Surgical time...I have to say it.....

March 8, 2007

The recent discussions about how long this surgery should take has

turned interesting. I must say I am more than a little worried about

this topic and what it means to those trying to make a decision about

surgery. So, at the risk of going way out on limb, I am going to say

what is on my mind (and I think is on a lot of peoples minds who have

undergone long drawn out staged surgeries). I don't mean this to

scare anyone, and I certainly don't want to undermine anyones

confidence in their doctor..but here it is.

The dabate rages on about whether you can have a fantastic revision

surgery for flatback with a " local " doctor and I think we may be

comparing apples and oranges, here is why.

Those of us that have gone to the surgeons on the forefront of this

surgery, SRS members with scads of published, peer reviewed research

into this condition have all undergone operative time well in excess

of 5 hours. Most of us had staged a/p surgery and no less than 2

discs replaced and fusion to the sacrum, instrumentation into the

pelvis with at least one osteotomy. Many of us underwent staged

surgeries of at least 2 days. I have heard of a few total times

around 8 hours...but I think 10 hours total would be closer to the

norm for this A/P surgery and less time if posterior only...if my

memory serves me (?).

Recently, folks are relating proposed surgical times by " unknown "

docs for A/P surgery and 4-5 levels replaced with a total operative

time of 5 hours. Hmmmm. Should you believe that the doctors that are

literally writing " the book " for surgery of flatback are the slowest,

pokiest, least dexterous surgeons out there, or alternatively, should

you wonder if the procedures they are doing are really the same?

I would propose that the difference lies in the latter, the

procedures done. That is why I think it is imperative to understand

completely what your proposed surgery is so you can understand the

difference in surgical times and what will be done to you, and more

importantly, what it means to you over the long term. Otherwise you

will simply not know how to evaluate a doctors proposal.

Would that we all could clap our hands and find ourselves in the

promised land of pain-free, upright, well working bodies.

Can you get a 10 hour procedure done in 5 hours? I would want a full

understanding and explanation of how that is to be accomplished

before I ever agreed to surgery. I think the time to ask that

question is before you have surgery. The information is here and

elsewhere on the web. We will be glad to help anyone learn how to

research the literature. It is heavy " lifting " ....the reading is

tedious and dull in many cases. The fact is you can not put too much

stock in any one patients outcome. Look at the longevity of the

doctors experience in your particular procedure, talk to him/her

frankly about their " outcomes to date " with your exact

procedure...and talk to their patients. If you can satisfy yourself

on all these accounts you will have done yourself a favor.

I was somewhat surprised to read that Ken, at this late date, has

just started a " list " and realized it is possible to track down

patients on his own. When I was in the reseach phase I not only

researched the procedure...but I went to every " flatback " scoli site

out there on the internet and re-read years of posts. I noted the

doctors and information about them and followed them forward in time.

When I had narrowed my list of doctors I contacted patients on my own

who had posted years back to see how they were doing. As says,

how someone is doing a few weeks or months after surgery is not the

same as how someone is doing 3-5 years down the road. (Incidently

Ken...I too have never have read of a patient of DrA.'s having

flatback revison surgery either. I am sure he has the technical

skills for the job and must have done it...but I just don't know how

you gain confidence in his abilites if you can't independantly verify

how his patients are doing).

If you are seeing a noted surgeon, yes, I think it is possible to

rely on their sole opinion and procede with surgery and have a great

outcome. But even within the ranks of the " top guns " I surely have

read about pretty poor " bedside manners " . Until you see more than one

doctor I don't know if it is possible to feel that you have found a

doctor who will likely be someone you are willing to have close

contact with for a number of years, if not the remainder of your life.

This is elective surgery folks. Pick the time, pick the hospital,

pick the surgeon. Pick well.

Thats my $.02,

Cam

March 8, 2007

Hi Cam...

I agree that most revision surgeries take 10+ hours. I think there are a lot of variables that determine how long it might take, but an estimate of 5 hours would worry me. (Hopefully, as Peggy mentioned, that’s just the scheduler’s guess.)

Having a surgeon suggest that he could do a long (as in area, not time) scoliosis revision in 5 hours would definitely give me pause. However, Dr. Harry Shufflebarger from Florida, who has a fairly good reputation from what I can tell, is really known for his speed surgery. I once heard him talk about a back/front/back surgery, done in one day, in less than 8 hours.

With that said, I think there are more doctors qualified to do revision surgery than those we’ve identified here. A PubMed search on FLATBACK or SAGITTAL IMBALANCE results in a lot of citations from doctors never mentioned here. While in a perfect world it would be beneficial to select a surgeon who has a great patient reputation for such, it’s not always practical to do so. Using the strict criteria we talk of so often here, I doubt that would ever have chosen Dr. Kumar. Thankfully, I’ll probably never have to face this issue for myself, but I think I’d personally exhaust all local options before considering going out of town for surgery. (Easy to say when you’re in the backyard of the guy who is widely considered to be the original maven of scoliosis revision surgery, huh?) I think there are dozens (maybe even hundreds) of scoliosis surgeons who do a lot of scoliosis revision surgery. Like Ken, I would definitely want to verify that my chosen surgeon has done a lot of similar surgeries (by talking to previous patients), as well as verify that the surgeon has had appropriate training. (By the way, Dr. Akbarnia did an informal fellowship with Bradford about 10 years ago, which is why I recommended that Ken consider him in the first place.)

I sometimes worry that the elitist approach to selecting the best surgeon might keep some people from getting help. However, I would encourage people to be really diligent about their research. Some of the biggest disasters I’ve heard about were almost certainly avoidable by choosing the right surgeon.

That’s my $.02. Do I owe you any change? ;-)

Regards,

On 3/8/07 7:45 AM, " cammaltby " <cammaltby@...> wrote: