Posterior-only osteotomies (was rePost-op walking goals

July 14, 2004

Okay, Elissa, here's another one for the " scratch your head " file.

When I had my hip replacement, due to my congenital hip dysplasia, my

OS had to lengthen my leg, which made all the muscles, tendons and

nerves really tight and painful. He had to be very careful not to

stretch the sciatic nerve too much, which would result in a foot drop

(kind of a paralysis of the foot). Okay, fast forward to when I have

the future posterior spinal osteotomy to crank me backward. Won't

this stretch the nerves and muscles that run between the back and the

hip/leg even more? I'm sure I've been told no by at least one

medical professional, but I can't figure out how the heck they yank

you backward WITHOUT doing so?

Ugh!!!!!!

loriann

Dislaimer: I know nothing either!!!

> As noted below, there's been a thread about the perceived decline

of

> posterior-only osteotomies. I don't pay much attention to the

> mechanics of this whole thing, but it seems to me -- heavily

> disclaimed that I'm a dingbat -- that a posterior-only osteotomy

> wouldn't really help restore lordosis, so if the goal was to

restore

> a curve, osteotomies on one side only wouldn't necessarily help

much.

>

> What I mean is this. If the goal is to take a stick-straight spine

> and make it into a curved shape again, you can't just take a wedge

> out of one side -- you need to make a wedge on the other side so

that

> the whole thing can bend.

>

> I don't know if I'm explaining that correctly and I *CERTAINLY*

don't

> know if my half-baked assessment is correct. But when I visualize

> trying to make something completely straight become curved by

cutting

> wedges out of it (and of course applying adequate force to make the

> bend, placing instrumentation and fusion mass to fuse it solid,

> etc.), it seems like you need one in the front to be the outside of

> the curve and one on the back to be the inside of the curve. But

> again, there are clearly all kinds of revisions that are nothing

like

> the one that I had. Hey, have I disclaimed this enough?

>

> Elissa

July 14, 2004

Hi Elissa...

I think, much of the time, all that's needed in the front of the spine

is replacement of discs with cages.

--

> As noted below, there's been a thread about the perceived decline of

> posterior-only osteotomies. I don't pay much attention to the

> mechanics of this whole thing, but it seems to me -- heavily

> disclaimed that I'm a dingbat -- that a posterior-only osteotomy

> wouldn't really help restore lordosis, so if the goal was to restore

> a curve, osteotomies on one side only wouldn't necessarily help much.

>

> What I mean is this. If the goal is to take a stick-straight spine

> and make it into a curved shape again, you can't just take a wedge

> out of one side -- you need to make a wedge on the other side so that

> the whole thing can bend.

>

> I don't know if I'm explaining that correctly and I *CERTAINLY* don't

> know if my half-baked assessment is correct. But when I visualize

> trying to make something completely straight become curved by cutting

> wedges out of it (and of course applying adequate force to make the

> bend, placing instrumentation and fusion mass to fuse it solid,

> etc.), it seems like you need one in the front to be the outside of

> the curve and one on the back to be the inside of the curve. But

> again, there are clearly all kinds of revisions that are nothing like

> the one that I had. Hey, have I disclaimed this enough?

>

> Elissa

July 14, 2004

Re posterior only - I cannot picture any of this either and do not have my films

here to help, but can say that I had the posterior only osteotomy and NO cage.

Osteo was at previously fused level - could this make a difference? All I know

is that I was straight before and now have nice lordosis.

>

> From: " Racine " <linda@...>

> Date: 2004/07/14 Wed PM 05:21:39 EDT

>

> Subject: Re: Posterior-only osteotomies (was re Post-op

walking goals

>

> Hi Elissa...

>

> I think, much of the time, all that's needed in the front of the spine

> is replacement of discs with cages.

>

> --

>

> > As noted below, there's been a thread about the perceived decline of

> > posterior-only osteotomies. I don't pay much attention to the

> > mechanics of this whole thing, but it seems to me -- heavily

> > disclaimed that I'm a dingbat -- that a posterior-only osteotomy

> > wouldn't really help restore lordosis, so if the goal was to restore

> > a curve, osteotomies on one side only wouldn't necessarily help much.

> >

> > What I mean is this. If the goal is to take a stick-straight spine

> > and make it into a curved shape again, you can't just take a wedge

> > out of one side -- you need to make a wedge on the other side so that

> > the whole thing can bend.

> >

> > I don't know if I'm explaining that correctly and I *CERTAINLY* don't

> > know if my half-baked assessment is correct. But when I visualize

> > trying to make something completely straight become curved by cutting

> > wedges out of it (and of course applying adequate force to make the

> > bend, placing instrumentation and fusion mass to fuse it solid,

> > etc.), it seems like you need one in the front to be the outside of

> > the curve and one on the back to be the inside of the curve. But

> > again, there are clearly all kinds of revisions that are nothing like

> > the one that I had. Hey, have I disclaimed this enough?

> >

> > Elissa

>

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>

July 14, 2004

If your original fusion was anterior/posterior, I imagine it would be necessary

to do the revision A/P as well, assuming that the osteotomy is through fusion

mass, which has filled in between the vertebrae, where the disc once was. If

the anterior side of the joint was not fused, then the posterior osteotomy would

free up the joint enough to bend backward into the desired. position. An

anterior approach might still be needed for stability, or maybe, if the anterior

portion of the disc is badly degenerated.

Sharon Green, Doctor of Sounding Like I Know More Than I Do.

Re: Posterior-only osteotomies (was re Post-op