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Thread: Dr. Lenke vs Dr. Lonner

  1. #1
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    Dr. Lenke vs Dr. Lonner

    Hi there,

    I need reinstrumentation with osteotomies in my thoracic spine. I have progressive deformity through a solid fusion. I electively had my rods removed to qualify for a public health service fellowship 10 yrs ago. Over the past 10 yrs I have lost 15-20 degrees of correction and have so much pain I have to wear a brace to stand any length of time. I am considering Dr. Lawrence Lenke at Columbia in NYC and Dr. Baron Lonner at Mount Sinai in NYC. I have listed my view of their pros and cons. I would like any members to respond with their thoughts or advice on who I should choose. I'd really appreciate it. Thanks

    Marie

    Dr. Lenke - PROS

    1. Known as best adult scoliosis surgeon in the world
    2. Believes there is less than 1% chance of parament paralysis
    3. Feels confident he can reduce my curve from 35 degrees to between 10-15 degrees using the least risky osteotomies (smith-peterson).
    4. Done over 1000 similar surgeries as mine
    5. On a scale of 1 to 10 challenging level with 1 being easy and 10 being extremely difficult, he rates my surgery a 2.

    Dr. Lenke - CONS

    1. Believes there is a 50% chance I will need a blood transfusion. They would get this blood from their hospital blood bank. There is no self donation before surgery because it weakens your system.
    2. Will need to extend my fusion 1 or 2 levels. One of the levels will be the L1 level which is the start of your lumbar spine. This will make my surgery more complex because not only will he have to break my original fusion to do the osteotomies, he will also be lengthening the fusion. I will have to grow new bone at the L1 level not just heal the existing fusion. Also I will have no flexibility at that level anymore which is important because there is a lot of movement in your lumbar spine compared to your thoracic. My thoracic spine is where my fusion currently is.
    3. I will need to do another full spine CT which is a lot of radiation. I just had one done a little over a year ago and nothing has changed about my back but his protocol is that I have a new one.
    4. Has a number of bad reviews however he does surgery on some of the most complex difficult cases in the world.
    5. The surgery will be a 2 man job and Dr. Lenke's 2nd surgeon working on me will be a fellow in training. A fellow in training is in their last year of training before becoming a practicing surgeon. A fellow is a rookie.
    6. Anytime I have a question pre or post surgery I have to go through his nurse.

    Dr. Lonner - PROS

    1. Believes there is a less than 1% chance of permanent paralysis
    2. Has technology to drastically lower my risk of needing a blood transfusion. He estimates my risk is under 5%.
    3. At the end of my surgery a plastic surgeon will come in and use a special stitching technique so my scar can heal to as minimally visible as possible.
    4. He is the sole operating physician. A resident may assist him but the resident will NOT be doing any of my surgery.
    5. The CTs I submitted to him are adequate for him therefore he is not requiring me to get anymore high radiation scans pre-surgery.
    6. He will not need to lengthen my fusion. Therefore my lumbar spine will not be messed with and my fusion will stay confined to my thoracic spine.
    7. Has very few bad reviews.
    8. On a scale of 1 to 10 challenging level with 1 being easy and 10 being extremely difficult, he rates my surgery a 3.5.
    9. Any time I have a question I get to directly contact Dr. Lonner through email and he answers me directly. I do not have to go through nurses.

    Dr. Lonner - CONS

    1. Has done approximately 100 surgical cases similar to mine. Dr. Lenke has done over 1000.
    2. He believes there is a good chance that he can reduce my curve from 35 degrees to between 15-20 degrees using the least risky osteotomies (smith-peterson). However he says it is possible I won't have much movement and in order to get my curve corrected to between 10-20 degrees he may have to do a riskier type of osteotomy. Dr. Lenke feels I have enough anterior disk space and he will not have to resort to a more invasive osteotomy.

  2. #2
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    That's a really great listing of pros and cons.

    Some further things that may help you decide include:

    1. Incidence of blood-bourne pathogens from blood bank blood. If the answer is zero will that matter?

    2. I would ask Lenke WHY he feels he wants to extend the fusion. The answer may matter in terms of whether you need future surgery. I would ask Lonner if he is postponing future surgery by not extending now. One of these approaches may lock you into future surgery and you need to know that. Going to L1 does not necessarily lock you into future surgery. It depends on if your lumbar is not structural and how straight they can drive your lumbar as far as I can tell.

    3. Residents helped with both my daughters' fusions and they are fine. They have identical fusions despite having different resident surgeons. That's because they had the same experienced surgeon operating next to them. Lenke and Lonner wouldn't exist if they were not given the chance to operate as residents. This issue never bothered me although my daughters has run of the mill T fusions so there is that. If they were complex cases then maybe I would be concerned.

    4. The radiation level on CT scans now has been lowered considerably. I would ask about that.

    Good luck.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  3. #3
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    Thanks for the feedback!

    It would not matter to me if the risk of blood borne pathogens is zero. It is just the science we have now. I would still have much trepidation about it. Science and medicine are not fixed and they are always evolving and new discoveries are made every day. Just because it would be zero now does not mean there is not some other unknown risk that has just not been discovered as of now. The sharing of blood materials can save lives but can also expose you to so many pathogens that may not be known at this time. However, I am not fanatical about it. If I need it then I need it and will get it but being able to avoid it makes Dr. Lonner very appealing to me.

    Dr. Lenke wants to extend the fusion up and down one level because my curve has advanced and that is his protocol for re-instrumentation surgery. It is not to avoid future surgery. Neither doctors see me needing future surgeries and both predict my lumbar curve will self correct partially once my thoracic curve is corrected. My lumbar curve is compensatory not structural.

  4. #4
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    Hi Marie...

    Congratulations on doing your research.

    I would personally not question or debate a skilled surgeon on their chosen technique, simply because your questions might conceivably cause the surgeon to alter their plan. You're choosing a surgeon because of their experience and reputation. Trust that they're going to do their best to fix your issue(s). At least in my book, I want my surgeon to use his knowledge and experience to choose the procedures that are going to produce the best chance at a good outcome, and not someone who is going to do plan B because they think that's what I want. As patients, we can't possibly guess what procedure is best for us (unless we go through medical school, residency, fellowship, and then practice for 30+ years).

    One thing to consider... if Dr. Lonner is truly doing 100% of your surgery, you're going to be at higher risk for intraoperative complications, and you're going to be under anesthesia considerably longer than surgeon performed by a 2-person team. Take a look at an abstract of a study that was conducted while I was at UCSF: https://pubmed.ncbi.nlm.nih.gov/28609324/

    You've chosen two very qualified surgeons. You'll never be able to really compare them, and even if you decide that one is significantly better than the other, there's still probably an equal chance that you'll have complications with the best surgeon, and a perfect outcome with the lesser surgeon.

    --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

  5. #5
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    Marie, Both are great scoliosis surgeons...tough choice. I have posted amazing articles and videos here on both of them. Use search.

    There are many people that feel that donating their own blood (autologous) in advance is better, but both autologous and allogeneic (Blood bank) have their own set of factors which if concerned, one could review.... To answer this question completely would take a mountain of material. There can be severe problems in donating your own blood.....(smug face) I used the blood bank. I can elaborate on this subject if you wish....

    I agree with Sharon on the L1 question. We are assuming you are age 28, you have not told us. It's important. You do have approx 30-35 degrees articulation per lumbar level per the Moe handbook. I am fused to my big toe and can do quite a bit....Its ok.

    On the CT, we do get our share of radiation under the O arm....I don't think another CT is something to worry about as long as its for surgery. Surgeons get a bit of a dose doing our surgeries on their hands. I have seen studies about this. Complications for scoliosis surgeons. And we thought we were the only ones.

    I have done 3 CT's.....but not for my scoliosis surgeries. Very extensive MRI was done right before my scoliosis surgeries. That was a LONG ride, over 1 hour in a fast machine. 60 plus x-rays since 1975.

    A Lenke fellow is no rookie. (smiley face) He was top 3% of his class in Med school, did a 4-5 year orthopedic residency and is 3/4 the way through his fellowship with the master of spine. He is real close and getting his final buyoffs. If Dr Lenke drops dead, he will finish your procedure.

    I communicated through my surgeon's assistant through e-mail. They sat about 10 feet from one another, so I would imagine that this was easy. Keep questions simple because many are hard to answer. Simple like "Can I pogostick on an icy lake?" Just kidding Doc, just kidding! (scoliosis forum humor)

    If they rate you a 2 and a 3.5 on a 1-10 scale, this doesn't sound too bad.... and correcting to a 10-15 is pretty darn good.

    Why did you pull your rods? Infection, pain, protrusion? Losing 15-20 degrees in 10 years sounds pretty aggressive. Its amazing how the forces of scoliosis are so relenting even while being fused....Your brace was strictly a soft tissue support device.

    I myself would be worried about flying up to New York. Boris Johnson spoke about locking down England today. I would also discuss COVID logistics with your surgeon.....COVID targets the nervous system, you don't need that right now.

    Can you get vaccinated BEFORE surgery???

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  6. #6
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    Wise answers.

    I had two surgeons for my surgery. What does a second surgeon do? In a video I recall seeing two people manipulating a spine while getting the rods attached, making sure everything bends the right way. Seems like it would be difficult for one person directing a nurse or working alone.

    But I would never ask the surgeon who works alone why he does so and would not let on that I was comparing one to another. At least, don't sound critical of them.

    As one who could never get much information out of my tight-lipped surgeon, I think it's great that they both communicate well with you. It doesn't matter if one goes through a nurse. I prefer to have something in writing because I don't trust my memory or my ability to understand something I hear for the first time, so email direct from the doctor works well. It wouldn't be a deciding factor for me though.

    If you're worried about contaminants in blood, wouldn't you worry about the same in the cadaver bone that they use? Are you worried about COVID-19 in blood? I'm sure they test it. Likewise I who have had a number of radiological scans in my life have just stopped worrying about them. One more won't make much difference where you have had so few.
    Last edited by Tina_R; 01-05-2021 at 03:34 PM.

  7. #7
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    Quote Originally Posted by Tina_R View Post
    What does a second surgeon do?
    It depends on the surgeon and on the procedure. When you have two experienced surgeons, I think they typically do the procedures (pedicle screws, etc.) on their side of the patient. If you're talking about a fellow or resident, and a complex procedure, the attending typically would be performing most of the difficult stuff, and watching carefully when the other surgeon is doing their part.

    I know that it's daunting to consider that someone other than your chosen doctor doing anything, but if we don't allow it, there will be no surgeons to perform on our kids.

    --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

  8. #8
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    I am sure Linda knows. But also these surgeries are long and everyone needs to step away sometime. I couldn't imagine staying in one spot for 14 hours.
    Last edited by jackieg412; 01-05-2021 at 04:22 PM.
    T10-pelvis fusion 12/08
    C5,6,7 fusion 9/10
    T2--T10 fusion 2/11
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16
    Broken neck 9/28/2018
    Emergency surgery posterior fusion C4- T3
    Repeated 11/2018 because rods pulled apart added T2 fusion
    Removal of partial right thoracic hardware 1/2020
    Removal and replacement of C4-T10 hardware with C7 and T 1
    Osteotomy

  9. #9
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    Thanks for all the response. Here is more info.

    1. My surgery is estimated to be about 5 hrs. Both doctors say about 5 hrs.
    2. Dr. Lonner often does use a second surgeon. I asked what kind of surgeon it would be in my case and he said in my case it is not necessary to have a second surgeon because it is a very straightforward revision and he sees little benefit in having a second surgeon for my type of surgery. However there will be a fellow or resident assisting him but Dr. Lonner does the surgery.
    3. I never asked "why" a particular surgeon works alone or chooses a particular surgical method. Often however they disclose "why" unprompted by me. So that is how I can give this information here and why I made the pro and con list. I take everything they propose to me 'as is'. I would never try to influence their approach to my surgery. I want them to do what they are most comfortable with. That will give me the best results in their hands.
    4. I do worry about cadaver bone but there is nothing I can do about it. I need my back fixed and both doctors will probably need to use it. However I have an option to possibly completely avoid a blood transfusion and avoid the hit to my system of losing so much blood so quickly. Afterall, you need a blood transfusion because your body is in a critical state compared to your body when it doesn't need a blood transfusion. If I never need the transfusion then my body never hit that critical state.
    5. Yeah, I'm worried about Covid in the blood too. I can get the vaccine before surgery and considering that.
    6. Radiation exposure from medical scans is cumulative over a lifetime. I'm 42 yrs old so still have decades of life left where I may need CT scans in the future. While I agree that an extra x ray or two will make little difference, CTs have a lot more radiation; up to 2 years worth.
    7. The article on 2 person vs 1 surgeon outcomes appears to be qualitative vs quantitative. I can only see the abstract but it appears to be questionnaire based which ask surgeons subjective experiences and opinions. It's the surgeons subjective reflections about surgery using 2 person teams vs one. Studies such as these have no hard data and are vulnerable to bias and faulty recall. It is still valuable since all these surgeons are very experienced but you can't tease out what types of surgeries really need 2 surgeons vs one based on this article.
    8. I agree there is probably equal chance of complications with each surgeon. However they do offer different things in my casse and that is why I made the pro con list and posted here. It comes down to trade offs and what I value. I was curious to see what other adult patients on this forum would do and how they would look at the tradeoffs of each.

  10. #10
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    What do the negative reviews of Dr. Lenke say about the greatest scoliosis surgeon in the world? That his operations didn't cure their problem or even worse, that he didn't respond to patients' concerns?

    Reviews are funny. There are so few of them for doctors that the sample size is often too small to make a judgment. Sometimes it's based on nothing more than the doctor's personality. Some of the reviewers never even went so far as to have surgery with the surgeons they review. Surgeons who do very tough cases would have more failures and failures probably prompt reviews more than successes do.

    The degree of difficulty is interesting. It sounds like a routine surgery for Dr. Lenke and more challenging for Dr Lonner, but maybe the latter is being more honest? Or maybe these figures are just their own perceptions.

    Is 100 surgeries of this type enough compared to 1000? For me it would be, I think.

    Not to influence you, but I think you are leaning toward Lonner. You have a point about the blood transfusion and the extension of the fusion with Lenke. Did Dr. Lonner say what he would reduce your curve to, was it by the same degree? Not that that's necessarily important.
    Last edited by Tina_R; 01-06-2021 at 03:16 PM.

  11. #11
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    linzlu28, I like the way you approach these subjects. I suspect you have some science training.

    In re complications, specifically infection, last I knew that was correlated with institution, not surgeon. So you would look for the infection rate of that hospital versus that surgeon.

    I am still perplexed why Lenke would add a level at both ends when that might not be necessary. I would want to know why he does that. Unless the reason is less chance for needing more surgery in the future, I don't know how he justifies it.

    Then we have surgeons like Dr. Hey who stand on their heads to save levels. I just don't get it.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #12
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    Here are other dual attending, dual team, or dual surgeon scoliosis surgery approach studies....Scroll through a few pages.
    https://pubmed.ncbi.nlm.nih.gov/?lin...m_uid=29050715

    Dr Lenke most likely wants the new CT for 3D printing your spine. You have to decide if you like this technology. It offers the ability to examine a full scale model of any area of your spine including spinal canal, wall thicknesses and proposed osteotomies....Ask if the amount of radiation of the CT will save or lower O arm Flouroscopy radiation since these values can run much higher than CT's. I had flouroscopy burns on my hips after my procedures and they hurt quite a bit.

    Dr Lenke might be concerned with adjacent level disease above and below your fusion mass which could explain why he wants to extend these levels.

    Insurance needs to be addressed. Co-pays can be shocking these days. I would have a good amount of total coverage in case you need more surgery on a complication. I had $3.9 million total 13 years ago and used more than half of that on several surgeries. It was one of the reasons why I ran out of the hospital and skipped re-hab. I would not recommend this route. Do not leave unless the hospital unless you are weaned to orals.

    Addressing infection is a good idea....On allowgraft....I had NO bone used in my surgeries, only synthetics.

    Ed
    Last edited by titaniumed; 01-06-2021 at 07:27 AM.
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  13. #13
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    Ed has a lot of good information. Just to add that I have had multiple problems. So consider the additional levels.
    Also, at this time there is the virus to add an additional level of concern.
    T10-pelvis fusion 12/08
    C5,6,7 fusion 9/10
    T2--T10 fusion 2/11
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16
    Broken neck 9/28/2018
    Emergency surgery posterior fusion C4- T3
    Repeated 11/2018 because rods pulled apart added T2 fusion
    Removal of partial right thoracic hardware 1/2020
    Removal and replacement of C4-T10 hardware with C7 and T 1
    Osteotomy

  14. #14
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    Quote Originally Posted by linzlu28 View Post
    3. I never asked "why" a particular surgeon works alone or chooses a particular surgical method. Often however they disclose "why" unprompted by me. So that is how I can give this information here and why I made the pro and con list. I take everything they propose to me 'as is'. I would never try to influence their approach to my surgery. I want them to do what they are most comfortable with. That will give me the best results in their hands.
    Sorry. I truly never meant to imply that you were trying to influence either surgeon. My point is that everything we say MAY influence what the surgeon does. For many of the procedures that are done during complex spine surgery, there are multiple ways to get those procedures done. Surgeons tend to go with what they like to do, and what has produced the best outcomes in the past. But, that doesn't mean they do the same thing every time. If they think a patient might be concerned about procedure A, it's simple for them to switch to procedure B.

    Quote Originally Posted by linzlu28 View Post
    6. Radiation exposure from medical scans is cumulative over a lifetime. I'm 42 yrs old so still have decades of life left where I may need CT scans in the future. While I agree that an extra x ray or two will make little difference, CTs have a lot more radiation; up to 2 years worth.
    I totally agree with this. While spine surgeons are concerned about radiation exposure in their patients, they also know that these scans can give them considerable help in assessing the problem. If I didn't think a test would have enough reward, I would certainly consider turning it down.

    Quote Originally Posted by linzlu28 View Post
    7. The article on 2 person vs 1 surgeon outcomes appears to be qualitative vs quantitative. I can only see the abstract but it appears to be questionnaire based which ask surgeons subjective experiences and opinions. It's the surgeons subjective reflections about surgery using 2 person teams vs one. Studies such as these have no hard data and are vulnerable to bias and faulty recall. It is still valuable since all these surgeons are very experienced but you can't tease out what types of surgeries really need 2 surgeons vs one based on this article.
    I don't have the full article any more, but there was way more to it than a surgeon questionnaire.

    I agree with Tina, that it sounds like you're leaning toward choosing Lonner. If that's the case, I think it's a good decision. While that might not be everyone's choice, I feel strongly that you should follow your own instincts. I think the best thing we all can do is to support your feelings. It's always appeared to me that one of the strongest indicators of a good outcome in complex spine surgery, is the amount of trust one has with their surgeon.
    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

  15. #15
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    Quote Originally Posted by titaniumed View Post
    Dr Lenke most likely wants the new CT for 3D printing your spine. You have to decide if you like this technology. It offers the ability to examine a full scale model of any area of your spine including spinal canal, wall thicknesses and proposed osteotomies....Ask if the amount of radiation of the CT will save or lower O arm Flouroscopy radiation since these values can run much higher than CT's. I had flouroscopy burns on my hips after my procedures and they hurt quite a bit.
    3D model printing is actually pretty rare in relatively routine spinal surgeries. At UCSF, that technology is only used when patients have very unusual anatomy. Even with unusual anatomy, enhanced CT scans provide the information needed.
    https://www.researchgate.net/figure/..._fig7_44641570
    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

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