Has anyone seen or discussed this?

[Bish]

Thought it was quite interesting. Does anyone know if she has a web site or email? It would be interesting to see how she is doing. Bish

http://www.vancouversun.com/health/H...444/story.html

[Jimbo]

Currently only available for thoracic scoliosis, unfortunately.

Anyways, I think I am going to like my scar

[Vali]

I remember reading that article last year. I recently read up on MISS and quite frankly, whilst I am all for 'moving forward', I'm not fussed about my scar, nor the time it took for me to recover. The surgeon whom i read about, says that, MISS surgery is indicated for :-
Cervical and Lumbar herniated discs
Degenerative Scoliosis
Cervical and Lumbar spinal stenosis and lateral recess stenosis
Spondylolithesis

Wonder why only degenerative scoliosis?

[jrnyc]

sounds like what Dr Anand does in CA...which he does for all scoli, including lumbar...especially 3 small incisions...and..i think really important things about minimally invasive are...No Cutting of Muscles...and Little to No Blood Loss!...and waaaaay less trauma to body!! the smaller incisions, in my book, is the icing on the cake.....but that is just my viewpoint...

i want to find someone who does less invasive for my lumbar problem for the major reasons...especially no cutting of muscles!!

jess

[txmarinemom]

Thought it was quite interesting. Does anyone know if she has a web site or email? It would be interesting to see how she is doing. Bish

http://www.vancouversun.com/health/H...444/story.html

Although I hope they continue to work on development of minimally invasive fusion, I'm bothered by a few things in this particular article.

1) Many fully invasive (at least thoracic posterior short segment) fusion patients are up walking the next day. Some may go to ICU if they've had complications, but quite a few of us don't. I spent about 30 minutes in PACU while I came out of anethesia and they got my room ready.

At 6 six weeks post up, I was certainly up walking - and smiling. I'd already walked a 5K, had been released to drive for 3 weeks, and was getting ready to head to a bike rally. Granted, I got more tired than usual ... but I was absolutely mobile and enjoying life.

2) Although it wasn't specifically stated, the article tends to slant modern (not MISS) surgery as more similar to the girl's Mom's experience. We're *many* years away from post-op casts - and Stryker beds (unless you're like TiEd, and between A/P surgeries).

3) Everything above is comparing an adult, open surgery to a teen who had minimally invasive. Consider the fact that kids/adolescents typically bounce back MUCH faster than us.

One thing I wonder as I keep hearing about MISS: As with an open approach, they *still* have to fuse the spine. Whether the rod and screws are placed percutaneously or via open exposure, the primary purpose of hardware is to sculpt the spine in situ - and then hold the spine until fusion is complete. Yes, to some degree, it reinforcement for later, but I'd almost call that a secondary function.

In traditional posterior surgery, the vertebrae are scraped (the body's response to injury is new bone growth), BMP (if used) is laid down, and grafting material is packed.

Does anyone have a clue how they perform this in MISS?

I'm not trying to be critical of it (and I'm certainly not advocating open approach as the long term preferred option), but does anyone else wonder how this approach can be possibly be as *accurate* as current methods?

I went back and looked at my surgery, and seeing all that was done, this question really plagues me...

Regards,
Pam

[txmarinemom]

... The surgeon whom i read about, says that, MISS surgery is indicated for :-
Cervical and Lumbar herniated discs
Degenerative Scoliosis
Cervical and Lumbar spinal stenosis and lateral recess stenosis
Spondylolithesis

Wonder why only degenerative scoliosis?

Vali,

My guess is because "degenerative scoliosis" typically relates to an issue that structurally affects a smaller area of the spine - and thus, correction requires a short segment fusion. Although degenerative scoliosis can be a secondary condition to existing scoliosis, it can also be a direct result of other issues.

Conditions like osteoporosis, wedge/burst fractures, and disc degeneration that allows listhesis (A/P or lateral slipping of the vertebral bodies) can cause it. If the small structurally damaged area can be repaired, I believe the scoliosis can effectively be eliminated in cases where the curve only exists due to spinal collapse.

Regards,
Pam

[Pooka1]

Wow Pam voiced several points I was thinking about.

Kids bounce back that quick or quicker than that girl in the article with open posterior fusion. The majority of them it seems. Also, Pam's recovery is more like a teenager's than an adult's so adults bounce back as quick or quicker also as she stated.

Neither of my kids went to the ICU. I only realized this when visiting the second kid after surgery and said I knew where the ICU was because my other kid was there too. They looked quizzical that my other kid went to the ICU and then told me the area was the recovery area, NOT the ICU. They were there a few hours, some of which was simply waiting for the regular room. What the heck do I know what these areas are called?

After reading Linda's comments about why early minimally invasive, video assisted, whatever procedures failed, I do not think trying to save muscle is worth it. Muscle heals... having to do a revision for lack of meticulously preparing the bone surfaces so that a fusion is almost certain to occur is far more important to me for my kids... I can't imagine a revision for lack of a fusion especially given what the surgeon said about the rate of pseudoarthrosis in kids. I am not so sure I would be that sure in a minimally invasive procedure from what I can glean... I'm probably missing important facts.

And cutting muscle didn't prevent my kids from getting back to school in a timely fashion.

[txmarinemom]

After reading Linda's comments about why early minimally invasive, video assisted, whatever procedures failed, I do not think trying to save muscle is worth it. Muscle heals... having to do a revision for lack of meticulously preparing the bone surfaces so that a fusion is almost certain to occur is far more important to me for my kids... I can't imagine a revision for lack of a fusion especially given what the surgeon said about the rate of pseudoarthrosis in kids. I am not so sure I would be that sure in a minimally invasive procedure from what I can glean... I'm probably missing important facts.

And cutting muscle didn't prevent my kids from getting back to school in a timely fashion.

OH! I can't believe I forgot this ...

I actually wrote Hanson the other day: After my own surgery, recently taking A&P I / A&P II, and currently knee deep in a semester of Kinesiology, I wanted an explanation of what was severed during surgery and was retracted.

I basically asked him that - and if things *were* severed, how were they reattached. SO much converges at both the spinous and transverse processes. Although I have my surgery photos, it's extremely difficult to see muscle.

He wrote back:

"When we expose the spine, there is a midline area where the erector spinae muscles coalesce and attach to the spinous processes. The interface between them is a fibrous layer called the fascia; the midline fascia is divided and the erector spinae muscles are then peeled back from the bony spine bilaterally. So, nothing is really severed.

After the surgery is done, the midline fascia (and erector spinae) are then sutured back together with interrupted sutures."

How cool is THAT to know?

Pam

[Pooka1]

That's very cool! Never knew any of that!

But for me, the bottom line is that if a revision is necessary, it is almost certain to be open. So whatever risk a person takes with minimally invasive, they are almost certainly looking at an open revision. Maybe Linda will dope slap me if that is wrong.

[txmarinemom]

Agreed, Sharon.

This is something entirely different from a surgery (i.e., VBS) where fusion doesn't occur. A newer incarnation of a technique (previously laid by the wayside) - where the only fix is full on revision - isn't something I'd personally consider.

To each their own.

[Vali]

Pam, i had exactly the same thoughts. I didn't go to ICU either - from recovery straight back to my room. Lost minimal blood. OK my muscles
did turn to moosh, but having played sport all my life, i knew how to get those back. I walked the next day - a few steps in the morning, progressing to walking the hospitals halls that evening. No point comparing fossilised apples with fresh apples, what about the in-between? Sorry all, don't mean to sound MEAN, but this stuff worries me, especially for parents who have a ahrd time making a decision for their child and then read stuff like this!

[txmarinemom]

For Vali ...

I just stumbled upon a good explanation of why MISS works for degenerative scoliosis ...

http://www.medicalnewstoday.com/articles/171912.php

[Pooka1]

I'm not fussed about my scar,

My one kid who was fused in October was so not fussed that she just bought a dress for the winter dance at school that exposes 95% of the scar (T4-L1). She wasn't looking for a dress that would do that; She just happened to like this dress and didn't care about the scar exposure.

Since it is still red, she will put foundation on the scar to make it less noticeable though so as not to cause a commotion.

[jrnyc]

Hey everybody
i posted earlier today....then i left to travel to manhattan to see my pain doctor for botox shots in my thoracic area...
....& in my post, i meant to say the smaller SCARS are the icing on the cake...the smaller incisions are what allows for less cutting, thus less muscle damage...etc

but i am referring only to what i learned from seeing dr anand in person out at cedars sinai....i do not know anything about what this doctor in vancouver does...

dr anand told me that he thoroughly cleans out the discs when he goes in with the 3 small side incisions...then he places the "spacers" between the discs....instead of using "cages"....the rods, screws, BMP, etc, all go in a few days later with the longer incision in the back....

he was very clear that he uses this minimally invasive procedure..his particular minimally invasive procedure...on ALL cases..not just thoracic...that was basically why i flew 3000 miles out to see him (& 3000 back...my spine did not appreciate either flight in either direction!!) i wanted to ask him if he thought such a procedure would work for my low lumbar problem...he said "absolutely!"....

i am going to see my nyc surgeon mid march & discuss all of this with him...

jess

[Vali]

I just stumbled upon a good explanation of why MISS works for degenerative scoliosis ...

http://www.medicalnewstoday.com/articles/171912.php

Thanks Pam. Very interesting article.