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

happyHBmomhhappyHBmom Posts: 2,070
edited 06/11/2012 - 7:46 AM in Back Surgery and Neck Surgery
I haven't all the details yet. It will involve going in from the back and the side, complete removal of my L2 vertebra, and realignment and fusion. It is something he's done before, and he claims an 80-90% success rate, success being significant decrease in pain levels within 8-9 months after surgery.

First will, of course, bee another MRI, cat scan, and so on.

Anyone have any details on this type of surgery? He would have a general surgeon there too to help him with the side incision.
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Comments

  • you know its a big complex operation and the term 360 or global means that the surgeon goes in from the back and front and sometime the side .the result you have more wound sites .the operation takes longer but if done well you and me should get a good result my only advice is to find a GOOD surgeon .this kind of operation is hard work and needs to be done by a competent person .so make sure that you do your homework and get the best ..is your body
    tony
  • Hi Buddha and Tony..

    Ive had fusions done where they cut through my stomach and also have had fusions where they went in through the side and the back..
    In all honesty the side/back hurt a little more than the front approach as my Dr said that doing it this way he had to cut nerves etc and the operation took 4 hours..When he did the frontal approach it only took it 2 and a half hours and that included putting in a Total DIsc Replacment as well..

    I also recovered quicker from the frontal approach..

    Hope this helps and just ask if I can help any further. :H
  • He said he would go in from the front and side, and has a general surgeon help him so he does not have to worry about anything except the spine.

    The surgery is big and involves removing what remains of my L2 vertebrae and then realigning my spine from L1-l3. I'm not sure what he'd fuse, I was too flustered to ask many questions, so I decided to wait until after the MRI etc.

    I believe he's an excellent surgeon. Board certified neurosurgeon with a full curriculum vitae, and experienced in complex spinal surgeries (which most are not, I have found). But I've never done this before so what do I know? This is my second opinion, same as the first as far as what the surgery would look like.
  • happyHBmom said:
    complex spinal surgeries (which most are not, I have found).
    Just wondering if you would be so kind as to elaborate on what you have found and from what source/s.

    "C"
  • Actually, I'm more interested in finding out information about the issues I asked about than in discussing the process by which I found the surgeon I chose. Why on earth would that information interest you?
  • I'm not asking about the process by which you chose your surgeon, that's your business. I am however, intrigued by your assertion that most spine surgeries are not complex. I am curious as to how you came to that conclusion. There are many members here who have undergone some pretty intricate surgeries as well as those who went in for some fairly common stuff that turned into their worst nightmare. I'm just wondering what the criteria is that determines whether a specific surgery is complex or not.

    Is it the number of levels, the location, length of surgery, type of surgery (MIS or Open), anterior vs posterior vs 360, amount of hardware, type of hardware, etc...

    I've always been under the impression that all spine surgery is complex, just some are more challenging to the surgical team than others.

    Anyway, just curiosity.

    "C"
  • Not to put words in HB's mouth but I think she is saying that not all surgeons have experience with the more complex surgeries like the 360. If I was having that surgery I would want to know that my surgeon has done it a few times already. This is why many of us have to seek out a specific surgeon who will treat us. For example very few surgeons will do thoracic so you have to search for those doctors.

    Of course we never know what will happen in that operating room, for spine surgery or any surgery. My father went in for what was a simple heart valve fix and someone slipped and cut a major artery. I went in for a pretty straight forward microD and came out with irreparable eye damage.

    Because there can be complications or even additional work to be done we want to find the surgeon who is best prepared to handle our situation. Going into a 360 I think HB is very smart to find a doctor who is experienced in this particular surgery.
  • 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, which includes 360, realignment the spine, vertebrectomy, something like a titanium cage, and then the fusion. I was looking for surgeons with specific reconstructive experience and preferred academic authorship.

    But that wasn't the topic of my post. I wanted to know what experience people have had with their surgeries, since I do know that people have had complex (360, corpectomy, etc) and what their recovery was like. I just wonder what I'm walking in to, and was hoping to hear from people who had been there. How painful was the recovery? How long were you unable to drive? How did you cope with life during the recovery?
  • I'll take a stab at this for you. I had a 360 revision surgery done in Jan. of this year. It was a 8.5 hour operation. It is a long time to be out and it takes a lot longer to get your lungs cleared out and working again. I was on oxgyen for 2 days after the operation.

    You are correct that what you have said your going to have done is complex, much more so then a PLIF. Your surgeon needs to be known for doing this type of surgery work, or I personally would still be looking for someone to do it. My surgeon did this type of surgery weekly and that along with he knew what needed to be done and had a team already together sold me on his qualifications. Mine went in from the back first to take out my failed fusion hardware, then had a vascular/general surgeon open me up in the front. There are a lot of things that need to be moved out of the way in order to reach the front of the spine. If the surgeon doesn't do this on a regular basis there is a good chance that a vessel, or organ can be bruised. A bruised organ can make a recovery that much longer. Your sexual hardware can also be effected as it lies in the way, at least it does on men.

    When the disk was removed and a cage and screw was added to the fron of my spine they closed me up rolled me over and went to work putting in new hardware for the fusion.

    I would be asking as much about the infection protocols at the hospital as anything else. This is the last thing you need to have happen is a infection, which by the way hospitals are noted for. Reading your posts I think you already know that.

    Getting set to leave the hospital after your surgery is no different then a regular fusion surgery in that you have to be able to walk, go up and down a few stairs, be able to eat, and also pee/poop.

    I was in the hospital for 6 days and did pretty well on my 1 3/4 hour ride home. I was well past ready to get into my own bed. I came home with a walker which I used for the first week. After that I kind of hugged the walls and used a cane. I was not walking alot but did get up for lunch and dinner in the kitchen. I did not each much at all even though I had a lot of good stuff around. I needed help doing most everything for the first 3 weeks home. I had my wife home all during my recovery. My experience was that if I tried to do something I wasn't ready for that I paid for it for 3 days afterward. If it hurt a bunch then don't do it.

    It was a slow process for me to really start feeling better and that process is still working. You will most likely start feeling better and wake up one day and say this doesn't hurt as much as it did. I took the pain medicine I was prescribed when I left the hospital and went back to the same amount I was taking before I had the surgery and then just started backing down on them. I still take some and I'm 7 months out.

    My surgeon would not let me go back to driving untill I saw him at the 3 month mark. Can't say I was really up to it much before then either.

    I did not endure the surgeon going in through my side. I was told by another surgeon that there are a lot of nerves in the side area and the most common problem was nerve damage. I would make sure that your general/vascular surgeon also does this on a regular basis, like weekly. The more the better in my book. My vascular surgeon did 4 to 7 of these surgery's weekly. He works with 7 spine surgeons at one of the big NYC hospitals. I was put at ease when I had my first meeting with him.

    There is no doubt that what you are having done will be complex and involved but what choice do you have? Are they talking of doing all this in one session on during a couple of them?

    If you have other comments or question feel free to send a PM.

    David
  • 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.



  • 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.

  • 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.



    Hi,

    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.

    David
  • 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.

    "C"
  • 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: 10,049
    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 Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • 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.

    Linda
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Well, I haven't been me for quite some time, so if I'm ever me again, I'll be happy. I do hope I don't have complications, but I know there is that risk. As with the rest of my health challenges, just take it all one step at a time. I'm just trying to go into it with as much understanding as I can of what I am going to be experiencing.

    Question, what did you do when you got home? Did you have help at home? People have been asking me whether I'll even be able to go home to my 2 story house, whether I'll need home health care, etc. I keep thinking it will be sort of like recovering from the accident itself, which I managed somehow.
  • The hospital will arrange for health care at home for you if they feel you need it. I didn't have a 360, but home nursing was discussed, however, I was fine for showering, etc.

    In regard to the stairs, the physio will check you out on this before you leave hospital.

    After I got out of hospital, I was on my own with two dogs. I did have a domestic service come in each week to clean the house and do the washing for four months. This was my time to get well again and I made sure I didn't do anything that might affect the fusion. I also had friends call in and help me. I had enough meals prepared and frozen to last me for a few months, and stocked up on on all the groceries, etc that would be needed.

    Trish











    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Each one of us experience things differently and to some degree make due with what we have.

    I would plan to have help there for at least the first couple of weeks. If you find that you can fend for yourself early on then you can dismiss the help. Kind of hard to get it in place once you find you need it if that turns out to be the case.

    If you can set up a place to sleep downstairs it would probably help you a bunch, at least as far as going up/down stairs. A bunch of meds in you and stairs tend not to mix well. How do you do now on the stairs? Do you have a bathroom downstairs?

    You would be the only one to be able compare what you felt like after whatever accident you had. Your body is going to be reeling from this surgery at least for a couple of weeks afterwords. Your not going to have much strength and will tire very, very easily.
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