Re: Does this sound like revision surgery? Please comment.

[Guest guest]

Jeri,

First of all - disclaimer - I am not a doctor but what you

posted about your spine seems kind of strange. You didn't mention

who your doctor was, but it seems like he taking a piece-meal

approach to your back and not seeing the whole picture. I would

definitely seek a second opinion. This is just my .02 but making

small incisions to slide out the broken rod doesn't really fix

anything. Are you seeing a scoliosis/revision specialist or just a

regular ortho doc? There is a big difference.

Best of luck. Barbara

> It's been over a week since I saw my MRI and CT scans with the

> surgeon. After thinking about what he's recommending, I think it

> doesn't sound like the revision surgeries I've read about here on

> this site. It sounds more like band-aid surgery to just correct

the

> broken hardware situation. I would think that a revision surgery

> would include breaking up the solid fusion below my broken

harrington

> rod to improve my sagital balance (Is that the term that means

adding

> some lordosis to make me stand straighter?)

>

> I'm not sure if I'm noticeably pitched forward, except for my neck

> (very noticeable in photos) which also has a very thick buildup of

> trapezius muscle on the left, making my neck look uneven from both

> front and side. I can not, however, stand flat against a wall

> without bending my knees.

>

> I'm still quite confused about whether this is the right surgeon to

> help me. Maybe I just wasn't clear enough about my pain and

posture

> concerns...

>

> Please tell me what you think. Below are numbered excerpts from my

> post the day I saw the surgeon.

>

> [1]Fused from T2-L3... fusion at T4-T5 clearly never healed... We

> could see a break through every view of the T4-T5 joint ... That's

> also where the rod is broken and laterally separated by the

thickness

> of the rod.

>

> [2]Originally fused from T1 down ... about 1 " of rod was removed in

> 1981 ... Currently the top of rod does not come even close to lining

> up with my spine (rod goes straight, spine curves markedly forward)

> L4 and lower disks are all somewhat arthritic, L4 is bone-on-bone.

>

> [3]Doc first said that one option would be to have a small incision

at

> the top to remove the top piece of the rod and a small incision at

> the bottom of my fusion to remove the main section of the rod...

> sliding them out, so to speak. After realizing that my bone graft is

> solid from T5 and lower, he said that would NOT be a good option.

>

> [4]He says to remove the top portion of the broken rod and replace

> just that part (T2-T5) with new instrumentation, and grinding up my

> non-fused bone graft and using the ground-up bone to re-fuse T4-T5

> would be my best option. ** Do you think this would straighten the

> forward pitch of my neck? **

>

> [5]He says fusing my arthritic discs below L4 would not be his first

> choice unless my low back pain gets worse. I didn't think to tell

him

> that it bothers me whenever I stand for any length of time or doing

> tasks like vacuuming, dishes (hand washing OR loading/unloading

> dishwasher) or walking for any distance longer than a few blocks.

>

> He thinks that taking care of one problem at a time is my best

option.

>

> Any comments?

> Jeri

[Guest guest]

Hi Jeri...

Get another opinion!

--

> Any comments?

Jeri

[Guest guest]

Jeri,

I think I may have responded to some of your questions previously,

but I wanted to add a few more thoughts, and I'm sorry if they are

repetetive - I didn't go back to my previous post.

I don't know what the true definition of spinal revision surgery is,

but I think of it as any additional surgery to a spine that has

already had surgery.

It seems like there is a lot going on with your back, and therefore

it's absolutely normal to come away from the initial visit with the

surgeon, start analyzing what was said, and come up with a bunch of

new questions. If you haven't already done so, you may want to

request a copy of the medical record that was written up as a result

of your appt. Oftentimes that helps clarify why the doc is making

the recommendation that he made. If you still have questions after

reading that, could you write them up and call his office to find out

what is the best way to get your additional questions answered?

Getting a second opinion as soon as possible is a must in my opinion

If the second doc proposed the same fix as the first, it goes a long

way toward giving you confidence that the proposed plan is the right

one for you. (I would also ask on many people with Harrington Rod

problems each has operated and what the outcomes and complications

have been. The more experience the better is my view.)

Now, if the second opinion varies wildly from the first, then I'd

probably ask each doc why he wouldn't recommend what the other doc

proposes.

Re: your point #4. This is something I'd ask each doctor with whom

you consult. It's very important that you clearly tell your docs

what all your symptoms are, and ask what is the likelihood that his

proposal will alleviate those symptoms.

I know of a couple of people who have had smaller surgeries to

correct problems with their Harrington rods or problems or

dengeneration above or below their rods. But their spines were still

out of balance, and so they continued to have problems until the root

cause (the imbalance) was corrected with additional surgery. I think

many tend to shy away from the piecemeal or bandaid approach in hopes

that getting the degeneration and the imbalance taken care of all at

once will help us avoid additional surgeries, and thus put the

nightmare of spine problems behind us sooner.

For some of us, it takes a lot of work and thinking and multiple

doctor opinions to sort through all this stuff and come to trust one

of them, Jeri. Hang in there,

loriann

> It's been over a week since I saw my MRI and CT scans with the

> surgeon. After thinking about what he's recommending, I think it

> doesn't sound like the revision surgeries I've read about here on

> this site. It sounds more like band-aid surgery to just correct

the

> broken hardware situation. I would think that a revision surgery

> would include breaking up the solid fusion below my broken

harrington

> rod to improve my sagital balance (Is that the term that means

adding

> some lordosis to make me stand straighter?)

>

> I'm not sure if I'm noticeably pitched forward, except for my neck

> (very noticeable in photos) which also has a very thick buildup of

> trapezius muscle on the left, making my neck look uneven from both

> front and side. I can not, however, stand flat against a wall

> without bending my knees.

>

> I'm still quite confused about whether this is the right surgeon to

> help me. Maybe I just wasn't clear enough about my pain and

posture

> concerns...

>

> Please tell me what you think. Below are numbered excerpts from my

> post the day I saw the surgeon.

>

> [1]Fused from T2-L3... fusion at T4-T5 clearly never healed... We

> could see a break through every view of the T4-T5 joint ... That's

> also where the rod is broken and laterally separated by the

thickness

> of the rod.

>

> [2]Originally fused from T1 down ... about 1 " of rod was removed in

> 1981 ... Currently the top of rod does not come even close to lining

> up with my spine (rod goes straight, spine curves markedly forward)

> L4 and lower disks are all somewhat arthritic, L4 is bone-on-bone.

>

> [3]Doc first said that one option would be to have a small incision

at

> the top to remove the top piece of the rod and a small incision at

> the bottom of my fusion to remove the main section of the rod...

> sliding them out, so to speak. After realizing that my bone graft is

> solid from T5 and lower, he said that would NOT be a good option.

>

> [4]He says to remove the top portion of the broken rod and replace

> just that part (T2-T5) with new instrumentation, and grinding up my

> non-fused bone graft and using the ground-up bone to re-fuse T4-T5

> would be my best option. ** Do you think this would straighten the

> forward pitch of my neck? **

>

> [5]He says fusing my arthritic discs below L4 would not be his first

> choice unless my low back pain gets worse. I didn't think to tell

him

> that it bothers me whenever I stand for any length of time or doing

> tasks like vacuuming, dishes (hand washing OR loading/unloading

> dishwasher) or walking for any distance longer than a few blocks.

>

> He thinks that taking care of one problem at a time is my best

option.

>

> Any comments?

> Jeri

[Guest guest]

Jeri,

I had my 2 harrington rods removed one year ago. One of the

revision surgeons I saw also recomended making two incisions, one at

the top and bottom, and pulling one of the rods out. I never felt

comfortable with this method, especially since you could see the

bone that had grown around my rod all the way down on the x-ray. I

mentioned this to one of the other revision surgeons I saw, and he

did not recommend that (I saw 4). He said there would be no way to

inspect the fusion for pseudoarthrosis and that was important to me

since that alone can cause pain as I understand it.

Several months ago there was a thread discussing the definition

of " revision surgery " . I think it was decided that rod removal

should not really be called revision surgery, but most of us agreed

that we would want a revision surgeon to do it since they take out

old hardware on a regular basis! Revision surgery (again as I

understand it) is the full blown surgery including osteotomies and

new hardware to realign the spine from HARMS, but someone correct me

if I'm wrong!

Good luck in your search for answers!

For my situation, I've taken the bandaid approach for now, but know

bigger things may be in store......because after two surgeries this

last year, I've not improved like I had expected. I'm only fused to

L2, so I'm not leaning forward due to the lumbar area (yet?), but

have lots of degeneration and pain above and below my fusion area

due to my imbalance. None of the revision surgeons I have seen have

recommended osteotomies, but I'm convinced I may need it someday

even though my imbalance is not large. I will end on a positive

note that the hardware removal was a large part of my problem, as I

had grown huge bursitis sacs with painful nerve endings. 80% of the

pain around the top of my hardware is gone. Unfortunately, it did

not help the neck pain or shoulder pain. I did not have

pseudoarthrosis or a broken rod, just painful hardware. Also, I

received an epidural steroid injection a couple of weeks ago for my

neck and it has helped somewhat. I'm seeing my doc Thursday for

results from recent sitting up MRI's of my whole back. This could

finally be done due the hardware coming out! Should be

interesting....

Take care!

in Texas

Fused in 1985 (21 years old) 2 harrington rods T4 - L2 and T5 - T10

Rods removed 2003 - Plano, Texas - Texas Back Institute

Cervical C6/7 disk removal and fusion for herniated disk Oct. 2003

> > It's been over a week since I saw my MRI and CT scans with the

> > surgeon. After thinking about what he's recommending, I think

it

> > doesn't sound like the revision surgeries I've read about here

on

> > this site. It sounds more like band-aid surgery to just correct

> the

> > broken hardware situation. I would think that a revision

surgery

> > would include breaking up the solid fusion below my broken

> harrington

> > rod to improve my sagital balance (Is that the term that means

> adding

> > some lordosis to make me stand straighter?)

> >

> > I'm not sure if I'm noticeably pitched forward, except for my

neck

> > (very noticeable in photos) which also has a very thick buildup

of

> > trapezius muscle on the left, making my neck look uneven from

both

> > front and side. I can not, however, stand flat against a wall

> > without bending my knees.

> >

> > I'm still quite confused about whether this is the right surgeon

to

> > help me. Maybe I just wasn't clear enough about my pain and

> posture

> > concerns...

> >

> > Please tell me what you think. Below are numbered excerpts from

my

> > post the day I saw the surgeon.

> >

> > [1]Fused from T2-L3... fusion at T4-T5 clearly never healed...

We

> > could see a break through every view of the T4-T5 joint ...

That's

> > also where the rod is broken and laterally separated by the

> thickness

> > of the rod.

> >

> > [2]Originally fused from T1 down ... about 1 " of rod was removed

in

> > 1981 ... Currently the top of rod does not come even close to

lining

> > up with my spine (rod goes straight, spine curves markedly

forward)

> > L4 and lower disks are all somewhat arthritic, L4 is bone-on-

bone.

> >

> > [3]Doc first said that one option would be to have a small

incision

> at

> > the top to remove the top piece of the rod and a small incision

at

> > the bottom of my fusion to remove the main section of the rod...

> > sliding them out, so to speak. After realizing that my bone

graft is

> > solid from T5 and lower, he said that would NOT be a good

option.

> >

> > [4]He says to remove the top portion of the broken rod and

replace

> > just that part (T2-T5) with new instrumentation, and grinding up

my

> > non-fused bone graft and using the ground-up bone to re-fuse T4-

T5

> > would be my best option. ** Do you think this would straighten

the

> > forward pitch of my neck? **

> >

> > [5]He says fusing my arthritic discs below L4 would not be his

first

> > choice unless my low back pain gets worse. I didn't think to

tell

> him

> > that it bothers me whenever I stand for any length of time or

doing

> > tasks like vacuuming, dishes (hand washing OR loading/unloading

> > dishwasher) or walking for any distance longer than a few blocks.

> >

> > He thinks that taking care of one problem at a time is my best

> option.

> >

> > Any comments?

> > Jeri