
Originally Posted by
titaniumed
Bent, My surgeon wasn’t on the SRS list, but did his residencies and fellowships at TCSC which was where the SRS was founded.
He was also young at the time which had me concerned. I had to weigh the older 10,000 surgeries under his belt vs the newly trained in new techniques. I picked younger....only because I believed in him.
USCF has done a study on “multiple” surgeons being an advantage. I had 2 scoliosis surgeons and a vascular surgeon for my ALIF. The team means a lot.....Scoli surgeons like to have vascular docs hanging around for ALIF’s
How many levels on your ALIF? Will they use BMP? I would address the autograft/allowgraft question. I had no bone used in my surgeries....All synthetics, and that was 8-1/2 year ago. Does anyone dig on the hip anymore? I think this might be in the past now.
Most of the scoliosis surgeons are trained at the main centers, UCSF, TCSC, HSS, or in St Louis. My second scoliosis surgeon was trained in Indianapolis.
Training and experience means a lot....where its done, who its with, history, and so forth.
Others should chime in....
Deep breaths...Welcome to the forum
Ed
Hi Ed...
I think just about every ALIF opening is done by a vascular surgeon... at least here in the U.S. It would be really foolish to try the approach without one, as even a small mistake could easily result in a patient's death.
Yes, there are doctors who still routinely use iliac crest bone graft. It greatly increases fusion rate, so some surgeons feel that it's worth the risk of additional pain.
J Neurosurg Spine. 2014 Oct;21(4):595-600. doi: 10.3171/2014.6.SPINE13902. Epub 2014 Jul 11.
A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested? Clinical article.
Pirris SM1, Nottmeier EW, Kimes S, O'Brien M, Rahmathulla G.
OBJECT:
Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation.
METHODS:
Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale).
RESULTS:
Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally.
CONCLUSIONS:
Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional investigation to provide more definitive answers regarding the ideal, safe, and cost-effective bone graft material to be used in spinal fusions.
--Linda