digging, I would suspect that the procedure has to do with the "wedging" of the vert we get with large thoracic curves. I had one that was practically a triangle, and they had to skip a screw on that level. Just a hunch.

Jess

Just wondering what Dr Lonner thinks about Dr Anands procedure? Does he know you are flying out for a consult?

On the hotel, I know one thing, I will never stay at a motel 6 again. Its still only worth $6 nite, and that's with the complimentary coffee and doughnuts. What a depressing place.

If you do not book your rooms, all your options are open. I personally like to wing it, just in case I want to travel elsewhere, like up the coast, or down to San Diego. The farther you are from downtown LA, the cheaper it will be.
Ed

[jrnyc]

Hey Ed
nope, dont plan on talking to dr lonner til after i see dr anand...fly out jan 25, back the 28th...wanna stay somewhere semi-nice...no motel 6's!

i am going to contact dr lenke monday..just to see how long it could take to get in just for a consult appt.......the more i read, the more i think that maybe, just maybe, that is where i should be looking....
checked his website, still cant figure out whether they take my insurance, so that is another reason to call monday!

however..a big however...how could it work if one had surgery with dr lenke but lives in the northeast? my geography isnt too good, but sounds like that would be quite a trip back & forth for check-ups!!

i looked at the photos on his website...felt lucky compared to some of the extreme curves! one person was bent over sideways! i think i actually resemble one or two as far as my curves are concerned...

hope your new year was/is a happy one...
jess

[Pooka1]

Originally Posted by titaniumed

Sharon

Without digging, I would suspect that the procedure has to do with the "wedging" of the vert we get with large thoracic curves. I had one that was practically a triangle, and they had to skip a screw on that level. Just a hunch.

Yes I agree it has to be something with very high angle curves because that permanent neuro injury rate is not that quoted for posterior spinal fusion and is especially not that for posterior spinal fusion plus real time neuro monitoring.

That's why I asked.

It is my understanding that with the real time monitoring, the rate of permanent neuro injury is very, very small because they realize that something is happening in enough time to stop whatever they were doing and even abandon the procedure if necessary to try again another day.

This is just another reason to not let the curve get too big.

And in re screws, my one kid has two screws at almost every level but the other kids has about half the screws on one side compared to the other. It might have to do with fixing the rotation... the kid with more screws was way more rotated. Who knows. Anyway, screws, rods, etc. are completely irrelevant after the fusion occurs and can come out if necessary.

[Pooka1]

Originally Posted by jrnyc

Hi Sharon
not sure if dr lonner was referring to the "reach around" thing so 2 incisions on 2 different sides are not needed...or if it is something else...

Almost missed this post for some reason...

That could be but I thought the reference was to what Sheena had done. I'm probably confused.

Now I am curious about what procedure 35 kids had such that 3 had a permanent neuro injury. That would be something to avoid it seems!

[titaniumed]

Sharon

I believe this is it. When curves get really bad.

http://www.spineuniverse.com/display...ticle2053.html

http://www.spineuniverse.com/display...ticle1808.html

http://www.spinal-deformity-surgeon.com/vcr-paper.html


The bonus link!
Great French site with pics
http://images.google.com/imgres?imgu...a%3DN%26um%3D1

Ed

[joyfull]

Sharon, I'm not sure what procedure Dr. Lonner referred to, but when I told him about the amazing corrections Dr. Lenke has gotten such as the correction I read about here in a woman in her 50's who went from 95 degrees to 35 degrees, that was his comment.

Jess, I think you need to see as many doctors as you like until you feel absolutely confident. It is a very major decision. Good luck in CA

[Pooka1]

Originally Posted by titaniumed

Sharon

I believe this is it. When curves get really bad.

http://www.spineuniverse.com/display...ticle2053.html

http://www.spineuniverse.com/display...ticle1808.html

http://www.spinal-deformity-surgeon.com/vcr-paper.html


The bonus link!
Great French site with pics
http://images.google.com/imgres?imgu...a%3DN%26um%3D1

Ed

Oh la la! I'm going to study that French site.

And that Lenke guy is shockingly good at what he does.

[titaniumed]

Sharon,
I thought you would like that one.


Gotta love Dr Bradford...

Performing a circumferential VCR approach for severe, rigid spinal deformity was first described by Bradford in the late 1980s.(1) He was the first to describe the use of a circumferential vertebral column resection coupled with concave rib osteotomies, convex thoracoplasty, and segmental spinal instrumentation with fusion in 13 patients with severe structural spinal deformities. In 1997, he and O. Boachie-Adjei (2) further expanded on Bradford's original case series by which they reported on 16 patients undergoing a circumferential VCR. Excellent deformity correction and rebalancing of the trunk was reported with few serious complications. More recently, Suk et al reported on a posterior-only approach with a VCR for fixed lumbar spinal deformities (3), as well as for severe, rigid scoliosis. (4,5) They reported excellent surgical correction with minimal long-term complications for lumbar deformities resected around the cauda equina region, with similar results for the thoracic scoliosis patients except for one permanent paraplegia postoperative. To date, no North American clinical series has reported on this technique for the treatment of primarily thoracic-based, severe pediatric and adult spinal deformities

Where the heck has Brad been? Poor guy is probably freezing in Canada.

Ed

[Pooka1]

Originally Posted by joyfull

Sharon, I'm not sure what procedure Dr. Lonner referred to, but when I told him about the amazing corrections Dr. Lenke has gotten such as the correction I read about here in a woman in her 50's who went from 95 degrees to 35 degrees, that was his comment.

Okay I think I see what you are saying. I don't actually know what procedure(s) Sheena had but I assumed a "regular" posterior fusion. Her curve was large but not as large as some of these other cases.

Jess, I think you need to see as many doctors as you like until you feel absolutely confident. It is a very major decision. Good luck in CA

I agree with this. It's important to feel like you understand the spectrum of opinion out there. There is a wide range of opinion on some cases (not on others) and it can be confusing. A good goal is not not let the different opinions blow your mind... they will converge on the right answer hopefully.

It's easier when there is no choice it seems. At least it seems that way... I have never been in a situation where there was some choice with either kid.

[Pooka1]

Originally Posted by titaniumed

Sharon,
I thought you would like that one.

Well to tell you the truth, when you said you found a French site with pictures, my mind wandered just a tad...

Gotta love Dr Bradford...

Performing a circumferential VCR approach for severe, rigid spinal deformity was first described by Bradford in the late 1980s.(1) He was the first to describe the use of a circumferential vertebral column resection coupled with concave rib osteotomies, convex thoracoplasty, and segmental spinal instrumentation with fusion in 13 patients with severe structural spinal deformities. In 1997, he and O. Boachie-Adjei (2) further expanded on Bradford's original case series by which they reported on 16 patients undergoing a circumferential VCR. Excellent deformity correction and rebalancing of the trunk was reported with few serious complications. More recently, Suk et al reported on a posterior-only approach with a VCR for fixed lumbar spinal deformities (3), as well as for severe, rigid scoliosis. (4,5) They reported excellent surgical correction with minimal long-term complications for lumbar deformities resected around the cauda equina region, with similar results for the thoracic scoliosis patients except for one permanent paraplegia postoperative. To date, no North American clinical series has reported on this technique for the treatment of primarily thoracic-based, severe pediatric and adult spinal deformities

Where the heck has Brad been? Poor guy is probably freezing in Canada.

Ed

You know, it's easy to think the average pediatric case (adults seem more complex) is off the hook complicated to treat until you read about some of these truly difficult cases. That isn't to say these average cases are walks in the park... my first kid wasn't for some reason per the surgeon although she "only" had a 58* T curve. But these surgeons are even more amazing than I thought.

In re Qikdraw, I was thinking about him recently. I think about him every time something reminds me of what a kid thinks going through the surgery. I hope he posts again.

[Sherie]

Originally Posted by titaniumed

Hi Sherie

Those are some nice looking post x-rays on Sheena. It almost looks like her lower is larger than 62, and looks like Dr Lenke took the angle off her plumb line. Without the x-ray markings, it looks like she was about 75 plus degrees prior to surgery. ??? Anyway, looks pretty good. Hope she is well.

I just cannot get over his wait time! Sheena waited 8 months, Rita 12 months, and now Joy for summer of 2011 is 18 months. Might be best to get on his waiting list, even without scoliosis.
Just in case. LOL


Ed

I've often thought it appeared larger than other 60ish curves, but his measurements were right in line with the other 3 surgeons we took her to.
But, thanks she's doing very well now.

LOL, no kidding, his waiting time is crazy, but he does get cancellations and will try to fill them. If you're flexible with your time (we were not), then you can possibly get in earlier.

[Sherie]

Originally Posted by Pooka1

Okay I think I see what you are saying. I don't actually know what procedure(s) Sheena had but I assumed a "regular" posterior fusion. Her curve was large but not as large as some of these other cases.



I agree with this. It's important to feel like you understand the spectrum of opinion out there. There is a wide range of opinion on some cases (not on others) and it can be confusing. A good goal is not not let the different opinions blow your mind... they will converge on the right answer hopefully.

It's easier when there is no choice it seems. At least it seems that way... I have never been in a situation where there was some choice with either kid.

Yes, Sheena had a regular posterior fusion.

Dr. Lenke gets some extreme cases, there is no telling what these 3 patients conditions were prior to surgery. I specifically asked him about complication rates for AIS, it was extremely low so I'm pretty sure whatever Dr. Lonner was referring to wasn't typical posterior fusion.

[jrnyc]

Thanks, guys....I agree that i need to hear all possible opinions & options..after i see dr anand the end of this month, i am kinda curious to see if anyone..dr lonner or dr lenke, (if i can get in for a consult)..thinks i could be a "reach around" kinda case..cause the fusion i am told by all doctors that i need is L4-S1 & T11-sacrum...my fusion supposedly would need to start where some people on forum have their fusion end! i know how many people say they dont want to have to go below L4, etc...so i dont know that i could actually have minimally invasive or a "reach around" with incision on one side of body only...up to going to dr anand jan 27, every surgeon has told me "no" to minimally invasive for my case....
but i want to thank this forum & all on it..until i found it, i didnt think i had any options other than surgery or no surgery.....so "Thank you!."

we will see what we will see...

jess

[joyfull]

Originally Posted by titaniumed

Sharon,
I thought you would like that one.


Gotta love Dr Bradford...

Performing a circumferential VCR approach for severe, rigid spinal deformity was first described by Bradford in the late 1980s.(1) He was the first to describe the use of a circumferential vertebral column resection coupled with concave rib osteotomies, convex thoracoplasty, and segmental spinal instrumentation with fusion in 13 patients with severe structural spinal deformities. In 1997, he and O. Boachie-Adjei (2) further expanded on Bradford's original case series by which they reported on 16 patients undergoing a circumferential VCR. Excellent deformity correction and rebalancing of the trunk was reported with few serious complications. More recently, Suk et al reported on a posterior-only approach with a VCR for fixed lumbar spinal deformities (3), as well as for severe, rigid scoliosis. (4,5) They reported excellent surgical correction with minimal long-term complications for lumbar deformities resected around the cauda equina region, with similar results for the thoracic scoliosis patients except for one permanent paraplegia postoperative. To date, no North American clinical series has reported on this technique for the treatment of primarily thoracic-based, severe pediatric and adult spinal deformities

Where the heck has Brad been? Poor guy is probably freezing in Canada.

Ed

I was surprised to see Dr. Boachie's name here. As far as I know, he doesn't routinely perform this and did not even mention it for my 90 degree curve, but wanted to do anterior/posterior. Perhaps he thinks it too risky. It seems that Dr. Lenke caught the ball and ran with it.

[RitaR]

Not to ask a silly question here - but what does "too risky" mean? I would think if it needs to be done, it needs to be done, all with good reasons I'm sure. I was just curious. Dr. Lenke said when I saw him last July he knew exactly what had to be done and knew right away he could achieve excellent improvement significantly. I was very impressed right away when I heard that.