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Thread: doesnt sound too minimal to me

  1. #1
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    Question doesnt sound too minimal to me

    i just received the write up from Dr Lonner...am confused...obviously, i need at least another visit, which i was planning...but now i am ...just confused!

    originally we spoke of L4 to S1 and T11 to sacrum...with bilateral pelvic fixation...that was a year ago, before the offer of minimal invasive made to me April 12th...

    however, the write up says...amongst other things...that i am "...particularly hypokyphotic in the thoracic spine, but with good overall balance"...i understand that part...

    it also says ".....lumbar spine reveals left lateral recess and foraminal stenosis of L4-5. Multilevel degenerative disc disease is noted"...is that just my spinal stenosis and disc disease problem...?

    he recommends the surgery...but this is the confusing part...
    "...in the form of lateral anterior approach from L1-L5 with interbody spacers and BMP. This would be followed by posterior instrumental fusion with less invasive muscle dissection technique and ileac fixation as well with interbody fusion from the posterior approach also done at L5-S1."

    HOWEVER...he later states..."The posterior procedure will be done from T11 to the sacrum and including the pelvis."

    SO....how many "posterior approaches" does that make...2...3?

    any explanations would be much appreciated...i will be calling the doctor and revisiting him...but am wondering if anyone thinks that T11 thing is a typo...?!!

    thanks...very much for reading this!

    jess

  2. #2
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    It sounds to me like he's going after you in every direction! I think if I were to go through all that, I would insist on having your 42* thoracic fixed. For crying out loud, it sounds painful. Sorry, don't mean to scare you. It's just while he's in there doing all that other stuff... Best wishes! At least you found someone willing to fix you and hopefully make you better in the long run.

  3. #3
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    Quote Originally Posted by jrnyc View Post
    i just received the write up from Dr Lonner...am confused...obviously, i need at least another visit, which i was planning...but now i am ...just confused!

    originally we spoke of L4 to S1 and T11 to sacrum...with bilateral pelvic fixation...that was a year ago, before the offer of minimal invasive made to me April 12th...

    however, the write up says...amongst other things...that i am "...particularly hypokyphotic in the thoracic spine, but with good overall balance"...i understand that part...

    it also says ".....lumbar spine reveals left lateral recess and foraminal stenosis of L4-5. Multilevel degenerative disc disease is noted"...is that just my spinal stenosis and disc disease problem...?

    I believe that is correct.

    he recommends the surgery...but this is the confusing part...
    "...in the form of lateral anterior approach from L1-L5 with interbody spacers and BMP. This would be followed by posterior instrumental fusion with less invasive muscle dissection technique and ileac fixation as well with interbody fusion from the posterior approach also done at L5-S1."

    HOWEVER...he later states..."The posterior procedure will be done from T11 to the sacrum and including the pelvis."

    SO....how many "posterior approaches" does that make...2...3?

    It sounds to me like he will be doing a lateral anterior approach to place the spacers and BMP from L1-L5. The posterior approach will be your less invasive instrumental fusion along with a spacer with BMP placed at L5-S1., so I would say 1 posterior approach.

    any explanations would be much appreciated...i will be calling the doctor and revisiting him...but am wondering if anyone thinks that T11 thing is a typo...?!!

    thanks...very much for reading this!

    jess
    Hope this helps. Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  4. #4
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    Thanks for the reply, Sally...but i still am confused about L5-S1 AND T11-sacrum...i dont get if he does that all at once...to me, it sounded like 2 separate cuts...or pokes, or however it is he said he would go in "less invasively" from the back...i do know the lateral thing will be a couple of "small incisions" on the side of the body...

    rohr...my thoracic is taken care of with botox shots...i specifically asked Dr Lonner if it would be likely that my thoracic would develop more problems after having fusion below it, and he said he didnt think so, and a doctor wont operate on the chance that something might happen well into the future....

    thanks again for the replies...

    jess

  5. #5
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    Hi Jess,
    The disc space at L5-S1 cannot be accessed laterally, so while he is putting the hardware in from T11-S1/pelvis, he will also access the disc space at L5-S1. I have no clue how many incisions he will have to make to accomplish all of this. I'm sure he will explain it more fully to you on your next visit, so try not to get yourself upset. This is the time when you just have to put your faith in God and your Doctor. Am I allowed to say God?
    Take care Jess, it will be just fine.
    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  6. #6
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    Thanks, Sally...for the information and the advice...i appreciate both!

    jess

  7. #7
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    Excellent explanation Sally.

    I know that the UCSF docs sometimes do 2 separate incisions for this type of anterior approach. There's a vertical one that's maybe about 3-4 inches that's usually about 2" left of center. The second one is on the side. I don't think I've ever actually looked at the incision, but I suspect that it's also about 3-4 inches. I don't, however, know if it's vertical or horizontal.

    It sounds like your posterior fusion will be anchored to your pelvis. I wouldn't worry about it. From what I can tell, it's no more motion limiting than fusion to the sacrum, and it's a lot more secure.

    --Linda

  8. #8
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    Quote Originally Posted by jrnyc View Post

    rohr...my thoracic is taken care of with botox shots...i specifically asked Dr Lonner if it would be likely that my thoracic would develop more problems after having fusion below it, and he said he didnt think so, and a doctor wont operate on the chance that something might happen well into the future....

    thanks again for the replies...

    jess
    Jess, I can't seem to find anyone interested in giving botox injections. I will ask about it again when I see the pain psychologist, general practioner, and neurosurgeon, as I do not have another appointment with the pain specialist. He just assumes that I am going to let him put in that intrathecal catheter. Dr. Tribus informed me today, that those only help with pain that radiates down the limbs. It might help with my left arm and leg, but that pain is not constant. My constant pain is in my neck and the neverending muscle spasms that I get under and in between my shoulder blades and in my neck and more often than I would like, in my ribs. Thanks again for the suggestion. I'm glad you get relief from it. I suppose I will be okay to let the scoli progress if I can get rid of the pain. I was really hoping to fix it early and get better correction since it is causing me so much pain AND progressing anyway.

    Best wishes on your upcoming surgery. It sounds like you are in good hands. And your doctor is right, if your 42* isn't progressing or hurting you, don't fix what don't hurt. (sorry if that sounded cheesy)

  9. #9
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    Linda...thanks for the reply... it helps alot when you & Sally explain it....

    rohr....i hope that you can find a pain doctor who will try the botox injections for you...they work so very well for muscle spasms!
    i am a ways away from the surgery date...i first have to have blood work done to see if i am "malnourished" due to low weight from lack of appetite due to pain meds....just had blood taken for my bio-identical hormone check (if it's not one thing it's another! ) so next month i'll get to checking what the surgeon has asked me to investigate....but thanks for the good wishes...cause i expect to get to that surgery date eventually...and sooner than i originally expected!

    jess

  10. #10
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    Much sympathy, jess. I was too baffled to attempt to figure out the surgical notes from Dr. Lonner (but I DID look up the number of vertebrae to try to count properly at least!)

    I hadn't considered that the various fixations might represent different points of entry, but it does sound like it. Looks like you got excellent explanations from the mavens of the site!

    It will all be over in the end and you'll be sound asleep while he's working on you. What stamina these doctors have! I'll bet that's why Dr. Neuwirth wanted to do two separate operations - so he could rest in between. His operative plan is P/A and up to four-five days apart waiting and, IIRC in an induced coma!! (THAT KILLS ME TO THINK ABOUT! And waiting until he can "Fit me in"!!! ) Not that I've decided in favor of him. I'm still in paralysis-panic mode.

    Otherwise, I'm looking at much the same thing as you, except that I have marked lumbar kyphosis (the "wrong kind" ie., not thoracic) and it's not hypo atall, atall! Guess my belly dancing days are really going to be over!

    Maybe we will even be recuperating around the same time. I have a lot more research to do first, though. You're way ahead of me.

    Hang in there!
    Last edited by Back-out; 04-27-2010 at 01:12 AM.

  11. #11
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    Hi Back Out
    thanks for the good wishes...and i may be ahead of you in researching doctors, but you're catching up fast!

    i see you edited one of your threads at 2 in the morning...and another at 5:44 a.m....i, too, have trouble sleeping...for years now! started happening at around age 50! just gets worse and worse! it'd be funny if we ever ended up in the same hospital, up all nite running around the halls!
    just kidding....i hear the meds they give you right after surgery keep you kinda knocked out!

    i hope you find the right doctor and the right hospital for you...

    best regards
    jess
    Last edited by jrnyc; 04-27-2010 at 06:48 AM.

  12. #12
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    Yeah, we could have a slumber party!!


    Amanda
    (only 1 AM)

  13. #13
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    Quote Originally Posted by Back-out View Post
    Yeah, we could have a slumber party!!


    Amanda
    (only 1 AM)
    I second that one!

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