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View Full Version : Minimally Invasive Scoliosis Surgery Featuring George Picetti, III, M.D.



Ballet Mom
04-19-2011, 04:31 PM
.

http://www.youtube.com/watch?v=CsHyG_gE2gU


I think the scars that remain after these minimally invasive surgeries are truly impressive.

Should my daughter continue to progress to a surgical level for some reason I would definitely have a consult with this doctor, and Dr. Newton in San Diego. They seem to be the top, expert, pediatric minimally invasive scoliosis surgeons that I can find in California.

If anyone knows of other top pediatric surgeons specializing in this technique, I'd be very interested in hearing about which ones they are.

jrnyc
04-19-2011, 07:11 PM
how old is your daughter?...for some reason, i didn't think she was within pediatric doctor range...

yes, i think minimally invasive will definitely be the future of scoli surgery and disc surgery! i wish more folks on forum were interested in watching videos on the subject...many here seem to be convinced that it can't work for large curves, can't work for lumbar curves, etc, when they haven't even investigated it!! i do not understand rejecting new procedures without knowing anything about them!

i don't know what age Dr Neel Anand at Cedars Sinai goes down to for patients...he only uses minimally invasive approach now for ALL his scoli surgeries...he told me that a year ago January....& that is for ALL size curves, all locations of curves...he now considers "old" scoli surgery "unnecessary cutting and trauma to nerves and other tissue"

best of luck with whatever you and your daughter decide, if/when it comes up for discussion...

jess

CAmomof2
04-19-2011, 08:40 PM
I am very interested in this for our daughter. I know in Canada they do it at the
BC Children's and in Montreal. I hope it becomes the way of the future.

jrnyc
04-19-2011, 09:52 PM
i honestly believe it will...i personally think minimally invasive is of interest to all kinds of surgeons, for surgery in all different areas of the body...the same way arthroscopic surgery of the knee, gallbladder, and other organs became popular...
it is now do-able for all size curves in all areas of the spine, according to Dr Anand

jess

Elisa
04-19-2011, 09:55 PM
I had a look at that video back sometime in November when I joined this forum. I must have looked at fifty or more u-tube vids on scoliosis. Looking at it again, is that just one rod or am I just not seeing the second one?

Pooka1
04-19-2011, 10:00 PM
I had a look at that video back sometime in November when I joined this forum. I must have looked at fifty or more u-tube vids on scoliosis. Looking at it again, is that just one rod or am I just not seeing the second one?

That's an anterior procedure. They use one rod on one side.. As I understand it, they can fuse less levels so that is important in curves that go into the lumbar. I don't know why the posterior is considered the gold standard and not the anterior. Linda will know. So will Dr. K. Maybe you can ask him.

Despite your son's large curve, it was well confined to the thorax so saving lumbar levels wasn't on the table which is a good break to catch after all he went through.

Ballet Mom
04-19-2011, 11:02 PM
how old is your daughter?...for some reason, i didn't think she was within pediatric doctor range...

yes, i think minimally invasive will definitely be the future of scoli surgery and disc surgery! i wish more folks on forum were interested in watching videos on the subject...many here seem to be convinced that it can't work for large curves, can't work for lumbar curves, etc, when they haven't even investigated it!! i do not understand rejecting new procedures without knowing anything about them!

i don't know what age Dr Neel Anand at Cedars Sinai goes down to for patients...he only uses minimally invasive approach now for ALL his scoli surgeries...he told me that a year ago January....& that is for ALL size curves, all locations of curves...he now considers "old" scoli surgery "unnecessary cutting and trauma to nerves and other tissue"

best of luck with whatever you and your daughter decide, if/when it comes up for discussion...

jess

My daughter will soon be turning 16 but she is still growing. Pediatrics typically goes to age 18 but I think it's a bit flexible. My kids' pediatrician said he'd gladly take care of them into their early twenties, which I'm very happy about.

I think Dr. Anand is talking about a different type of minimally invasive surgery than the one I have posted here. I think he uses the following type set-up instead of endoscopic, and the scars are much more pronounced following the surgery.

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

From what I've read, the endoscopic minimally invasive surgery that Dr. Picetti does in the video I posted is really restricted to smaller, flexible thoracic curves with perhaps a compensatory lumbar curve. I've read only 20% of scoliosis surgeries could be done this way. But it's a start. I'd love to find more information about the endoscopic surgeries, but the information about it seems to be quite limited.

Ballet Mom
04-19-2011, 11:05 PM
I am very interested in this for our daughter. I know in Canada they do it at the
BC Children's and in Montreal. I hope it becomes the way of the future.

Please let us know all the details if you find out anything else!

Ballet Mom
04-20-2011, 12:22 AM
I see that Blue Cross considers endoscopic minimally invasive scoliosis surgery investigational and not eligible for coverage. I guess that would explain the small number of the procedures and lack of information.

"Percutaneous or endoscopic spinal surgical techniques are considered investigational and not medically necessary."

jrnyc
04-20-2011, 02:06 AM
well, i may well not be clear on what your daughter needs...
but what Dr Anand discussed with me was lumbar, since i do not need much thoracic surgery now that the botox shots are helping me in the upper spine area...

i did understand that Picetti works on pediatric patients with flexible curves, growing bodies, and mostly thoracic curves...

i do not think the link you posted shows the same video i saw on Anand's website at Cedars....and...when i visited Anand in CA, he also showed me a different video...

but whatever your daughter needs, i hope she can get it, if/when necessary, as minimally invasive as possible!
i thought minimally invasive endoscopic surgeries were being done for thoracic curves starting several years ago, & were still being done....that they preceded any kind of minimally invasive procedure for lumbar spine...actually, i was kinda waiting for lumbar surgeries to catch up!

the scars Anand described to me for T11-pelvis (my needed fusion, including side approach for discs and posterior approach for rods, started out considered for T4-pelvis instead) are very small....the patients of his i talked to described their scars as quite small, also...minimal disruption to muscle and tissue...there were patients who did have surgery for thoracic curves, but they weren't pediatric

i really hope you can find the info on endoscopic you seek, and that insurance will catch up with the 21st century!

best of luck
jess

Pooka1
04-20-2011, 06:39 AM
Maybe Linda can comment but clearly kids at least return to competitive sports in less than a year. So whatever they do in a open posterior procedure is entirely back to normal within 6-8 months. Both my kids appeared to be healed muscle-wise by about 3-4 months as they felt normal and could move normally. The shoulder pain that was the last to go on the one kid was not due to muscle disruption because she had it prior to surgery. The other kid was back to normal quicker than that.

I think the minimally invasive procedures must have shorter recovery periods for the muscles but the restrictions placed after surgery in the out months are to allow the fusion, not for the muscles which have healed long ago by that time as far as I can tell from my two young associates. In fact they feel completely normal only a few months out and it becomes virtually impossible to keep them to the restrictions for the fusion.

I assume it is similar for adult but I don't know that.

The main difference is the anterior versus posterior for TL curves since it is vital to save levels. If my kids had TL curves, I wouldn't be concerned with minimally invasive versus open but I would be extremely concerned with anterior versus posterior.

Linda will come along and dope slap me if any of this is wrong. I do know for a fact that posterior is the "gold standard" for some reason and based on the investigatory nature of endoscopy and minimally invasive approaches, I guess that means posterior open is the gold standard. That would explain why most surgeries appear to be that.

Pooka1
04-20-2011, 10:21 AM
Oh hey here is a reason to think hard about anterior screw constructs even though they save levels...

From that Reame et al. 2011 paper on pediatric complications...


The rates of new neurological deficit were significantly higher for procedures utilizing anterior screw only constructs (2.0%) or wire only constructs (1.7%), compared with pedicle screw only constructs (0.7%) (p<0.001).

Still, if the anterior procedure got the kid out of countdown range, it would probably be worth the slighty extra risk though it's a tough call for a parent to make in my opinion. The risk is almost three times higher (assuming all else equal which is is NOT) but still low and as I understand it, many/most of these neuro problems resolve.

So much for a parent to consider when dealing with a TL curve. It seems like the diciest situation in terms of options.

Ballet Mom
04-20-2011, 01:39 PM
well, i may well not be clear on what your daughter needs...
but what Dr Anand discussed with me was lumbar, since i do not need much thoracic surgery now that the botox shots are helping me in the upper spine area...

i did understand that Picetti works on pediatric patients with flexible curves, growing bodies, and mostly thoracic curves...

i do not think the link you posted shows the same video i saw on Anand's website at Cedars....and...when i visited Anand in CA, he also showed me a different video...

but whatever your daughter needs, i hope she can get it, if/when necessary, as minimally invasive as possible!
i thought minimally invasive endoscopic surgeries were being done for thoracic curves starting several years ago, & were still being done....that they preceded any kind of minimally invasive procedure for lumbar spine...actually, i was kinda waiting for lumbar surgeries to catch up!

the scars Anand described to me for T11-pelvis (my needed fusion, including side approach for discs and posterior approach for rods, started out considered for T4-pelvis instead) are very small....the patients of his i talked to described their scars as quite small, also...minimal disruption to muscle and tissue...there were patients who did have surgery for thoracic curves, but they weren't pediatric

i really hope you can find the info on endoscopic you seek, and that insurance will catch up with the 21st century!

best of luck
jess

Thank you Jess. My daughter may not need anything, but I'll be prepared for the worst in case she does. She continues to look like her curve is progressing rapidly when she's in her growth spurts as her curve becomes much more noticeable and her right scapula gets very pointy and sticks out. And then suddenly it looks straightened out again. Which has just happened again, but she just apparently had another rapid growth spurt. It really makes me believe that some of these scoliosis cases are tight tendon/ligament issues.

I just hope these things stop when she stops growing. I really do wish she'd stop growing!

I'm glad to hear the scars on the other minimally invasive surgeries are small also. I saw a picture with two vertical rows of scars due to one of these procedures where the pedicle scews were inserted directly from the skin on both sides of the spine, and all I could think was I sure would have wanted just a direct straight cut down the middle of the spine. But perhaps they heal and fade better over time.

Ballet Mom
04-20-2011, 01:59 PM
Oh hey here is a reason to think hard about anterior screw constructs even though they save levels...

From that Reame et al. 2011 paper on pediatric complications...



Still, if the anterior procedure got the kid out of countdown range, it would probably be worth the slighty extra risk though it's a tough call for a parent to make in my opinion. The risk is almost three times higher (assuming all else equal which is is NOT) but still low and as I understand it, many/most of these neuro problems resolve.

So much for a parent to consider when dealing with a TL curve. It seems like the diciest situation in terms of options.

Yes, I had made note of the larger complication rate on the anterior constructs but unless you know how serious they are and if they resolve, it's kind of meaningless.

I did read an article with Dr. Picetti where this surgery causes a problem of one leg seeming to become a different temperature than the other leg, which may be some of these complications. I don't think he mentioned if it was a permanent issure or not. I'll try to find the article.

I'm not too worried about a posterior approach on a TL curve. The longer term results of selective fusion have been quite good. I think Lenke must have pretty well determined which curves could benefit from the selective fusion procedures.

It's pretty sad that the poster girl for the SRS had a surgery that allowed her to be flexible enough to be a champion golfer, but no one else will be able to get the surgery unless they're quite wealthy and can pay for the surgery themselves.

jrnyc
04-20-2011, 02:11 PM
very simply, i thought posterior approach requires less moving around of internal organs...no?

jess

Pooka1
04-20-2011, 03:02 PM
very simply, i thought posterior approach requires less moving around of internal organs...no?

jess

I think the key issue is not having to deflate a lung with the posterior approach. I think the anterior approaches including the VBS procedures require deflating a lung but I could be wrong. I think someone here said it takes up to 2 years to get that lung back to full capacity? Am I remembering that correctly? It sounds wacky.

Ballet Mom
04-20-2011, 03:33 PM
Here's the comment about the complications of endoscopic anterior scoliosis surgery:


"iScoliosis.com: Are there any complications that you have had unique to thorascopic techniques that are different from standard posterior?

Dr. Picetti: If the chest tube is not attended to appropriately, or it is pulled out too early, the chest can become filled with fluid. We have had some portal site numbness that has lasted up to six months. There have been several kids that have had a sympathectomy effect, where by the disruption of the normal sympathetic nerves that run along the front of the spine, they notice a difference in temperature of one leg from another. Their leg will be warm for a while and then that goes away. Those are probably the main ones."

Ballet Mom
04-20-2011, 03:38 PM
Here's the entire interview with Dr. Picetti, which is no longer found at the iScoliosis.com link. I'll post the entire interview in case the link I found it at disappears also. It's quite an interesting interview:

http://sci.rutgers.edu/forum/showthread.php?t=5907


Minimally Invasive Surgery for Scoliosis

Scoliosis surgery can be scary for patients of any age, especially when faced with a five to seven day recovery, post-operative pain, and the anxiety caused by knowing you'll be left with a long scar. The idea of the scar can be the most frightening factor of the surgery, especially for young patients and their families. However, some new technology, created by Dr. George Picetti, is working to lessen the signs of scarring and make the entire scoliosis surgery easier on the patient.

The technique is called thoracoscopic instrumentation. It uses video technology to correct certain types of curves "endoscopically." The procedure works by making several very small incisions while the surgeon corrects the scoliosis through an endoscope.

We should emphasize that endoscopic instrumentation and correction of scoliosis is not for everyone, and only a small number of patients with scoliosis would be considered candidates for this type of surgical correction. Patients with a double thoracic curve, neuromusuclar curves, significant amount of kyphosis (hunching of the spine), or lung problems could have problems during this endoscopic procedure. However, as you will see the technique is a viable alternative and step toward the future of surgery.

iScoliosis.com: How did you become interested in thorascopic instrumentation?

Dr. Picetti: I first began to think about this when I was driving home from doing a case, an endoscopic case, where we did an anterior release through the endoscope followed by a routine posterior fusion. Although the endoscopic technique for doing the fusion on the front of the spine was intriguing, I just felt that it wasn't the end point. It seemed that I should be able to complete the rest of the surgery by inserting instrumentation into the spine endoscopically, and avoid the need to correct the deformity from the back. So, on the way home on the freeway, I started having ideas about how I could instrument the spine through the endoscopic portals. I pulled off the road several different times and wrote down my ideas. By the time I got home, I basically had drawn out the entire concept on scrap pieces of paper. We then went to the lab and continued to develop these ideas. So, actually, my whole idea of how to do this happened on my drive home from work!

iScoliosis.com: What year was that?

Dr. Picetti: I believe it was about 1993-1994, when we first started.

iScoliosis.com: Since that time how many instrumented cases do you think you have done?

Dr. Picetti: I have done over a 100 endoscopic scoliosis corrections so far.

iScoliosis.com: From the patient's perspective, what are the advantages of thorascopic surgery over the more standard open, posterior approach?

Dr. Picetti: In our experience, the advantages of thorascopic surgery are that the cosmetic result is significantly improved, the recovery time is much less, the amount of post-operative pain is significantly reduced, and the time to return to normal function is dramatically improved.

iScoliosis.com: What is the average hospital length of stay after thorascopic compared to a standard posterior instrumentation and fusion?

Dr. Picetti: The average length of hospital stay for thorascopic instrumentation in our institution is about three days compared to our posterior instrumentation patients, who tend to stay 5-7 days.

iScoliosis.com: What is the ideal curve for thorascopic instrumentation?

Dr. Picetti: I think that a very flexible, single right thoracic curve is the ideal curve for thorascopic instrumentation.

iScoliosis.com: From the patient's perspective, what are the absolute contraindications to having their scoliosis corrected using the thorascopic approach?

Dr. Picetti: I think that there are several curve patterns where correction using the thorascopic approach is extremely difficult, such as a double thoracic curve, for example. Someone who has a significant amount of kyphosis or hunching over of the spine makes it very hard to correct with this approach. Some patients with major lung problems may not tolerate the single lung ventilation that is necessary to do the procedure. Absolute contraindications, I think, would be someone who has a huge kyphosis, or a thoracolumbar junctional kyphosis where the kyphosis might get worse after the surgery. Neuromuscular curves, like those seen with Cerebral Palsy, would be difficult endoscopically.

iScoliosis.com: How do the kids feel about their scars?

Dr. Picetti: My favorite story is a patient who had her surgery around prom time. She was about 2 1â?„2 months out from her surgery and she went to the Mall to buy her dress for the prom. She was in her brace and trying on prom dresses. She happened to meet another girl there who had had a standard posterior surgery. The young girl took off her brace and tried on a long backless gown. When she went out and looked in the mirror, the other girl walks out and she says, "I thought you had scoliosis surgery"? She said, "yes I did," and showed her the little incisions on the side of her chest. The other girl went and got one of those high neck dresses and was in tears, asking why she had a big scar down her back when her new acquaintance had five small incisions that you can't even see when you are wearing this backless gown. So that meant a lot to me to hear that.

iScoliosis.com: Do you brace kids after surgery?

Dr. Picetti: Yes. I put them in a brace for three months.

iScoliosis.com: What is the acceptance of your peers about the endoscopic technique?

Dr. Picetti: I think initially that a lot of people thought what I was doing was voodoo. I got a lot of grief from many people, but I think that is changing significantly now. I think a lot of people are realizing it is not a fad or a passing trend. It is something that is not going to go away. Our early results show reasonably good outcomes, so it is no longer a technique that is up for debate.

iScoliosis.com: What is your feeling about the learning curve for surgeons who
want to start doing endoscopic instrumentation?

Dr. Picetti: I think the learning curve for thorascopic instrumentation and fusion for scoliosis basically has to do with how well the surgeon can remove a thoracic disc. The instrumentation part of the procedure is actually fairly simple. Obviously, I think that surgeons who want to use this technique should have extensive experience doing the procedure using a standard thoracotomy incision and approach to the spine through the chest. They must have a thorough understanding of the normal and abnormal anatomy of the spine. If they have these skills, then they should be able to perform an excellent discectomy and obtain a solid fusion using the endoscopic technique.

iScoliosis.com: How many surgeons do you think are doing endoscopic scoliosis corrections now in the U.S.?

Dr. Picetti: We have had several courses and trained a lot of different surgeons, but there are probably somewhere between 10 and 20 surgeons who use this technique regularly, I think. Many surgeons are becoming more interested in the technique, obtaining the proper training and experience, but have not done many cases so far. There are many centers that are beginning to do lots of cases on a regular basis, however, and the experience is growing.

iScoliosis.com: Are there any complications that you have had unique to thorascopic techniques that are different from standard posterior?

Dr. Picetti: If the chest tube is not attended to appropriately, or it is pulled out too early, the chest can become filled with fluid. We have had some portal site numbness that has lasted up to six months. There have been several kids that have had a sympathectomy effect, where by the disruption of the normal sympathetic nerves that run along the front of the spine, they notice a difference in temperature of one leg from another. Their leg will be warm for a while and then that goes away. Those are probably the main ones.

iScoliosis.com: Do you envision any new technology in terms of instrumentation in the immediate future?

Dr. Picetti: There will probably not be a whole lot of new technology such as new instrumentation in the immediate future. We are expanding the indications for the endoscopic technique, such as developing an endoscopic double dual rod for adult thoracolumbar scoliosis, which produces a much stronger construct. There are kids who are hyperkyphotic that we may consider now using a dual rod with structural graft so that now we can get a better correction endoscopically.

iScoliosis.com: Thank you.

The information provided is not a substitute for professional medical advice. All of the content is educational in nature and for general information purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified medical professional regarding any questions or medical conditions.

Click here to find a doctor who performs this surgical procedure or read about a patient treated with this technology.

http://www.iscoliosis.com/articles-i...ml?mastbox=yep

LindaRacine
04-20-2011, 05:39 PM
how old is your daughter?...for some reason, i didn't think she was within pediatric doctor range...

yes, i think minimally invasive will definitely be the future of scoli surgery and disc surgery! i wish more folks on forum were interested in watching videos on the subject...many here seem to be convinced that it can't work for large curves, can't work for lumbar curves, etc, when they haven't even investigated it!! i do not understand rejecting new procedures without knowing anything about them!

i don't know what age Dr Neel Anand at Cedars Sinai goes down to for patients...he only uses minimally invasive approach now for ALL his scoli surgeries...he told me that a year ago January....& that is for ALL size curves, all locations of curves...he now considers "old" scoli surgery "unnecessary cutting and trauma to nerves and other tissue"

best of luck with whatever you and your daughter decide, if/when it comes up for discussion...

jess
Jess...

I don't think the issue is whether it can work, or whether it can work with large curves. I think the issue is people wanting to wait to see the real long-term results of of such surgeries.

--Linda

LindaRacine
04-20-2011, 05:50 PM
That's an anterior procedure. They use one rod on one side.. As I understand it, they can fuse less levels so that is important in curves that go into the lumbar. I don't know why the posterior is considered the gold standard and not the anterior. Linda will know. So will Dr. K. Maybe you can ask him.


I seem to recall several papers stating that anterior and posterior procedures had similar results in terms of correction, but anterior procedures resulted in more morbidity. I don't think there have been any comparison studies on the long-term results. Since most of the top scoliosis surgeons performed some number of anterior only procedures in the past, and have gone back to the gold standard of posterior procedures for most AIS patients, I'm guessing that they think they're getting better long-term results with the posterior procedure.

--Linda

CAmomof2
04-20-2011, 06:02 PM
Here's a link to some info for Montreal. It's on page 15. http://webversion.staywellcustom.com/shriners/2011/spring/canada/

and

Info for BC Children's
http://www.bcchf.ca/ckfinder/userfiles/files/SOC_Spring2010.pdf

Pooka1
04-20-2011, 08:02 PM
I seem to recall several papers stating that anterior and posterior procedures had similar results in terms of correction, but anterior procedures resulted in more morbidity. I don't think there have been any comparison studies on the long-term results. Since most of the top scoliosis surgeons performed some number of anterior only procedures in the past, and have gone back to the gold standard of posterior procedures for most AIS patients, I'm guessing that they think they're getting better long-term results with the posterior procedure.

--Linda

If the anterior procedure kept the fusion above L3 and therefore out of countdown range and the posterior did not then the anterior would be the gold standard in my book. I do know it is claimed to save levels but saving levels in the thorax is not worth the added risk because the patient will not notice. Staying above L3 arguably is probably worth the added risk.

titaniumed
04-21-2011, 12:13 AM
This might be of interest...

http://www.scoliosis.org/forum/showthread.php?11081-Min.-Invasive-Interesting&highlight=dr+blackman

The search button here will reveal some interesting old threads.
Search;
Anand
Blackman
Picetti
Minimally invasive

Ed

Ballet Mom
04-21-2011, 04:00 PM
Thanks Ed. I had read that Blackman link which was quite interesting, especially about the loss of correction in some cases. He actually used fairly stiff, large curves for these procedures, and I had figured his study was one of the reasons they felt the moderately sized, very flexible curves were suitable for the endoscopic anterior procedures.

I'm finding more information now when I know the appropriate terminology. If I look for endoscopic or thoracoscopic scoliosis surgery, I find a lot more information on this procedure. There is lots of information on those other percutaneous minimally invasive procedures which is what pulls up if I simply use minimally invasive as a search term.

Thanks for your suggestions, I will give you in return a link you might find interesting as an engineer. I think you mentioned you might be interested in designing some of these scoliosis implants, so at this link you can find an orthopedic surgeon discussing all the nuts and bolts of an implant system. Enjoy, lol! (You can just click on the screens discussing the implant system itself if you're squeamish. Can't remember if you are or not).

http://www.orthopaediced.com/flash/deckey_01/

Ballet Mom
04-21-2011, 04:50 PM
Okay, here are the conclusions of one of the latest studies (by Dr. Lonner) on this anterior thoracoscopic surgery:

"CONCLUSIONS: For single thoracic curves of <70 degrees in patients with a normal or hypokyphotic thoracic spine, video-assisted thoracoscopic surgery can produce equivalent radiographic results, patient-based clinical outcomes, and complication rates in comparison with posterior spinal fusion with thoracic pedicle screws, with the exception that posterior spinal fusion with thoracic pedicle screws may result in better major curve correction. The potential advantages of video-assisted thoracoscopic surgery over posterior spinal fusion with thoracic pedicle screws include reduced blood loss, fewer total levels fused, and the preservation of nearly one caudad fusion level, whereas the disadvantages include increased operative times and slightly less improvement in pulmonary function."

http://www.ncbi.nlm.nih.gov/pubmed/19181984


If it came to surgery, I would definitely get an evaluation by at least Dr. Newton in San Diego for my daughter to see what he felt, seeing as flexibility is important for my daughter and her ballet, even if only recreational in the future.

jrnyc
04-21-2011, 06:25 PM
some doctors do both...and make the decision based on what the patient needs...and also considers if the patient makes a request...
Dr Lonner does both as far as the lst time i saw him....i requested MI approach, and he said he would do that for me...i havent done it ....yet...

Dr Anand believes strongly that MI is then only way to go now...and that it is an advance on fully open scoli surgery, whether posterior, anterior, or both...i do not for one moment believe he (or ANY surgeon, for that matter) will do a procedure because it is becoming "popular" or trendy....i think everyone with any ethics knows just how unethical that would be!

i will say again, every surgery was "new" at some point...arthroscopic surgery for ankles, knees, etc, was such a huge advance and makes such a huge difference with less damage to tissue and faster healing, it was amazing...i was a beneficiary of that advance...

i notice that "regular" surgery for scoli is not without it's problems...and there are enough people needing revision surgery...sometimes more than one revision...that it is not a perfect procedure

if/when i finally have spinal surgery for lumbar, i will not consider anything but MI...to me, it is the most advanced...
but...to each their own...people have choices now...and that is always a good thing!

jess

LindaRacine
04-21-2011, 07:03 PM
I have zero information on whether the same dynamic is going on for minimally invasive - I don't think we've had enough years to evaluate it. But I think it's better to chose the best surgeon and let them choose the method.
Exactly. No matter how much research we read on our own, we'll never be able to understand the details as much as a good specialist.

--Linda

Pooka1
04-21-2011, 07:04 PM
QUOTE by Dr. Lonner: "...and the preservation of nearly one caudad fusion level, ..."

Heh? So on average anterior saves "nearly" one caudal level?!? Not any distal levels and not even a whole caudal level???

How does it work to save a level above but not below??? What's the physics of that???

That would make it completely useless for trying to stay as much out of the lumbar as much as possible. I can't imagine how that justifies the almost three times risk of neuro injury over posterior (though still very low).

jrnyc
04-21-2011, 08:00 PM
hi hdugger
i would expect to get at least 3 opinions on ANY major surgery for anything i ever may need done...
i am sorry there is a surgeon anywhere who didn't present all the pros and cons on breast cancer surgery! unfortunately, i think everyone needs to research any serious procedure they are facing...not all doctors think alike, no matter how ethical they may be....& since it is our own body and we will have to live with the results, we are the ones burdened with researching it all.....kinda "cant trust anyone completely" when it comes to major cutting and stitching, as it were....
i am very happy there are more and more choices coming in spinal surgery...i personally believe if the world is still here 50 years from now, spinal surgery will look a lot different than it does now...just my own speculation..

jess

jrnyc
04-21-2011, 08:14 PM
is it the medicine, or the money..??
4 weeks is expensive, and so much of what insurance will pay for is driven only by that!!

jess

titaniumed
04-22-2011, 12:17 AM
Thx Ballet Mom

Very Informative.... I never dreamed that I would watch a scoli surgery with Jerry Garcia’s “The Wheel” in the background, great music selection I must say.

Dr Decky trained under Dr Bradford at UCSF who pioneered my corpectomy procedure years ago....nice of him to make the videos, show the procedure and the hardware, which without, we would probably still be using Luque wires....

Dr Picetti is a great guy also. At the meetings in Sacramento, he takes the time to answer everyone’s questions.

Hd, that was nice of you to go over to the hospital during Elias surgery....I had to attend a GE Aviation conference. Extremely boring stuff.

Ed

mariaf
04-22-2011, 08:27 AM
is it the medicine, or the money..??
4 weeks is expensive, and so much of what insurance will pay for is driven only by that!!

jess

Sadly, this is true Jess.

That is why the Shriners' philosophy is so unique in the medical world - the only thing they look at - and take into consideration as a factor when deciding on a treatment plan - is what is in the best interest of the patient...period.

jrnyc
04-22-2011, 08:36 AM
i am so glad Shriners is there for the kids!

too bad adults don't have a place like that!
i'd be glad if we could just get insurance companies to pay for needed surgeries, without calling things "experimental" whenever they think they can get away with not paying for something!

jess

Ballet Mom
04-22-2011, 12:05 PM
Here's a link to some info for Montreal. It's on page 15. http://webversion.staywellcustom.com/shriners/2011/spring/canada/

and

Info for BC Children's
http://www.bcchf.ca/ckfinder/userfiles/files/SOC_Spring2010.pdf


Thank you for posting these CAmomof2!

This is actually minimally invasive surgery with a posterior approach, two rods and the pedicle screws with only three keyhole incisions for access. So this would be a big improvement on the posterior approach if the longer term results hold up. As Jess says, this does appear to be the wave of the future. The insurance companies will have to get on board at some point.

This is not the same surgery as I'm looking at for my daughter though. What interests me about the anterior thoracoscopic surgery is the three levels that don't have to be fused, which increases the spine flexibility at the end. It remains to be seen what will happen to this particular minimally invasive surgery, however, it certainly is a good thing for the SRS' champion golfer who had this procedure done!

Ballet Mom
04-22-2011, 12:47 PM
I'm in the "find the best surgeon you can find and do whatever they recommend" camp. Otherwise, I think that sometimes surgeons alter their methods to do what's popular, even if it's not the most effective thing.

When my mom had breast cancer (20 years ago), her surgeon told us we could choose whether we wanted a lumpectomy or a mastectomy - he presented it as if it was just a matter of preference. But, when we did some research, it turned out (again, at that time) that although the lumpectomy was very popular with patients, it was far less effective in assuring that the cancer wouldn't return. So, it became popular because patients wanted it, and chose the surgeons who performed it, and not because it was an even equivalent way of treating the disease.

I have zero information on whether the same dynamic is going on for minimally invasive - I don't think we've had enough years to evaluate it. But I think it's better to chose the best surgeon and let them choose the method.

That's usually good advice, however, if someone is interested in a spinal procedure that can be used to save some flexibility, it is pointless to take them to a surgeon that doesn't specialize in that type of surgery.

Fortunately, Dr. Newton is a surgeon I would take my daughter to in any case for a consultation. I like his training (Texas Scottish Rite), I like his research (the fusionless tethering, which may eventually take the place of vertebral stapling) and other SRS studies. I like that he believes bracing works in those kids who will consistently wear their brace, and I really like that EOS machine they've installed at Rady Children's. It is a bonus that one of his surgical interests is endoscopic surgery.

As to breast cancer patients having a choice between lumpectomy and mastectomy, I'm glad they have that choice. The great thing about now and twenty years ago is the internet. It is hard to communicate effectively in the short amount of time patients and doctors have together. I don't know anything about breast cancer, but in the space of one minute I was able to go to a site and have a total rundown of the benefits and risks between the two surgical options and what patients should consider in making this decision. It sounded very reasonable to me. I'm sorry it sounds like your mother drew the short straw. That's why I bring it up all the time. Medical risks are very real risks.

Another thing that would cause a choice for lumpectomy vs mastectomy is not due to popularity. Reconstructive surgery after mastectomy is tremendously expensive. I know a professor who had it done and she comments on the tremendous amount of money the insurance company was required to pay for the reconstruction. So basically, for most people who choose lumpectomy, they will be happy with their decision and so will the insurance companies. If one ends up with the short straw, they end up with a mastectomy anyway and continuing treatment and reconstruction. One has to make medical decisions very wisely, the internet is a great help.

The other issue is that everyone is assuming these posterior pedicle screw implants are the gold standard and there aren't surgeries better than it. Well, I have read a few surgeons in their studies raise a warning flag that the stiffness of the pedicle screw systems seems to be causing early deterioration of disks on either side of the fusion. So it really remains to be seen if this surgery is going to end up better than other systems, no matter the cheerleading that goes on in this forum. Yes, it achieves better cosmetic results, but will it lead to everyone needing continuing revision surgeries in the future? I'm not trying to scare anyone, I'm simply saying they don't know. And anyone who says they do know is not telling the truth. So it is possible that the anterior surgery with a more flexible construct may actually be the better surgery for those with moderate, flexible curves.

Ballet Mom
04-22-2011, 01:01 PM
hi hdugger
i would expect to get at least 3 opinions on ANY major surgery for anything i ever may need done...
i am sorry there is a surgeon anywhere who didn't present all the pros and cons on breast cancer surgery! unfortunately, i think everyone needs to research any serious procedure they are facing...not all doctors think alike, no matter how ethical they may be....& since it is our own body and we will have to live with the results, we are the ones burdened with researching it all.....kinda "cant trust anyone completely" when it comes to major cutting and stitching, as it were....
i am very happy there are more and more choices coming in spinal surgery...i personally believe if the world is still here 50 years from now, spinal surgery will look a lot different than it does now...just my own speculation..

jess

I agree. Words of wisdom.

Ballet Mom
04-22-2011, 01:07 PM
Dr Decky trained under Dr Bradford at UCSF who pioneered my corpectomy procedure years ago....nice of him to make the videos, show the procedure and the hardware, which without, we would probably still be using Luque wires....
Ed

Glad you enjoyed the video!

Dr. Deckey is a great surgeon, no doubt. He is one of the orthopedic surgeons who specializes in the spine, who is NOT a member of the SRS, that I would feel absolutely comfortable with performing my daughter's surgery (if she ends up needing it).

Pooka1
04-22-2011, 01:24 PM
There are at least two former SRS surgeons in my area who, last I checked, are no longer listed on the SRS website after previously having been listed.

I have been stating that our surgeon is not an SRS member which is true but I don't know if he ever was. He may or may not have been given the Grand Central Station nature of SRS membership.

It was one of those former SRS surgeons who referred us to our surgeon while they were listed with SRS.

Ballet Mom
04-22-2011, 04:40 PM
Hi hdugger,

I think perhaps you're misunderstanding what my intent is in planning a consult with a surgeon who specializes in the anterior endoscopic surgery. It isn't to demand that type of surgery for my daughter. It's to find out through his experience with that type of surgery, whether my daughter would even be a candidate, what he feels about the risks and benefits of that type of surgery, in what situtations he uses it and whether he would recommend it in my daughter's case. I find it hard to believe he's still specializing in endoscopic surgery simply because parents come in demanding it for their kids.

If she turned out to be a candidate, I'd have to find out if there was any way to finance the surgery, either by changing insurance companies if there are any that pay for that type of surgery, or talking to the surgeon about being able to pay just the difference in cost between the two different surgeries. Who knows if it could even be done? It's simply something to investigate.

My daughter has seen a lot of top scoliosis surgeons in So Cal. We're blessed to have a lot of great surgeons in California. I wouldn't hesitate to have any one of the surgeons we've been to perform any surgery my daughter might need (although I'd pick one that recommended a selective fusion over one that recommended fusing both curves, lol).

I totally agree that surgeons should be able to explain all the risks and benefits of surgery, unfortunately in those appointments lots of people are simply in shock and don't remember the conversation well or don't think to ask the right questions. That's why I think the internet is good, not to actually replace the surgeon.

I think it's great that your family was able to make the choice you felt was best for your mom. I probably would have made the other choice for myself. Thank goodness for informed choices! :-)

LindaRacine
04-22-2011, 06:47 PM
There are at least two former SRS surgeons in my area who, last I checked, are no longer listed on the SRS website after previously having been listed.

I have been stating that our surgeon is not an SRS member which is true but I don't know if he ever was. He may or may not have been given the Grand Central Station nature of SRS membership.

It was one of those former SRS surgeons who referred us to our surgeon while they were listed with SRS.
Hi...

I'm not sure who you're referring to, but I think it's probably unfair to apply it to the entire SRS membership. As far as I know, all of the California surgeons I know (and that's quite a few), who were at one time members of the SRS, are still members. The only reason surgeons are forced to drop out is if their percentage of spinal deformity surgeries is reduced below the 20% of all surgeries level, and the surgeons actually call attention to it.

--Linda

--Linda

Pooka1
04-22-2011, 07:05 PM
Okay I agree the remark was irrationally exuberant.

I am just trying to say that I just happen to know that two guys were were previously listed are not listed as of today. I don't recognize many names but two I do recognize fall off the list. One was our guy until he referred us to another surgeon. And maybe our surgeon used to be an SRS guy and the first guy still thought he was. Who knows.

I have no way of knowing if two guys in a few years is at all representative of the SRS guys as a group. I just find it amazing that two that I happen to be familiar with dropped off the list while I was looking. But you are saying it probably is not representative so I accept that.

kennedy
06-19-2011, 12:57 AM
I watched that video on youtube a couple years ago