Re: I got a copy of my records from Dr Bridwell today/Sharon

[Guest guest]

Sharon,

You misunderstood my comment. I am disqualifying myself for surgery.

A doctor has the right to have any opinion he wants. And I'm sorry,

but I don't consider such comments an " error. "

Kathy

> >

> > and I am a bit frustrated and curious how one page can say one

> thing

> > and another page can say something else entirely.

> >

> > first -- a review of the standing xrays by the radiologist in

july

> >

> > there is moderate rotatory levoscoliosis centered in the upper

> > lumbar spine, as well as a mile dextroscoliosis of the thoracic

> > spine. In the sagittal plane, there is straightening of the

lumbar

> > spine, leading to a kyphosis at the thoracolumbar junction and

> > straightenting of the thoracic spine. Because of this, the

> > cervicothoracic junction is displaced anteriorly relative to

the

> > lumbar sacral junction.

> >

> > The vertebral body heights and disc spaces are normal, and

there is

> > no evidence of degenerative disease.

> >

> > then -- a review of prone xrays in october -- with comparison

to

> the

> > earlier standing xrays

> >

> > there is unchanged moderate rotatory levoscoliosis centered at

L#,

> > as well as a mild dextroscoliosis of the thoracic spine.

Attempted

> > posterior fusion from T10 through L5. Degenerative dis disease

is

> > seen at L5-S1 with vacuum phenomenon. In the sagittal plane,

there

> > is lumbar hypolordosis and decreased thoracic kyphosis is prone

> > positioning. The vertebral body heights are normal. Motion is

> > present at L5-S1

> >

> > moderate thoracolumbar scoliosis does not change with prone

> > possitioning, while thoracic kyphosis is partly reduced in the

> prone

> > position

> >

> > The doctor's notes in july

> >

> > heavy and overweight. Cornal balance not too bad. Pitched

forward

> > in the saggital plane. Has a CT and MRI study -- suspicious for

> > nonunion at L1-L2. Definitely a nonunion with Grade II

> > spondyloloisthesis and a vacuum disc at L5-S1.

> >

> > talked about potentially a three stage apporach -- first stage,

> take

> > out the implants, get fixation points, do whatever

decompression.

> > Second staage do either mulitple smith-petersen or a single

pedicle

> > subtraction procedure and instrumented fusion T10 to the sacrum

and

> > pelvis. Thrid stage four months later, anterior fusion at L5-

S1.

> > Whether we do the anteriorr fusion at 5-1 down the road or more

> > recent would depend on whether it appeared that her leg pain

was

> > foraminal stenosis or more central stenosis. On the MRI, some

> > places you can see her canal very well and other places there

is

> > some scatter. Talked to her about aerobic conditioning and

weight

> > loss as well.

> >

> > doctor's note in october

> >

> > her abdomen is absolutely huge when she is in a supine

position. I

> > do not think doing any kind of anterior operation on her would

be

> > wise. (and I weighed less on that visit!)

> >

> > looks 10-15 years older than her stated age. Has a component of

> > fixed sagittal imbalance. Seems neurologically intact.

> >

> > CT-myelogram shows some stenosis at L5-S1. She does not have an

> MRI

> > (!!) We reviewed each and every one of a huge quantity of films.

> >

> > surgery would probably be a two stager. First stage removing

the

> > harrington implants and getting fixation points and the like.

> > Second stage pedicle subtraction osteotomy at L3 and

instrumented

> > fusion T10 to the sacrum and pelvis. A 10-15% risk of weak

> > quadriceps or weak foot on one side and roughly 1 in 1000 to 1

in

> > 500 of paraplegia and 3-5% risk of major wound infection. She

> > should have a thallium stress test because she is clearly much

> older

> > than her stated age. I am a little concerned about her overall

> > hygiene as well. She seems to be a fairly nice and friendly

> > person. Ideally we would want to structurally graft 5-1

> anteriorly,

> > but her 5-1 disc is very collapsed. I don not think it is a

very

> > good disc for a TLIF and I do not think doing an anterior of

any

> > sort on her would be advisable at all.

> >

> > it looks like when she is prone, her spondylolisthesis reduces

at

> L5-

> > S1. When she is standing upright there is a 6mm or so

> > sppondylolistthesis at L5-S1 and I think she has had a

laminectomy

> > there before.

> >

>

[Guest guest]

Kathy, I meant that if he made the comment not believing the patient would ever see it, that it was an error.

[ ] Re: I got a copy of my records from Dr Bridwell today/Sharon

Sharon,You misunderstood my comment. I am disqualifying myself for surgery. A doctor has the right to have any opinion he wants. And I'm sorry, but I don't consider such comments an "error." Kathy> >> > and I am a bit frustrated and curious how one page can say one > thing > > and another page can say something else entirely.> > > > first -- a review of the standing xrays by the radiologist in july> > > > there is moderate rotatory levoscoliosis centered in the upper > > lumbar spine, as well as a mile dextroscoliosis of the thoracic > > spine. In the sagittal plane, there is straightening of the lumbar > > spine, leading to a kyphosis at the thoracolumbar junction and > > straightenting of the thoracic spine. Because of this, the > > cervicothoracic junction is displaced anteriorly relative to the > > lumbar sacral junction.> > > > The vertebral body heights and disc spaces are normal, and there is > > no evidence of degenerative disease.> > > > then -- a review of prone xrays in october -- with comparison to > the > > earlier standing xrays> > > > there is unchanged moderate rotatory levoscoliosis centered at L#, > > as well as a mild dextroscoliosis of the thoracic spine. Attempted > > posterior fusion from T10 through L5. Degenerative dis disease is > > seen at L5-S1 with vacuum phenomenon. In the sagittal plane, there > > is lumbar hypolordosis and decreased thoracic kyphosis is prone > > positioning. The vertebral body heights are normal. Motion is > > present at L5-S1> > > > moderate thoracolumbar scoliosis does not change with prone > > possitioning, while thoracic kyphosis is partly reduced in the > prone > > position> > > > The doctor's notes in july> > > > heavy and overweight. Cornal balance not too bad. Pitched forward > > in the saggital plane. Has a CT and MRI study -- suspicious for > > nonunion at L1-L2. Definitely a nonunion with Grade II > > spondyloloisthesis and a vacuum disc at L5-S1.> > > > talked about potentially a three stage apporach -- first stage, > take > > out the implants, get fixation points, do whatever decompression. > > Second staage do either mulitple smith-petersen or a single pedicle > > subtraction procedure and instrumented fusion T10 to the sacrum and > > pelvis. Thrid stage four months later, anterior fusion at L5-S1. > > Whether we do the anteriorr fusion at 5-1 down the road or more > > recent would depend on whether it appeared that her leg pain was > > foraminal stenosis or more central stenosis. On the MRI, some > > places you can see her canal very well and other places there is > > some scatter. Talked to her about aerobic conditioning and weight > > loss as well.> > > > doctor's note in october> > > > her abdomen is absolutely huge when she is in a supine position. I > > do not think doing any kind of anterior operation on her would be > > wise. (and I weighed less on that visit!)> > > > looks 10-15 years older than her stated age. Has a component of > > fixed sagittal imbalance. Seems neurologically intact.> > > > CT-myelogram shows some stenosis at L5-S1. She does not have an > MRI > > (!!) We reviewed each and every one of a huge quantity of films.> > > > surgery would probably be a two stager. First stage removing the > > harrington implants and getting fixation points and the like. > > Second stage pedicle subtraction osteotomy at L3 and instrumented > > fusion T10 to the sacrum and pelvis. A 10-15% risk of weak > > quadriceps or weak foot on one side and roughly 1 in 1000 to 1 in > > 500 of paraplegia and 3-5% risk of major wound infection. She > > should have a thallium stress test because she is clearly much > older > > than her stated age. I am a little concerned about her overall > > hygiene as well. She seems to be a fairly nice and friendly > > person. Ideally we would want to structurally graft 5-1 > anteriorly, > > but her 5-1 disc is very collapsed. I don not think it is a very > > good disc for a TLIF and I do not think doing an anterior of any > > sort on her would be advisable at all.> > > > it looks like when she is prone, her spondylolisthesis reduces at > L5-> > S1. When she is standing upright there is a 6mm or so > > sppondylolistthesis at L5-S1 and I think she has had a laminectomy > > there before.> >>