19 Year Old Male. Scoliosis Progressing.

[LindaRacine]

This is a great question. I want to go to the meeting at UCSF on Dec 3rd, hopefully I wont forget this question.

I remember reading in the past that they do want a little bit of movement, otherwise they would just increase rod and hardware diameter and size. It seems that they could just throw some 1/2” diameter rods in there and it would never break regardless of a non-union. You do know that if you don’t fuse, your hardware is guaranteed to break, its just a matter of time.

Most or all of the pedicle screws used today are Titanium. Rods can be Vitallium, 316, Titanium, or alloys with varying amounts of Cobalt and Chrome. I have Synthes “Pangea system” which is all Titanium. Check out all the neat tooling. I know, sounds very Tim Allen. LOL
http://www.synthes.com/MediaBin/US%2...ngeaJ6418A.pdf

Since screws do go to 7mm, one wouldn’t want to go with the largest size just in case they need to do a revision and use a larger screw in the same hole. You would want that option.

The success of fusion seems to be in the technique, not the hardware selection.....people fuse without hardware, they did that 60 years ago when they used casts. Leave hardware selection to your surgeon.
Ed

Ed...

Metals are not mixed. If one has SS rods, they have SS screws. SS is really still the gold standard.

--Linda

[JDM555]

Thanks for the article Ed, but it still doesn't really answer my question. It makes some sense in the sense if it's very stiff, then the bones won't have any stress, thus causing them to weaken. But at the same time, you get a more solid hardware that doesn't bend or cause your spine to progress while your spine fuses. I'm guessing this is why surgeons use these cobalt chromium in younger people because it gets more risky as the patient is less active. If kids run around and play sports and what not, having stiff hardware shouldn't be a problem, but if you're in your 50's and 60's and don't really do much, the little amount of stress would be absorbed by your hardware, if that makes sense.

It has it's pro's and con's, I guess any of those metals would work, it wouldn't be a big deal in terms of what works, they all do. I'll let my surgeon do what he does best. I just thought it was interesting since I've never heard of another type of metal used for rods besides titanium and stainless steel.

And Linda, I've read a lot of people using Cobalt Chromium rods with Titanium pedicle screws. I've never heard of all cobalt chromium though, so I think SS doesn't mix and match, and titanium doesn't mix and match, but Cobalt Chromium mixes with titanium in the hardware.

[titaniumed]

Linda
I don’t know why I thought that titanium was the direction that they were headed in???
Must have been an article I read at some point. And mixing is scary, but can be done with certain metals without electrolysis.

One shocking thing I read last week in Dr Cotrel’s book “The sands of Berck” was that they were using coil pull springs in Warsaw, Poland around 1960. They had too many problems with wrapping around the spine and stopped after a few years. They were trying anything to prevent fusion.
Ed

[titaniumed]

John

You bring up some good questions here, I have no idea how surgeons select hardware, or why some get 2 screws per level or clamps at different levels. Each construct is different. I have read that since the pedicle screws are driven in at an angle, (depends on which level, and how badly rotated) that the strength of the whole package comes from the triangle. (Looking from the top down, or a CT view). Since the screws are driven in at an angle, screw pullout is harder.

With my huge anchors, and 2 screws on each level going all the way up, its kind of like ripping up railroad tracks to pull a screw loose!
Ed

[loves to skate]

John

You bring up some good questions here, I have no idea how surgeons select hardware, or why some get 2 screws per level or clamps at different levels. Each construct is different. I have read that since the pedicle screws are driven in at an angle, (depends on which level, and how badly rotated) that the strength of the whole package comes from the triangle. (Looking from the top down, or a CT view). Since the screws are driven in at an angle, screw pullout is harder.

With my huge anchors, and 2 screws on each level going all the way up, its kind of like ripping up railroad tracks to pull a screw loose!
Ed

Ed, Some hospitals select the hardware for all patients because of cost constraints, but the surgeons at the hospital where I had my surgery had the option of choosing other hardware depending on the individual needs of the patient.
Sally

[mabeckoff]

I have Cobalt rods and titanium screws

Melissa

[Elisa]

I don't like sharing pictures lol. The scar looks nasty right after surgery. I'll take pictures and keep them to myself. And show as I return back to myself, and how I got straighter and X-Rays of course. I'll keep this thread as a blog. It's a damn long thread, but it acts like a blog pretty much. Has everything from Day 1 till now.

I know, I'm a detail monger, lol.

You're doing a great job of keeping all the details here so I'll keep checking back for updates. ;-)

[Elisa]

I have Cobalt rods and titanium screws

Melissa

I bet that's the combo my son has as well. I know he definitely has cobalt-chromium-molybdenum rods but am still curious about the screws. I'm going to ask Dr. K when we see him on the 27th.

[JDM555]

I have Cobalt rods and titanium screws

Melissa

Yup. That seems like the new popular type of hardware to use. CC rods and Titan. screws. My surgeon said all Titan., so I'm asking him why not CC. I'll see what he says. I asked Dr. Bederman and he said with my case, any of the three can work, but CC and SS are similar in stiffness, when titanium is a lot softer. He said it's not as crucial for me, because from T9-L1, I'm fused and I'll be having XLIF and adding spacers in the bottom 2 levels. Makes sense, but I still don't want to curve whatsoever, I want to stay 0-5* post-op for many years, so why not use the strongest?

I know, I'm a detail monger, lol.

You're doing a great job of keeping all the details here so I'll keep checking back for updates. ;-)

Lol. I'll update as I get closer. It's very very tough, I want to get surgery asap. I kinda wish there wasn't a damned wedding on Nov. 5th. If it was open, I would of had surgery down on the 21st, which is in 2 weeks. This wedding better be worth it! If there is no open bar I'm going to be PISSED hahaha.

I bet that's the combo my son has as well. I know he definitely has cobalt-chromium-molybdenum rods but am still curious about the screws. I'm going to ask Dr. K when we see him on the 27th.

Yeah, I wouldn't be surprised. Like I said, it's what almost most surgeons use nowadays. CC rods and Titan. screws. Lonner, Boachie, Lenke, etc. just to name a few. I'm sure other top surgeons are doing the same.

[Elisa]

There is no wedding without open bar, haha!

Good to know top surgeons use CC and titanium screws and that Shriners didn't skimp on the metalwork given my son was a 100% a charity case. :-D

[LindaRacine]

John...

I'm going to give you the advice I've given out many times. Stop worrying about things like what exact procedures will be done, and what type of implants will be used. Some of the biggest disasters I've heard about come when patients try to influence what the surgeon does in the O.R. As patients, we can't possibly know all the pitfalls of our requests. And, I've seen all too many times, that surgeons will do what a patient wants, even if they think it's not the best procedure, because they want to please their patients. I've even seen this in some of the surgeons I respect the most. What you don't want is the surgeon trying something out for the first time on you.

It sounds like you have a lot of confidence in the surgeon you chose. If that's the case, don't try to second guess him. If you're insecure about some part of the procedure, perhaps he's not the right surgeon for you.

--Linda

[JDM555]

John...

I'm going to give you the advice I've given out many times. Stop worrying about things like what exact procedures will be done, and what type of implants will be used. Some of the biggest disasters I've heard about come when patients try to influence what the surgeon does in the O.R. As patients, we can't possibly know all the pitfalls of our requests. And, I've seen all too many times, that surgeons will do what a patient wants, even if they think it's not the best procedure, because they want to please their patients. I've even seen this in some of the surgeons I respect the most. What you don't want is the surgeon trying something out for the first time on you.

It sounds like you have a lot of confidence in the surgeon you chose. If that's the case, don't try to second guess him. If you're insecure about some part of the procedure, perhaps he's not the right surgeon for you.

--Linda

You make a good point and you're correct. But I'm not second guessing a procedure, I'm just curious to why he's not using vitallium/cobalt-chrome. I'm not forcing him to do it this way, and even if he did it to make me happy, this wouldn't affect the surgical approach much. Again, I'm curious to why he is only using titanium, and not vitallium like many other surgeons, when vitallium is stronger and still looks good on MRI's/CT scan's like titanium. If he would explain to me "I choose this because I've worked with titanium for many years and know what I'm doing" I'll respect that and understand. Just curious, that's all.

And again, I'm not insecure about the surgical approach, he's doing exactly what I had in mind. He is my surgeon, and I've picked him. I'm just asking questions, many patients tend to do that before getting cut open for a spinal surgery, especially when it's fixing previously failed spinal surgeries.

[jrnyc]

hey John
don't blame you...i would ask why this metal and not that metal....i would want
to know the reasons....
i saw Dr Lonner just over a year ago to discuss surgery...he said he liked SS and
felt it was strongest...i said why not titanium...he said he could use titanium for
me and would do so if it mattered to me....

by now, maybe he likes cobalt...i do not know, since it has been over a year....

i think you need your questions answered to put your mind at rest...
even trusting a surgeon, it is nice to know how/why they are doing the things they
are doing for your surgery...to me, it is reassuring to know how a doctor/surgeon
is thinking....
plus, then there are no surprises...

best of luck
jess

[LindaRacine]

You make a good point and you're correct. But I'm not second guessing a procedure, I'm just curious to why he's not using vitallium/cobalt-chrome. I'm not forcing him to do it this way, and even if he did it to make me happy, this wouldn't affect the surgical approach much. Again, I'm curious to why he is only using titanium, and not vitallium like many other surgeons, when vitallium is stronger and still looks good on MRI's/CT scan's like titanium. If he would explain to me "I choose this because I've worked with titanium for many years and know what I'm doing" I'll respect that and understand. Just curious, that's all.

And again, I'm not insecure about the surgical approach, he's doing exactly what I had in mind. He is my surgeon, and I've picked him. I'm just asking questions, many patients tend to do that before getting cut open for a spinal surgery, especially when it's fixing previously failed spinal surgeries.

John...

Almost all spine implants are made in only one metal. A few of the really popular ones are made in both SS and titanium. If you push for implants that are made of anything other than stainless steel or titanium, you're essentially asking for a specific implant. It's highly likely that that system isn't one that your surgeon hasn't used previously. While most systems are relatively similar, there are differences, and each system comes with it's own tools. Tools that your surgeon might not have any experience in using. So, what may seem like an innocent inquiry can turn into a situation where you're an unknowing guinea pig.

--Linda

[JDM555]

I understand. If you really want to get technical regarding tools, using the titanium or vitallium rods doesn't change the fact I'm still using titanium pedicle screws. Like I said before, SS doesn't mix hardware and Titanium doesn't mix hardware, only thing that mixes is the Vitallium rods and Titanium screws. If both titanium rods and vitallium rods use titanium pedicle screws, how would the tools differ exactly? Some people even have 1 vitallium rod and 1 titanium rod in their backs. It doesn't become an issue of what "system" to use, it just becomes an issue of what type of rod to use. I'm sure vitallium can be found in the same diameter, length, etc. and be bent for my spine just like titanium rods.

And again, I'm not forcing him to do anything. I'm curious to see why he picked Titanium. I actually think the first time I saw him, I told him I was thinking about having titanium hardware, and he agreed ever since. Researching more about it, I found out there is vitallium which has the pro's of a titanium rod, without the con's of it. Like I said, if he says "I'm using titanium because I've been using it for years and I know what I'm doing", then case closed. I'll be happy with what he decides. I won't force him to use something he doesn't use. If it turns out he has expertise using Vitallium rods, then don't you think me being curious was worth it?

I think you, having had a revisional surgery recently, should understand why I'm curious. Maybe it's different for you, but the fact that I had surgery at 19, where I was opened up twice, and it wasn't successful and I've basically been partially handicapped for the past 3 years, makes me very wary of what my next option is, regardless of my surgeon. Even if I had Lenke or Boachie, I would ask these questions. I think the thing you should be concerned about, is a patient diving into a spinal surgery and not having any questions, that's a red flag. And trust me, I know from personal experience.