View Full Version : Anterior Procedure?

04-20-2008, 01:12 AM
Hello, this is my very first post, although I've been reading the forum for some time now and have learned a lot. What a wonderful resource! My story is similar to many. My spine started curving at puberty, and I wore a Milwaukee brace for a couple of years. At 16, doctors told me my spine had stabilized when I stopped growing. I don't know what my curves were then, but my spine seemed pretty stable until around age 50 (I'm 61 now), when it began to worsen. It now feels like it's collapsing on itself, and my quality of life has certainly diminished. Seven years ago, I saw an orthopedist who told me surgery could NOT make my spine any better, only keep it from getting worse.....and I believed him.

Then last summer, two friends from other states told me about two friends of theirs (both my age or older) who had recently had successful scoliosis surgery. I soon spoke with each of them.....and I began to have hope.

This began my search to educate myself about different procedures and to find a surgeon. Eventually I was able to see Dr. William Horton at Emory of Atlanta.

My current curve is nearly 80 degreees, and he wants to fuse T-2 to L-5. Since my spine is quite rigid, he says I can expect only a correction to +-61 degrees with a posterior procedure; however, if he adds an anterior procedure (5 days earlier), I MIGHT be able to come away from both surgeries with a correction to 40 - 45 degrees.

I certainly would like to have the best correction possible, but here is my dilemma: Is it worth going through the anterior procedure also (which I understand is even more difficult and risky), in order to get, possibly, 20 degrees more correction? I would really appreciate any advice from those of you who have faced a similar situation.


04-20-2008, 07:16 AM
Hi Peachy,

I'm 52, and in my case, the surgeon was able to get a fantastic correction with an anterior approach. Originally I was told that my 70-degree curve would be corrected to somewhere in the 30s, but as it turns out, I was much more flexible than expected. I had both approaches (anterior and posterior) done on the same day in a single 9-hour operation.

Recovery from my surgery has been long and a bit difficult. I am extremely happy with my cosmetic results, but the anterior portion of the surgery was by far the more painful and problematic for me, and I'm still sore and tender in that area. My muscles are still not happy with their new positions in my drastically altered back. Sometimes I wonder if Boachie wasn't too aggressive with my surgery.

I don't really have advice for you, since you should weigh all your options with opinions from 2 or more surgeons. But I do believe a posterior-only approach is not as traumatic and carries a bit less risk of complications, especially for someone your age.

Best wishes to you!


04-20-2008, 08:41 AM
Dear Peachy,

Welcome to the forum. Isn't it wonderful to have hope and to realize that indeed something can be done for you. As I have posted previously, that many doctors I've seen didn't know that anything could be done for me, dismissed my problem or ignored it. I have been turned down in the past many times for scoliosis surgery. However, as you also are finding out that now many older patients can be helped and can get significant relief and correction. I am 63 and am having a revision of an old fusion that I had at age 16 for a curve of 92 degrees thoracic and 68 lumbar in June. My surgeon will be Dr. Lenke in St.Louis. I think he will be taking a more aggressive approach for my problem, fusing T1-L5 with an apical VCR (Vertbral column resection), which is the removing of a vertebra to straighten the severe curve. Everyone's scoliosis is different and takes on its individual configurations with its resultant problems. Somehow, because my curve is so high, it is causing severe breathing problems and I am losing lung volume at a fast rate and will have a significant shortened longevity if this continues. That is why I need a more aggressive approach. He thinks he can correct the curve by 60% which would bring it to about 38 degrees. He also thinks he can increase my lung volume by 25%. If the rate of loss of lung volume could be slowed down to normal (which is about 1% per year), I could have a normal longevity and look forward to a functional old age.
His colleague, Dr. Keith Bridwell, also does alot of scoliosis surgeries and is very well respected. I had heard he is somewhat conservative in his approach. My spine also is very rigid. Good luck as you seek out your best options. They are some excellent scoliosis surgeons out there. Do seek a few
different opinions from excellent scoliosis surgeons. You may have to travel, but it will be worth it.

04-20-2008, 08:43 AM
Oh! I will be have a posterior only approach which will decrease risk of pulmonary complications as I am so pulmonary compromised.

loves to skate
04-20-2008, 01:11 PM
Hi Peachy,
I had both posterier and anterior surgeries for my lumbar scoliosis at age 67. My surgery was mainly to distract the vertebrae and then instrumentation to keep the vertebrae separated. My Doc told me that with the anterior approach, he could give me a much more stable fusion with the cages and artificial bone substitute. There was very little done to correct the curvature except to take the twist out of my spine, but with a lumbar curve, it isn't that important. Anyway, my point is that I am fairly thin which probably makes it easier and safer to do an anterior approach. My incision was from slightly above and around the naval to just above the pubic bone. It is still a little tender to the touch, but not bad. If you are in good physical condition, I don't think your age matters all that much, however, that is just my opinion. Ask the Doctors lot of questions about that concern. Best wishes.

04-20-2008, 02:28 PM
I want to add that I was in excellent physical condition before my surgery - perfect weight, walked 3 miles a day and did Pilates. It's not always a guarantee of a quick and/or complication-free recovery. I was a very youthful 52, but I don't feel so young at the moment.

The one constant you can bet on with this surgery is that everyone's experience is vastly different. I know I went crazy beforehand trying to predict what my outcome would be based on other peoples' experiences -- an exercise in futility. It is what it is.

I don't mean to be a downer -- I'm just feeling crabby today (gee, could you tell?!)......!

04-20-2008, 11:30 PM
I was younger than you are when I had my A/P surgery done in 2004. I was 48 at the time of surgery and I am now 52. When you are talking to other people please be aware that there are a few different kinds of anterior surgery. There is the kind that "Sally" had (which I also had - lumbar anterior) and then there is the other one that I had, thorasic anterior, which I think is the one that you are referring to. I think that the later one is the more common one when someone says they had A/P surgery. My incision for my thorasic anterior surgery starts just under my right breast and goes around the right side up to the middle of my shoulder blade. This one was very hard during the recovery phase. It hurts the most and I now have intercoastal neurolgia(Rib Nerve Pain) from it. The 7th rib was removed during surgery. I still have some breathing issues since the surgery. My nerve pain is under my right breast in the ribs and feels like pins and needles and a really big muscle cramp. I would also get checked out by a pulmonologist before you decide which way to go. Best of luck to you in your search on what would be best for you.

04-21-2008, 05:24 AM
I had surgery in Dec '07 at age 55. I had a posterior fusion from T-3 to the sacrum and 2 days later the anterior procedure - and it just involved the lumbar area. Dr Bridwell did my surgery. He is conservative and never mentioned the thoracic anterior approach for me. What I gather is that he does not think it is worth the risk. With stiffer spines his goal is stabilization.
I don't think he is in to rib removal or otherwise added pain and length of recovery to get a better cosmetic result.

My curves were in the 60's and he said I got about a 50% correction. Sometimes I hear of those who got terrific corrections and wish I had, but then again, I really went for surgery to stop pain and progression - not to become "perfect". And my goal is to not need any further surgery down the road, so I am very glad that I went to Dr Bridwell. St Louis is 600 miles from home but it was worth it to know I had one of the best scoliosis surgeons in the country.


04-21-2008, 11:59 AM
Welcome, Peachy.

Yep, thatís what our spines do as our curves get bigger and bigger. They start to collapse from gravity and the degenerative changes caused by our scoliosis.

What Theresa has described is the thoracoabdominal approach that is often recommended along with posterior for the treatment of big stiff curves. It entails disrupting the diaphragm, lung collapse and rib removal. Two surgeons recommended A/P from T2 to the sacrum for me and one suggested an ALIF as an added bonus. Dr. Bridwell recommended posterior only and possibly a distal anterior, which is what JanL had. He said he has backed off from doing thoracoabdominal surgeries especially in older patients and added that it really would not give me that much more bang for the buck.

Dr. Gupta initially recommended A/P also but has now decided on only posterior and said that I can get my 80ļ curve corrected to somewhere in the 40s. Coincidentally, I was sitting in his office and praying that I would not have to have such an invasive surgery; and thatís when he turned to me and said he thinks I can get by with only posterior. Iím nearing 60 and to go through all that rib removal stuff and pain for an added 20 degrees or so of correction is just not that important to me. Probably if I were younger I would opt for more correction, but this surgery is going to be tough enough as it is.

Jan, all of us would like to hope that we can have a one-time surgery and then move on with our lives, but that is not always the case even with the best of surgeons. When I spoke to Hermine who had the same surgery you had by Dr. Bridwell, she told me that sheís having some issues, in particular her unresolved leaning to the left. There simply are no guarantees with this surgery. But Iím thrilled for you that you have had an uncomplicated surgery and what appears to be a fairly rapid recovery.

Wishing you all the best, Peachy, that you make the decision that is right for you.


04-21-2008, 08:55 PM
Chris WBS

Don't get me wrong, I know I still have a long way to go with my recovery and every now and then I feel a sensation that makes me wonder! And, I think one of my legs may be a smidge shorter than the other and wonder if I should wear a small lift to get the best possible balance.

I get frustrated having to ask for help at times - I have been religious about not bending! Once I dropped something at a store and didn't have my reacher and had to ask a very elderly lady to pick it up for me - I felt terrible.

And as careful as I've been, I've had 2 mishaps- 1) while pushing a grocery cart one of my legs started sliding out in front of me. I couldn't imge what was happening. I ended up on one knee but holding on to the cart and not bending my back. Turns out there was an orange peel under my foot!

2) At work an elevator door slammed into my left shoulder as I was trying to get in - I asked that the engineering dept get the elevator company to adjust the timing on the door. Don't know if it did any damage but I can't wait to see the Dr at the end of June to make sure all the hardware is still in place!

With all the hardware, I do feel my back is stronger and don't have that "collapsing" feeling anymore. I know only time will tell that the fusion is solid and I just hope for the best.

04-22-2008, 12:46 AM
Hey there Chris,

It's been a long time since we have "talked". I actually had both anterior procedures done. The big one in the ribs and the one where I was cut from just left of the belly button down to the pubis. I had three discs removed in the lumbar and replaced with cages full of bone graft. They also did the same thing in the thorasic part of the spine in the front. They removed another three discs and put in cages packed with bone chips. Then the hip graft incision and of course the big one on the back from T1 to the top of my "crack". Wish there was a better way of saying that.

By the way, I am coming up on yet another one year anniversary mark!! The end of May will be one year from my last surgery with Dr. LaGrone. So far I'm still standing straight!! As of right now, I don't expect anymore surgeries in the near future. Now the distant future, only time will tell!!!

04-22-2008, 11:59 AM
Hi Peachy - welcome.

I had my fusion done through only anterior surgery - like most people posting here I am in the 'older' age group - but still, I was only 42 when I had the surgery done so may have different considerations than you..

I had diaphragm cut through, lung collapsed and 2 ribs removed for my bone graft (my ribs were impacted from my curve so had to go). My incision is from near my belly button on the front, up around my rib line and up to my shoulder blade on the back. getting over the incision was the worst of the surgery for me and even now 2 years on, I still have pain and occasional swelling if I overwork myself.

The last 2 weeks I have faced a personal trial as I have had a chest infection and today my doctor confirmed that it has settled right down low in my lung where it was so badly disrupted.

All this means that anterior is more risky, but like you it meant a better correction for me. My options looked like posterior surgery to fuse me at the point I was (with maybe a minor correction) or anterior to get the best possible correction. In the end I got around 50% and much improved sagittal balance.

Personally i thought it was worth the extra risk but you have to make up your own mind.

Good luck, whatever you decide.

04-22-2008, 05:57 PM
Thanks so much to all of you! I appreciate so much your sharing your experiences with me. I might send some PM's to a couple of you with another question or two.

And thanks to Theresa for explaining the difference between Lumbar Anterior and Thorasic Anterior. That has bearing on the following:

Something else has happened since I posted my question. Yesterday the nurse called with, supposedly, answers to some questions I had emailed to the surgeon. Those questions mainly addressed the issue of what would be the downside if I did NOT have the anterior procedure and did just the posterior. She said the only downside would be cosmetic appearance from the FRONT. I said I didn't understand why straightening my spine by 20 more degrees would only improve the appearance of the front. (Why not the back also?) I asked if the anterior would cause the fushion to be stronger since bone grafts would be put in front of spine as well as in back. She said, "No, since ANTERIOR WOULD ONLY BE DONE TO THE BOTTOM (her words) OF THE SPINE."

This confused me all the more since during my previous office visit, I had asked the doctor to show me exactly where the incision for the anterior approach would be. He drew a line with his finger from beside my right breast across my ribs to my right shoulder blade. That makes it sound like Thorasic Anterior instead of "bottom of the spine". When I continued to question her, she replied, "I'm only telling you what the doctor said".

I was already on the surgery schedule for May 22 and 27. For the past few weeks, I've felt like I was being hurled down a mountainside with no way to slow down and no one to help me. Can't sleep through the night. I know that once this surgery is done (whatever kind I end up having), there will be no going back, so I need to understand as much as possible beforehand in order to make the best decision possible....(Again, thank the Lord for this forum!)

So....this morning, I got up and called the surgeon's office and cancelled the May date. It had not been posted yet, so I don't think they're too mad at me. Anyway, at this point, although I've heard good things about Dr. Horton, I really would like to get another opinion. And, even if I go ahead with this surgery with him at a future date, I will insist on another office visit before then to get my questions answered.

I really feel more relieved and relaxed right now than I have in weeks. If anyone can suggest a good spine surgeon in or near Georgia, I'll be grateful.


04-23-2008, 09:56 AM
Peachy-- I'd like to add my welcome too. It's good to have you here! It sounds like you have a good plan. This is definitely not something you want to enter into without feeling like you've explored it adequately. You have time to do that. You would hate to be on the recovering side of this surgery wishing you had checked things out better.

I was originally scheduled for both A/P surgeries, 5 days apart, but then my surgeon decided he could accomplish what he wanted with just the posterior surgery. We are all so different though-- with what our problems are, flexibility, etc., that we can't say "well, this worked for me, so it should work for you" or anything like that. My correction was quite good with just the posterior approach, but that wasn't a promise of any sort. The surgery was to stabilize my spine to prevent increases in the curves with time. I knew it would be corrected some, but had no idea he could do as much as he did.

Anyway, best wishes as you explore your options and get a 2nd (or more) opinion. Keep us posted on things! BTW--there are some very helpful books on scoliosis that show what all these approaches are, etc. I just posted about them here... http://www.scoliosis.org/forum/showthread.php?p=59073#post59073 in case you're interested in reading either of them. Or maybe you already have them! :) Susie