Announcement

Collapse
No announcement yet.

Last opinion...now it's decision time...

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Last opinion...now it's decision time...

    I had my 4th (and final) opinion yesterday up in NYC with Dr. Federico Girardi at the Hospital for Special Surgery. It was quite interesting to say the least. Some brief background: posterior spinal fusion 1993, revision 1995 and pain getting progressively worse from about 2004 until now. Saw 3 orthopedic spine specialists in my area - all 3 said pretty much the same thing: (1) remove L5-S1 disc, replace it with cage and bone protein; (2) remove Harrington rods/hooks; (3) fuse L1-S1 and further fuse spine to sacrum with pelvic rods going into either side; (4) osteotomies to correct Flatback. I was told 12-14 hr surgery (1 dr would do it in 2 stages 1 week apart so 2 weeks total in hospital) - HUGE risks for blood loss and nerve damage - 40% never work again (I'm an OT) - 2 yrs until fully recovered - and out of work atleast 1 yr (given the nature of my work - i do alot of patient transfers, ADL's, functional mobility, etc) - brace for 3 months - all 3 couldn't emphasize enough how "big and complex" this operation would be and all of them stressed how risky it was.

    NOW, Dr. Girardi on the other hand had this to say: (1) still remove L5-S1 and put cage and bone protein in to fuse it; (2) flip me over and remove hardware; (3) fuse approximately L3-L4-L5 and that he would see once he got in there if he'd need to fuse to my sacrum or not. Having had 2 prior posterior lumbar fusions, i have bone grafting scars on either side of my iliac crest (L/R) - if the pelvic bone was brittle and thin (from the grafting) he wouldn't fuse spine to sacrum. If it was strong, he would. He would NOT do osteotomies - he said the L5-S1 fusion would fix that (?? - really ?? - i thought the osteotomies would fix it but maybe i'm wrong??) - he said a brace would be up to me (again, i thought that was strange since i had one for both surgeries before) - if i wanted a brace he'd give me one. He said the whole operation would be maybe 6 hours - that seems really short given that the other dr's said it was such a complex procedure. I'd be in hospital about 4 days then to rehab for a week or so. But the thing that REALLY surprised me was that he said although i'd not be allowed to do any lifting or bending for the first 3 months, after 3 months there would be NO restrictions - i could do basically whatever i wanted and return to work. IS HE SERIOUS?? Now i don't know about all of you, but having gone thru TWO previous spinal fusions, i can assure i was in no shape to work (let alone lift and transfer patients!) 3 months post-op! And if this surgery is bigger and more complex than the other 2, how would that even be possible??

    I don't know...don't get me wrong, i was happy to hear his optimism, but realistically, is this REALLY what i should expect?? I thought i'd be 100% sure of who i'd pick after this consult but now all i can think of is "Why is his picture so much rosier than the other THREE??"

    Thoughts?? Insights?? Anything to help me sort this out
    1993/1995: PSF w/ Harrington rods T3-L4
    Jan. 24, 2012: ALIF of L4-L5, L5-S1 w/ cage spacer and BMP
    Jan. 31, 2012: PLIF of L1-S1 w/ pelvic anchors
    Scheduled Nov.15, 2012: Fusion T2-S1 w/ pelvic anchors to fix T12 fracture
    http://i31.photobucket.com/albums/c3...ot/myback2.jpg - BEFORE
    http://i31.photobucket.com/albums/c3...CT2342x406.jpg - AFTER
    http://i31.photobucket.com/albums/c3...CT1410x229.jpg - AFTER
    www.jerseyot.blogspot.com

  • #2
    I think your radar seems to be working well. If you have flatback, how does he think he'll get you balanced without the osteotomy? I would definitely be concerned.

    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #3
      Revision

      Hi, It's Lu again, sounds like Dr. G. painted a good picture, It is a big complex surgery, so take your time, if you are going to wait till spring you have a lot of time, and good luck. for me it is 4 month, and I still can't bend over without bending my knees. I am a hairdresser and went back to work last week (3 day a week) and that was a lot sooner then I though. 9 years ago I was out 7 month, but then I worked 5 days a week, good luck what ever you do. Lu

      Comment


      • #4
        Hi,

        My first thought after reading your post was "if it sounds too good to be true..."

        It sounds like you are facing a huge decision and I truly understand how hard it is when several opinions are the big/scary surgery and then another comes along and says something entirely different. My problems were not as severe as yours, but I got two opinions that said T10-sacrum/posterior/8 hr surgery and one that said L4-L5 only, 2 hour surgery, back to work in 4 weeks, etc, compared to 3-6 months off. It was a very hard choice at first. Then I went back and talked extensively to the one who ultimately did my surgery T8-sacrum, and he explained that the smaller surgery would only be a temporary fix at best. He said I would surely be back within 2 years for the big one any way (even the small surgery guy admitted this when pressed). I know your situation is different, but I would be extremely skeptical about the simpler surgery too. Like Linda said, if you have flat back, how will it be fixed without an osteotomy? Also I am confused because in 1) he says fuse L5-S1 with a cage (that is a fusion to the sacrum), then he says he will get in there, do A and P and "see" if you need fusion to sacrum. This doesn't make sense because he already said he would fuse to sacrum in step one.

        One other thing that helped me was to sign a release of information and read the consultation notes from each surgeon. Here they usually outline what surgical recommendation they are making, so you can read through each one and compare what they would propose and why.

        Good luck with your choice,
        Gayle, age 50
        Oct 2010 fusion T8-sacrum w/ pelvic fixation
        Feb 2012 lumbar revision for broken rods @ L2-3-4
        Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


        mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
        2010 VBS Dr Luhmann Shriners St Louis
        2017 curves stable/skeletely mature

        also mom of Torrey, 12 y/o son, 16* T, stable

        Comment


        • #5
          haven't had the surgery...yet...
          but i have consulted with several SRS surgeons....
          ALL said after fusion, with disc replacement also, from either T4 or
          T11 to sacrum/pelvic fixation, with a few "-otomies" and
          "-ectomies,"as i refer to them....at least 2 osteotomies included...
          i would NEVER be lifting anything heavy again....
          that was from Dr Boachie, Dr Lonner, Dr Neuwirth, Dr Errico,
          Dr Anand, and a few other names i've forgotten...

          i believe what Linda wrote you....

          would this surgeon let you talk with any of his other patients....
          someone who has had fusion to S1 and IS lifting heavy things....?

          i think you should stick with a surgeon who doesn't make warning
          bells go off...trust your instincts!

          best of luck
          jess

          Comment


          • #6
            You have consulted with four surgeons. Did you get a sense as to which surgeon is most experienced at doing successful revisions? Also, taking hospitals into consideration, HSS is the highest ranked orthopedic center in the nation. The best hospitals employ the best doctors.

            Have you checked out some of the doctor rating sites? I rated my surgeon on one of these sites so that others who may be seeking feedback could read about my experience. Dr. Girardi appears to be a huge fan of his patients. http://www.vitals.com/doctors/Dr_Federico_Girardi.html And he is certainly well credentialed.

            If I had to make your decision, I would go with the surgeon who is most experienced at doing revisions. And certainly ask to speak to some of his patients who had a similar surgery as what is being proposed for you.

            Comment


            • #7
              surgical considerations

              Jess has an excellent idea: talk to the doctor's patients who had similar problem/surgery to your proposed surgery. That helped me.

              IMHE going into surgery in the best physical condition helped me post-op be able to return to work at my profession after 6 mos.

              One problem with delaying the surgery too long is that the pain and inactivity wear one down to the point where optimization of pre-op physical condition is impossible--thus prolonging recovery unnecessarily.
              Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
              Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

              Comment


              • #8
                thanks so much to all of you who have responded - i really appreciate your insight and comments....i think i may just call and ask to speak to some of his former patients who have had the same surgery as what he proposed to me. That's a really good idea. This is such a huge decision - i feel as though fear is clouding my judgement and making it more difficult for me to make a decision on who will do this surgery (and where)! I just don't want to make the WRONG decision. I'm also thinking that since Clements was the first ortho i saw and the one to hit the nail on the head with regard to what needed to be done given the LEAST amount of info (all he had when i saw him was a couple of really bad quality xrays - the others had MRI, CT and full scoliosis series xrays) - i will bring in all of my scans and show him to see if his opinion has changed at all and to get a better feel for what he would do - and see if he really thought i needed 2 surgeries 1 week apart as he said when i met with him in July.
                1993/1995: PSF w/ Harrington rods T3-L4
                Jan. 24, 2012: ALIF of L4-L5, L5-S1 w/ cage spacer and BMP
                Jan. 31, 2012: PLIF of L1-S1 w/ pelvic anchors
                Scheduled Nov.15, 2012: Fusion T2-S1 w/ pelvic anchors to fix T12 fracture
                http://i31.photobucket.com/albums/c3...ot/myback2.jpg - BEFORE
                http://i31.photobucket.com/albums/c3...CT2342x406.jpg - AFTER
                http://i31.photobucket.com/albums/c3...CT1410x229.jpg - AFTER
                www.jerseyot.blogspot.com

                Comment


                • #9
                  All I know is when I met Dr Bederman for the first time, I knew that he was the one that I could trust to work on my back. I did not have that feeling with my first surgeon at all nor anything else that I went to for second opinions
                  Melissa

                  Fused from C2 - sacrum 7/2011

                  April 21, 2020- another broken rod surgery

                  Comment

                  Working...
                  X