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Um, tell me about 360 degree surgeries, fusions, realignments, and so on



  • When will you be meeting with this surgeon again? I would definitely know what someone is going to do before letting them do it. Things like hardware, bone grafting sources, recovery times, bracing, post surgery care as to whom you will follow with once surgery is over, what consist of a problem, length of hospital stay, actual surgery time and then the expected recovery times, what is the rate of fusion with the bone needing to fill in the space of the two disc and the vertebre. Will you be able to talk directly to him following surgery once home if you have issues or whom is your contact person? Check out the link on 38 questions to ask a surgeon in the FAQ section. What you can't answer would be things to formulate questions around.

    Although most of my experience lies in the cervical spine, as far as driving it is out for me until November when I see the surgeon again. But that has more to do with bracing and no movement in my cervical spine allowed. I would think in your case as soon as you can get off the heavy narc's following surgery you would be able to do small amounts of driving? But then again you know what they say about assuming. I would also ask to speak to a patient he has performed this surgery on, if it is not common and not widely used. I know in my last surgery by the means at which they had to get my hardware out, with a saw and being so close to the cord, my surgeon fully admitted all the risk and what we could do if it would go wrong. So I would be finding out how many of these surgeries he has done without a doubt. I mean I all out asked my surgeon how many patients have you used that saw on this close to the cord?

    So while there are many here whom have had complex surgeries and very complex surgeries each person experience are so very different and what made the surgery complex. Your best source is getting all the facts from your surgeon. You said this was a second opinion situation, so i would have been prepared with all the questions. But now i would most definitely make another appointment either with the first surgeon or this second opinion surgeon and get all the answers. Which surgeon are you having do the surgery the 1st or 2nd one? That is whom I would get all the answers from. Also I would find out the name of the surgeon who would be assisting him as well and check his/her credentials. I would also take someone with you for your next meeting just as a second set of ears and to be sure all your questions are answered. When is surgery scheduled for or when will someone being contacting you on it?

    I agree I would never let anyone operate on me whom is just a academic and not a practicing surgeon. Don't even think I would consider using them as a opinion either, if they are not qualified to do the surgery?
  • This is my second opinion, but I didn't choose my first opinion, I was referred by my doctor. He is, however, one of the other doctors in the area well known for doing complex surgeries.

    I will be seeing him again after my MRI and CT scans are done. No, I'd never let someone operate on me without knowing exactly what the operation entailed :) But asking people who had similar operations what they experienced is also helpful!

    He is certainly not solely an academic, I'm not sure where you got that idea. He does several surgeries a week, being a trauma surgeon as well as a non-trauma neurosurgeon. I believe I mentioned that in another post, and also that he's done many surgeries of the type that I need. Many surgeons write academic papers about interesting cases that they have in their practice. Surgeons who do so allow you to gather insight into their experience by searching their articles.

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  • happyHBmom said:
    Dave, thanks. What was the cause of your surgery, if I might ask?

    I was told 6-9 months total recovery, is this about right?

    I asked if he has done many of these surgeries. He said "Many many of them." I was told I could meet the general surgeon as well. Is this important? I couldn't think of what I'd ask him.

    I will ask about the length of the surgery and whether it will be in one or more settings. He did not say- there is much unanswered as we were working on old MRIs and did not have current information to work with.


    I had a failed fusion L3,L4 area with a broken screw on one side and a loose screw on the other side. I ended up having to wait almost a year because of a HMO insurance plan not having qualified doctors. In their eyes a orthro can do any surgery. Eh? Wrong.

    The recovery time is probably in the ball park, but keep in mind there are different degrees of recovery. I was told at least a year. If you have not had surgery on this area before you are ahead of the recovery game. The more surgery's you have, in the same location, the harder it is to recover. At least it was/is for me.

    I agree that you should take a second pair of ears with you and also a notepad with your questions written down. I did this and still ended up not having all my questions answered.

    I made a seperate trip into NYC to meet the vascular surgeon and found out a lot of information as I asked him to fully describe the operation step by step. It was a full day trip and I felt it was well worth the time and effort. Keep in mind this surgeon will most likely be cutting into you in 2 different locations so its your call. He will be the one doing all the opening/closing so you spine guy can get in to do his work. This is much differnt then going in through the back. I would be asking what the risks/complications of each surgery site might be. This surgeon needs to be every bit as experienced as your nuerosurgeon is. He should be doing this type of operation(s) regularly.

    You are correct in getting new film work done, as you and the surgeons need the latest info. There are some other Cat scan type filming that can precisely locate where everything needs to be as far as alignment goes. Ask who will be doing your Nuerological monitoring also.

    You may also need to donate blood.

    If you are concerned that your surgeon may be giving you a standard answer on the number of your type surgery's ask for 3 recent people he has worked on similar to your situation. I believe tamtam mentioned this also.

    You don't want to have to go through this type of surgery again and the best way that I know of to prevent that is to cross your T's, and dot your I's. It can be hard/frustrating to do. A lot of people don't ask enough questions judging from what I've read on this forum. It is a personal thing I guess. I wanted to know exactly what was going to take place.

  • SDavid, this is very helpful!

    It's just good to know others have been through the same process.

    I do not expect he is giving me a sales pitch when he tellls me how often he has done this type of surgery. I had a good feeling about his confidence being geniune.

    The former surgeon did not suggest surgery although that was a year ago. He felt it was too risky. He did not seem confident about the surgery.
  • happyHBmom said:
    I think you misread my sentence. I did not say most spine surgeries are not complex, although I would guess if you did a true study you'd find the simpler surgeries much more common. I was saying that most surgeons are less experienced in the more complex surgery that I required,
    Ah yes, my bad I obviously did misread your sentence. I agree that it's not a good thing to be a guinea pig on any surgery, whether simple or complex. Definitely worth doing your homework to find out if the surgeon you are getting the opinion from and possibly having do the surgery, is not only qualified, but well experienced. However, there are surgeries that just aren't that common and are very complex. Sometimes you are left with no choice really. You either take the chance that the surgeon can successfully pull it off, or continue to suffer and risk permanent disability.
    happyHBmom said:
    I was looking for surgeons with specific reconstructive experience and preferred academic authorship.
    Why throw in the requirement for preferred academic authorship?
    happyHBmom said:
    But that wasn't the topic of my post.
    Not the topic, but a part of the post. Like the vast majority of posts here, they tend to go off on tangents with the click of a mouse.

    Sorry for the misunderstanding. Now that you've edited your post, what you were trying to say is much clearer.

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  • I wanted a surgeon who did not just follow instructions, but was innovative- that is what makes surgeons write papers, when they develop innovative solutions to problems surgeons have been having and either have not solved, or have solved in a less effective way.

    Surgeons (doctors, therapists, etc) who are frequently published are often (not always, you have to read the papers to be sure) the better problem solvers.

    I agree, not everyone has a lot of choice. I have more than most. I hope I got it right. I won't really know until this is all over. I have a LOT of questions left to ask him, obviously- I still am kind of stunned by the concept.
  • I am almost 6 months post op 360. My experience has been very similiar to Bkins. My surgery was at a spinal cord hospital, where that is all they do.

    I was in the hospital for 6 days and it was difficult but I got through it....I did great the day of surgery (although I don't remember it at all), I walked in the hall and was happy. By the next morning, I had developed pneumonia and plurecy and had a difficult time breathing. I also needed 3 transfusions.

    I had/have a lot of abdominal swelling. None of my clothes fit, I had bought some presurgery that were the next size up and roomy. Those didn't even fit!:( I went from a small to a large and it took a couple weeks to fit into the mediums.

    I started Physical Therapy on day 14. This was my 3rd surgery so I knew my PT very well.

    The recovery is long, I have been told 12-18 months for nerve damage and 12 months minimum for fusion recovery.

    I came home with a walker, and a 3-1 raised toliet seat/shower chair. I didn't need my walker and only used it the first day home~I hated it! I only used the 3-in-1 for the raised toilet seat.

    I walked every day several times. Initially walking to the end of the driveway and little by little increased my distance to 2+ miles by 6 weeks.

    I had a hard TLSO brace and was initially told to wear it 23 hours a day. At my first post op visit, I got released to wear it when I was up out of bed.

    After 6 weeks, I wore it when I was up, walking or doing an activity. But if I was just moving from roon to room, I didn't wear it.

    At week 14, I stopped wearing the hard brace and moved to a "softer" brace. I hated this brace! It was aweful and so painful. I went cold turkey and stopped wearing it (with my surgeons okay) and did great weening off the brace. My core muscles were good as I started PT on day 14.

    Initially, my hubby, friends and family did the cooking and meals. I was independent with my self care except for putting my socks on.

    I was released for driving at my first post op, but I definately wasn't able to drive. I started driving to and from PT which is close to me, all surface streets (no freeways) around 6 weeks, out of necessity as my hubby was working.

    Around 3 months, I started driving on freeways. I went back to work at week 15, not because I was ready, but because I was out of Family Medical Leave act.

    Returning to work has been very difficult, but I think I may have just turned the corner. The past 2 weeks have been much better.

    I herniated the level above my fusion around week 8 and it remains to be seen what will happen with this.

    I had my thyroid out years ago. My body went into shock following my 360 and stopped absorbing my medication. This has made my recovery difficult, but we are working on getting my levels back up.

    I am doing most of the things I need to be able to do, shopping, groceries, cooking, laundry, cleaning with the exception of vaccuming. The one thing I still struggle with is standing in one place.

    Hope this info is helpful! Wishing you the very best during your journey!
  • dilaurodilauro ConnecticutPosts: 12,976
    Even the simplest of surgeries can have their complications. There are way too many factors to even try to list them here.

    Spinal surgeries, while have become more common to me are still difficult procedures. Why? Only because the involvement with the spinal nerve cord. If it was just bones to deal with, they heck, it should be easier.

    Chosing the surgeon is so important. When I knew I had to have two total shoulder replacements, my local Ortho wanted to do them. He is a young and very capable surgeon. However, I went down to NYC to see a group based on the recommendation of my physiatrist.

    Bottom line, the local doctor maybe does 4 or 5 total shoulder replacements a year, the surgeon in NYC, does about 3 or 4 a week.
    That said it all to me....

    Plus the surgeon was very open and made me feel at ease. Sometimes those extras mean so much
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • dilauro said:

    Spinal surgeries, while have become more common to me are still difficult procedures. Why? Only because the involvement with the spinal nerve cord.

    There are a whole slew of reasons why the 360 surgery is way more complex then just a regular spine surgery although no spine surgery doesn't have its risks. The spinal nerve cord is just one of the potential problem areas. There are many vessels and organs that need to be moved or worked around and damage to any one of them can leave you with every bit as many problems as a damaged cord.

    Bottom line, the local doctor maybe does 4 or 5 total shoulder replacements a year, the surgeon in NYC, does about 3 or 4 a week.
    That said it all to me....
    The above statement is worth its weight in gold. You want someone that does these types of surgery's on a regular basis and by regular I mean weekly. The air of confidence comes out right away just by how they answer questions without having to think about it. I had a local surgeon that wanted to do my surgery also but he wanted a few days to think about wether to go in from the front or side. He clearly didn't do a lot of 360 surgery's so I ended up in NYC also.

  • any spine surgery is routine. We're talking about operating near the spinal cord, on nerve roots that come from the spinal cord -- nerves that travel down arms and legs, etc. The whole body is affected. I did not plan on having a 360 surgery. It was all supposed to be done from the back, but they could not get out my three totally ruptured discs because I had too much scar tissue. So, they put in my hardware -- two rods and seven screws -- trying to fix the scoliosis and spondy as they went. I was in the operating room for nine hours the first day and lost a lot of blood, so I had to recover for four days and get three units of blood before they went back in from the front. From the front, they took out all three discs, inserted metal cages or dowels, filled them with cadaver bone, then packed it all up with BMP and some of my own bone marrow (taken from my hip). That surgery took most of the day too. I was in the hospital for an entire week. Couldn't wait to get back home again. Took a full 18 months to recover, but I'm almost back to being me again.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
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