Minimally Invasive Scoliosis Surgery Featuring George Picetti, III, M.D.

[Ballet Mom]

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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]

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]

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]

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]

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]

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]

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-s...s-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]

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]

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]

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]

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]

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]

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]

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]

very simply, i thought posterior approach requires less moving around of internal organs...no?

jess