In a recent thread started by ladare (Considering T-12 to L-5 Fusion), there were several posts relating to "whether anterior/posterior-combination increased surgical success as opposed to posterior approach alone".
Well, this question greatly concerns me since I'll be having surgery later this year, at age 61, to be fused from T-3 possibly to the sacrum for an 80 degree, rather rigid curve with some stenosis.
I've seen two surgeons so far. One gave me the option of doing both A/P or posterior alone, saying that adding anterior approach might give 20 extra degrees of correction, but did not say that it might help fusion. Second doctor said that posterior was all that was needed. I'm to see third doctor next week.
I've been reading everything I can get my hands on concerning whether, in general, the combination of the two approaches is better, particularly when fusion is carried through the lumbar spine. I would like to post some passages I've found........
(note: "Pseudoarthrosis" is failure of fusion.)
Dr. Michael Neuwirth in Scoliosis Sourcebook (p.122 & 123) says,
Sounds like he was describing me! ..... over age 55 with large, rigid curve over 75 degrees. Yep, that was me alright!
Then in Scoliosis Surgery, The Definitive Patient's Reference, David Wolpert says pretty much the same thing on page 36.
Also, on the HSS site, in an interview called "Adult Scoliosis with Low Lumbar Degenerative Disease and Spinal Stenosis", Dr. Boachie says,
Hmmm, I'm wondering why neither surgeon I saw pushed doing A/P when it sounds like I fit all the criteria for using a combination approach. Of course, if all things were equal, I'd much prefer doing just the posterior since it would be easier on me, but, on the other hand, I certainly want the best fusion possible. I would appreciate hearing from others who've had to have long fusions that extended into the lumbar or sacrum on how those procedures were done. I'm going to New York next week for the third opinion (with Boachie), so I want to find out all I can beforehand and have all my questions ready for him.
Thanks,
Peachy
Well, this question greatly concerns me since I'll be having surgery later this year, at age 61, to be fused from T-3 possibly to the sacrum for an 80 degree, rather rigid curve with some stenosis.
I've seen two surgeons so far. One gave me the option of doing both A/P or posterior alone, saying that adding anterior approach might give 20 extra degrees of correction, but did not say that it might help fusion. Second doctor said that posterior was all that was needed. I'm to see third doctor next week.
I've been reading everything I can get my hands on concerning whether, in general, the combination of the two approaches is better, particularly when fusion is carried through the lumbar spine. I would like to post some passages I've found........
(note: "Pseudoarthrosis" is failure of fusion.)
Dr. Michael Neuwirth in Scoliosis Sourcebook (p.122 & 123) says,
A patient who has a very large, rigid curve - one measuring more than 75 or 80 degrees on a bending X-ray - will probably achieve the best results by undergoing both anterior and posterior procedures (A/P surgery). --------------- By operating front and back, performing a circumferential (wrap-around) fusion, the surgeon can considerably reduce the pseudoarthrosis rate. --------------I usually recommend stabilizing lumbar curves from the back as well as from the front once a patient passes the age of fifty-five or so. Although the posterior surgery does not provide any additional correction, it further stabilizes the curve, which becomes more important as the risk of pseudoarthrosis increases. -----------A/P surgery is also necessary when fusion to the sacrum or pelvis is required.
Then in Scoliosis Surgery, The Definitive Patient's Reference, David Wolpert says pretty much the same thing on page 36.
Also, on the HSS site, in an interview called "Adult Scoliosis with Low Lumbar Degenerative Disease and Spinal Stenosis", Dr. Boachie says,
There are decompensated thoracolumbar lumbar curves for which it is necessary to fuse to the sacrum. If posterior fusion alone is done, there is a very high pseudoarthrosis rate in such cases, reported to be up to 49%. There is also higher loss of correction and incidence of imbalance. In these cases, you should consider a supplemental anterior fusion. -------- Once you talk about fusion to the sacrum in an adult, then you are thinking of anterior and posterior just because of the problems of pseudoarthrosis and loss of fixation.
Thanks,
Peachy
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