Considering a T8-L5 fusion

[trulyaries]

Chris WBS -
My experience was unusual; certainly not the norm. My first surgery was the longest fusion -T4-L4. I had no problems for 5 years, then developed spinal stenosis and had additional lumbar fusion. I asked why the surgeon wasn't going to the sacrum at that time and got the same answer I have heard many times: "we don't like to do more than we have to." I continued to have problems and when my surgeon said "everything looks fine" I said "buh-bye" and sought out other opinions, all of whom told me my lumbar area never fused! My last two surgeries were done by a new surgeon who I like very much. When I first saw him, we did discuss A/P procedures, and he said the same as above: "we don't ... blah blah." But he did acknowledge that occasionally an additional anterior procedure might be necessary, which it was. (My primary physician, who did my pre-ops, was shocked that a second procedure was necessary. He said my surgeon is top notch and it was very rare for him to have to do an additional surgery. So I don't think it was him; it was my lousy lumbar!)

I'm guessing, but I believe the first doc is in his late 50s, the second one mid-50s. Both have excellent professional reputations, although the first one has absolutely no personality or bedside manner.

I trusted my surgeons' opinions regarding recommended procedures and I would have found it very difficult to insist on a procedure contrary to what they thought was the best approach, especially at the beginning of my journey. My only regret is that I didn't find the SECOND surgeon before the first one.

You just can't make yourself sick worrying about what MIGHT happen. And I don't think it's productive to try to second-guess the surgeon. Just my opinion.

[Chihuahua Mama]

Anterior/posterior

But for how long? Checking Dr. Pashman's web site yesterday, here's what he says: "The anterior and posterior combination increase the surgical success rate dramatically."

I think, based on my consult with Dr. Pashman, who is the busiest spine surgeon in California, that statement is accurate FOR ME and has everythinig to do with other conditions of the spine, not just scoliosis. I have DDD, stenosis and spondylo-however-it-is-prounounced. Because of all those factors combined, an anterior/posterior approach will absolutely increase my surgical success. I have 3 bad discs that need to go at L1-4. But that statement (Pashman's) may not be true for everyone.

So, I also agree with txmarinemom that it depends on the surgeon.

Neither opinion is absolute. What I've learned so far is that there are few "standards" in this surgery. It's all about you, your pain, your surgeon and most, your trust in your surgeon. You have to do your homework and pick the best.

[Chihuahua Mama]

Geish, thanks for the straight story

Well I didn't mean to scare the "crap" out of anyone, but again you asked so I told. Wiping really is the issue. I was able to pat dry in the front after a few days

Well, it DID scare the crap out of me, but anymore? I'm pretty easily scared! I did slightly over-react (yah, think??) last night...all in one day, I changed surgeons, scheduled my surgery (anterior 6/16 and posterior 6/23...one week apart) and gave notice of surgery at work.

Too much for one day. My apologies to all. I very much appreciate the information, even the crappy stuff.

Sigh...thanks to the veterans ofscoliosis/fusion surgery for their patience with us pre-surgery patients. I did freak right out and expect it won't be the first over the next 3 weeks. I feel sorry for my family.

[Geish]

LOL Don't worry about it...It's what we are all here for. To learn and to share and to help if we can.

It's kind of funny, but I never had a moment of panic or worry. I just knew I needed the surgery and put complete faith in my surgeon (Thank you Dr Ganocy) knowing he would make the decisions that were right for me. I even told him before he wheeled me into the OR, after he let me know he wasn't sure if he could stop at L4, "when you are in there and see what's there, do what you would do if I was your wife. Give me the same medical treatment you would want for her." He did end up going to the sacrum and I have no regrets.

So keep asking those questions and we will help all we can!
Alicia

[Singer]

One more word on wiping....

Chi-Mama and others, the thing to remember about this surgery is that from where you sit NOW, with your wits about you and pre-surgery, the thought of someone else wiping your butt is horrifying. But after surgery, you are so affected by the drugs and by the intensity of the whole experience, you are very desensitized to these types of things. I honestly wouldn't have cared if the Prince of Wales wiped my butt by the time I was fortunate enough to poop!!!!

There's just no way to project how you will feel about anything post-surgery. It's an unknown adventure.

[ladare]

Wow! I had no idea my question would generate so much discussion, so much useful information, so much insight into the experience of others with scoliosis. Thank you all for sharing so much! I'm really impressed how interactive and supportive this forum is. Contemplating this significant surgery can be so overwhelming, and I was feeling VERY alone in my situation. Now I don't feel alone at all any more. You are all wonderful, courageous, honest, determined people. Honored to be in your circle! I'm scheduled for another MRI on 5/29 and we'll see what the doc has to say then.

Lisa

[ladare]

hi Lisa,

"...I wonder should I just take the next year and get myself in good shape physically, i.e. swimming, quit smoking, take my calcium more religiously, eat better etc.. and just get on with the surgery or wait another two or three years. I am very consumed with this right now..." dolores A

Delores, I do believe that getting as healthy as one can get before surgery is a very good thing to do, especially since this type of surgery and recovery is not insignificant. I've tried to get as fit as I can (with some success), but the pain really prevents me from doing anything anymore so it would be a wasted effort to pretend I would do any better in the next year. I would think that quitting smoking would probably be the most beneficial before surgery (and understandably probably the hardest to do...). For me, the pain is overriding every reason to postpone the surgery for me.

[Geish]

Chi-Mama and others, the thing to remember about this surgery is that from where you sit NOW, with your wits about you and pre-surgery, the thought of someone else wiping your butt is horrifying. But after surgery, you are so affected by the drugs and by the intensity of the whole experience, you are very desensitized to these types of things. I honestly wouldn't have cared if the Prince of Wales wiped my butt by the time I was fortunate enough to poop!!!!

There's just no way to project how you will feel about anything post-surgery. It's an unknown adventure.

Now I know I would have been very excited if it was Prince William! He's a hottie! Could that be arranged? LOL

[Susie*Bee]

Geish and Singer-- you both had me laughing pretty good...

Ladare--you got plenty of responses because this topic (especially the "wiping" aspects ) hit a nerve with so many and opened up a sensitive subject... then the discussions get pretty interesting!

Dolores-- Lisa is right in saying it (getting in shape) depends on how immediate/debilitating your scoli situation is. Here are some suggestions for getting into shape (of sorts) when facing surgery "down the road" but not necessarily years away. These are relatively mild...

Exercise-- work on arm and leg strength, not your back. Work on being able to squat down--and get back up! Some people do this all the time, others (like me) haven't in years -- or is it ever???? That's what I've been working on big time, for the past 6 months. Your arms and legs will be doing much of the work during recovery and beyond, and if they are weak to begin with, it makes it hard. Try to do some kind of cardio exercise, as that gets your heart in shape for the surgery. Fast walking or bicycling, etc. If your back is too achy or your joints are bad, see if you can do a recumbent bike somewhere, as that's easy on you.

Food-- Losing weight (if needed) isn't as important as eating nutritionally -- you can do both, but you sure don't want to enter surgery and recovery without having had all the pluses that a sound diet gives in the way of vitamins, calcium, protein, etc. That goes for skinny people too. Eat well in the months leading up to surgery. Same with post-op, of course. Taking a vitamin supplement is good, but nothing like eating the real thing through real (and preferably fresh) foods.

Meds-- again, a vitamin supplement is good. If you are doing autologous blood donations, they will have you take iron as well, but they'll tell you about that. I also took/take two (2) 600 mg. calcium with vitamin D tablets daily-- and my scoli doc told me to take a bone strengthening med right after he first saw me 3 years ago, so I have been ever since. My family doc prescribed Evista.

Smoking-- quit! I know it's tough. I smoked a LONG time ago, for about 15 years. There are many "helps" available nowadays to help you quit. Some surgeons won't even operate if you're a smoker. There's a correlation between smoking and failed fusions. You REALLY don't want to go through the ordeal of this surgery and recovery and not have done all you can to prevent failed fusion (pseudarthrosis). We older scolis have a higher chance of it anyway. Make sure your scoli doc knows you smoke and see what he/she says.

PROBABLY what your doctor meant about not waiting till your 60s has to do with the fact that in general, as we age, we decline in our endurance capabilities for such a huge surgery... this is BIG trauma to our body, our heart is put under duress, our bones will probably be more brittle and harder to work with, we lose more flexibility so it is harder to get correction, we may have developed other problems-- DDD, stenosis, listhesis, etc., complicating things. In other words, there are greater risks and possible complications. Best thing to do is to ask him/her next time you're there what he meant. I thought I was in fairly good shape at 56, as I've been really active, but discovered this was pretty debilitating for me. Everyone is different. It's not a walk in the park for anyone, at any age. But the younger you are the better off you'll be. Of course, there are some in their 60s-- and even older, who have done extremely well.

I am still torn about my decision. (NOTE: of "WHEN", not "IF"!!!) I knew I would need to go back to work for a few more years and had planned to go back last August (I'm an elementary school librarian)... but just was not able to. I REALLY wish I could have waited till I retired, but, like ladare, knew I needed to go ahead with this as it wasn't going anywhere but worse. It would have been so much more convenient if I could have been DONE with working...!!! Now I have to go back to work this coming August, and I am not looking forward to it-- I know it will be pretty rough. At least I think it will be. I guess time will tell. Regardless, I know it was best for me to do it when I did...

Best wishes in figuring out what is best for you. And it's really good that you are wondering what to do to get ready and all. I think you'll do fine.

[loves to skate]

loves to skate

Another suggestion for exercise before surgery is water aerobics or just swimming. It is not hard on any joints. The chlorine in the pool may be hard on the skin though. Sally

[txmarinemom]

Smoking, General Health & Age at Fusion

...I wonder should I just take the next year and get myself in good shape physically, i.e. swimming, quit smoking, take my calcium more religiously, eat better etc.. and just get on with the surgery or wait another two or three years.

Dolores:

I'll be 40 in just a few months, and I smoked for 24 years.

I watched my Dad die of lung cancer, I watched what it was doing to my face, I knew I was pissing money away every time I bought a carton ... and still I smoked. Only when my oldest child picked it up did I say enough. I know how hard it is to get there. I haven't had one single puff since September 25th, 2006.

IMHO, you're wasting your time and money to even *consider* fusion surgery until you've quit smoking - and I mean QUIT ... not just a month or two. I did THAT too many times to count.

Fusion failure is a big concern from smoking, but it's not the only concern, by far.

Here's a link to the intro of an article on spine-health.com and the issues it points out:

Quitting Smoking Before a Spinal Fusion
By: William W. Deardorff, PhD, ABPP
March 17, 2008

An extensive amount of research has firmly established that cigarette smoking is bad for patients undergoing lumbar fusion surgery. But just how bad is smoking? How does it impact a spinal fusion? What do I need to know to help my chances of successfully quitting smoking? This article addresses those questions and more.

Smoking causes a number of significant problems for patients undergoing spinal fusion including the following:

• A significantly decreased rate of successful fusion (called non-union or pseudoarthroses)
• Markedly poorer clinical outcomes (i.e. pain reduction) regardless of whether or not a successful fusion in the spine is achieved
• Poorer functional rehabilitation after surgery
• Lower overall patient satisfaction with the spine surgery

While not specific to scoliosis, another article related to spinal fusion gives you an idea on the percentage of failed cervical fusions ... and name yet another increased risk associated with smoking - post-op infection:

Cigarette Smoking and its Impact on Spinal Fusions
Larry Davidson, M.D.
(Last Updated: 08/13/2007)

Cigarette Smoking and Failed Fusion

Certain factors have been found to affect the success of spinal fusion. Some of these factors include the patient's age, underlying medical conditions (e.g. diabetes, osteoporosis), and cigarette smoking. There is growing evidence that cigarette smoking adversely affects fusion. Smoking disrupts the normal function of basic body systems that contribute to bone formation and growth. As mentioned previously, new bone growth is necessary for a fusion to heal.

Research has demonstrated that habitual cigarette smoking leads to the breakdown of the spine to such a degree that fusion is often less successful when compared to similar procedures performed on non-smokers. In a study of patients undergoing anterior cervical fusion (fusion of the neck), it was observed that smokers had an increased rate of nonunion (up to 47%) as compared to non-smokers.1

Another study evaluated tobacco use in patients who underwent lumbar (low back) fusion. The patients who smoked had failed fusions in up to 40% of cases, compared to only 8% among non-smokers.2 Similar findings have been reported in other studies as well.

Post-Operative Infection

Cigarette smoking compromises the immune system and the body's other defense mechanisms, which can increase the patient's susceptibility to post-operative infection. A study conducted by Thalgott et al showed that cigarette smoking was a risk factor for infection following spinal fusion.3


References
1. An HS, Simpson JM, Glover JM, Stephany J. Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 1995; 20: 2211-16.
2. Brown CW, Orme TJ, Richardson HD. The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine 1986; 9: 942-3
3. Thalgott JS, Cotler HB, Sasso RC, LaRocca H, Gardner V. Postoperative infections in spinal implants. Classification and analysis -- a multicenter study. Spine 1991: 8: 981-4.


Yes, bone growth stimulators can attempt to combat pseudoarthritis, but that's not the only issue.

As far as getting shape pre-op:

I HIGHLY advise it. Your body will adapt better, you'll heal faster, and you'll have a much easier surgery AND recovery.

The argument can be made the younger you have the surgery, the easier time you'll have. If you can do all you outlined in a year, why wait another 2-3 years? You still have to do the same things to give yourself the best chance of successful recovery - and a year is ample prep time if you're motivated.

Best regards,
Pam

[dolores a]

Thanks Pam,

Your post was very enlightening, I know that I have a lot to accomplish in the next year! Your post very much sent home the message about quitting my smoking habit. I actually have tears in my eyes because I know I have to this for me and my family. Your post was very informative, not that I don't already know the affects of smoking, but to have someone that does not even know me would send this message really was very encouraging, thank you, thank you! Quitting is going to be my mission, as I know when I get my second opinion, it will be that I will need this surgery. So I might as well accept it and get on with it.

Thanks again,
Dolores

[dolores a]

Thanks to all who who posted, you all will be probably be my incentive to stop!!!

Dolores Angel

[txmarinemom]

Your post was very enlightening, I know that I have a lot to accomplish in the next year! Your post very much sent home the message about quitting my smoking habit. I actually have tears in my eyes because I know I have to this for me and my family. Your post was very informative, not that I don't already know the affects of smoking, but to have someone that does not even know me would send this message really was very encouraging, thank you, thank you! Quitting is going to be my mission, as I know when I get my second opinion, it will be that I will need this surgery. So I might as well accept it and get on with it.

I know exactly what you're going through, Dolores ... it's tough, but you can do this! And the sooner you cross this bridge, the sooner you can have surgery and reclaim your life.

Feel free to email me if you'd like - and I'm even open to phone calls. In addition to being ready to quit, a strong support group and visualizing myself as a non-smoker (I never had on previous attempts to quit) really helped. It seemed I always had some reason I couldn't quit *yet* ... a party to attend, stress at work, New Year's Eve, etc., etc ... the list was year 'round. I had always found it impossible to drink at ALL without smoking, and really thought that would be the worst part. I was amazed it wasn't at all when I finally decided to stop.

Of course I know you already knew smoking wasn't healthy - surgery or no surgery. It was something I knew too - yet continued to do it (even after knowing my risk of lung cancer increased exponentially with my Dad's diagnosis).

My actual quit date was Sept. 22nd, 2006 (but I don't count it as the "real" one ... I tried cold turkey for the first 3 days - and cheated 6 times).

From previous attempts, I knew the patches gave me horrible nightmares (even when removed before bedtime - and I have such a screwy sleep schedule *anyway*, bedtime is just hard to predict), and the gum KILLED my TMJ.

The lozenges turned out to be a great option for me. I started using them (at that time, they were reimbursable under my flex spending plan) Sept. 25th, 2006 - and was down to one 4mg a day (split into quarters) when I first saw Hanson Oct. 9th, 2007. Yes, I still was using the lozenge (teeny bits) as a crutch more than a year after I quit smoking - but whatever works, works. And it's a hell of a lot better than smoking: I didn't stress over it and neither did Hanson.

I'd discontinued them completely for at least a few months prior to surgery.

Several friends of mine have tried Chantix, and I'd say it had emotional/mental effects on almost all of them. It's not a drug to be taken without some serious investigation. BTW, none of them successfully quit, either. I think people who go that route are looking for some easy fix, and no matter which path you take, it is a struggle with willpower. Unfortuntely, there is no magic "cure'.

In pulling that information on smoking/fusions, I learned some things. I never knew the risk of post-op infection increased, nor the poorer clinical outcomes, rehab outcomes, etc.

I appreciate your sweet note, but don't ever feel ANY of us on here who willingly take the time to help another member (new OR old) are "strangers". We're all bound by this beast, and many of us fight the same battles (besides the obvious of a common enemy). If we can't take what we learned/experienced and at least try to make things easier for someone else, it makes what WE went through feel without purpose - if that makes sense.

Trust me ... stick around, and you'll have the opportunity to pass it along .

Hang in there, hon. Buzz me any time.

Best regards,
Pam

[Peachy]

Beast!

We're all bound by this beast, and many of us fight the same battles (besides the obvious of a common enemy). If we can't take what we learned/experienced and at least try to make things easier for someone else, it makes what WE went through feel without purpose - if that makes sense.

Pam, yes, that makes perfect sense! You put into words what I have felt....we're all bound by this scoliosis beast! Until the past year, I had never actually met anyone who had gone through what I did while growing up with scoli; I thought I was the only one! I have often thought of it as a "beast" attached to my back, forcing me more and more out of shape.

Fortunately, I now know I'm not by myself, and I've found that something CAN be done about what I've lived with so long. Somehow, sharing our experiences with others who've been through similar things does make it a little easier. That's why I'm so grateful for this forum!

Peachy
80 degree curve