Answers about Controversial Trends in Spine Care

i appreciate the advice. I live alone and have no one who can help me. No family are close enough geographically or have the ability to take time off to help. My Mom is almost 95 and is in Independent living in a senior living community where I used to work--but, like yours, I take her to doctor appointments and help her shop, set up her pillbox, etc. She's not totally independent. This surgery will present a lot of unique challenges I haven't faced before, including not being able to help my Mom nor take her out weekly. Where did you get that S-shaped pole you mentioned? That sounds great! As long as I've been in the business, i've never seen one of those nor a shower chair with wheels. The shower chair with wheels, I'm afraid, would be seen as dangerous in the senior living industry... I suppose they lock in place, however.

The minimally invasive scoliosis procedure involves two much smaller incisions: one on the back and one on the side. The recovery period is much shorter and it's much less invasive overall, as you can imagine. I so wish I'd known about it and hadn't just left the decision up to my doctor. He really thought he was giving me the correct advice since it's a relationship of about 20 years now. i have images that go back years but I haven't asked for a comparison to see how my curves have progressed over the years. i know now mine are at 68 and 42 degrees. It's definitely in the severe category. I had to quit working because of the pain. My lowest ribs are inside my pelvic girdle and they cause me a huge amount of pain and discomfort when leaning or lifting. I can't wait for them to be lifted out of there in surgery.

I hope to hear from others who are post-op or longer to find out what life is like with rods, pins and screws, basically the length of my spine. I will have several lumbar and thoracic fusions.

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@cbove2 Hello, I am a Mayo cervical spine surgery patient. May I ask a bit about your diagnosis and how a surgeon would address it? That matters a lot in what procedure is done and from what approach.

A Misonix tool is for cutting bone very precisely and I am sure it is valuable, but there will be situations where the tool is of little value that involves something other than bone. I looked at Dr Cantor's website, and he doesn't explain what his approach is. Promoting a new technological tool doesn't tell the whole story, and you need a complete picture to understand the entire problem and various solutions for it.

Fusions are not necessarily bad, and it depends on where it is and how much movement is normal in that part of the spine. Head turning is accomplished by C1 through C4 with very little assistance from C5 or lower levels. I have a single level fusion at C5/C6 and my movement is the same and in normal range with one exception. I cannot touch my chin to my chest, it's darn close though. I have no hardware; only a donor bone spacer. The advantage is the fusion bond is stronger than any hardware to be screwed in, there will never be an immune response to foreign materials place inside, there are no screws to become dislodged or migrate, and the bone retains some of it's flexibility. I know that may sound odd because bones are rigid, but they do flex a bit because of the protein matrix in them. I am over 5 years post op and all other levels are fine. Sometimes adjacent segment disease is going to happen anyway, and even to people who have not already had a fusion. Adjacent segment disease also happens with artificial discs, but possibly at a lesser rate. That is something to ask a surgeon about.

Motion preserving hardware can fail. The spine can try to stabilize it by growing bone around it. There can be allergic reactions to metals that are now part of the spine.

The decision you make needs to be based on all the opinions and information you get, and not just the opinion of one surgeon who loves a specific tool. As much as a new paint brush doesn't make someone a good artist, a high tech tool doesn't make someone a good surgeon. They bought a tool and are using that to market themselves. The tool can make surgeries better if it is in the right hands.

You need to learn the benefits and risks of each procedure and when is the time right to do it. In general, I think active young people tend to want artificial discs so they can get back to activities with shorter recovery times. Fusion healing and bone growth takes time. For me, it was 3 months until the fusion process began to set. Think about how an aging spine will affect the procedure that you choose, and will you have good bone quality as you age? For me, the choice to avoid foreign materials in my body was huge... and I was right about that because when I broke my ankle and lived with some internal titanium plates, it caused pain, inflammation, and I had chronic hives for months that no one could explain. I had them removed after I had healed for a year, and I have not had hives since then. I used to have pierced ears and had to give that up because I reacted to every type of metal that was used, so none of this really surprised me.

It is good to get a lot of respected opinions before you choose. I also watched as many presentations at surgical conferences that I could find online as they discussed different cases, how to solve problems and what to watch out for. Sometimes, the risks are not spelled out so clearly to patients, but when surgeons talk to each other, they are pretty honest about the pitfalls because they are there to teach. One thing to look at is how respected a surgeon is in his (her) own field. Are they presenting and teaching at the spine society conferences every year? Are the institutions they are affiliated with respected? Keep in mind, some surgeons are in this for profit and they may own their surgery centers. Take that into consideration when you are trying to decide if you are getting an objective or a biased opinion.

Can you explain what it means to use a Misonex tool early enough to avoid a fusion in the future? I don't know what that means. Has the surgeon fully explained why he thinks this tool has improved benefits and in what situations it is beneficial?

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Thank you for your indepth thoughts. I am 75 years old in November and want to maintain an active lifestyle. When I had the neurology consult with the Mayo PA she was pretty adamant that I would need 2 disks (C5-6 and C6-7) and some hardware with screws. Your mobility sounds excellent. I listened to Dr. Cantor's YouTubes and he indicated that with the Misonix (there are other ultrasonic bone scalpels - this seems to be the latest version with a curved head for better control). The ultrasonic scalpel permits bone work with less blood loss and it does not affect the soft tissue such as nerves, muscle, etc. - less post-op pain and better healing.
I agree that YouTubes and testimonials may not give an accurate picture of a specific individual's scenario. I have not heard from the website after uploading the MRI. I also plan to check with Hopkins and HSS about their protocols. I am not in a huge rush and have travel planned in the spring, so unless healing and recovery would be possible in a matter of weeks, this will have to wait until later and i will have to be careful with my neck and avoid further injury.

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I just saw more breakthrough spinal technology that I may need in the future for my lumbar disks 🙂 -https://www.beckersspine.com/spinal-tech/item/53538-empirical-spine-advances-motion-preserving-device-for-spinal-stenosis.html?origin=SpineE&utm_source=SpineE&utm_medium=email&utm_content=newsletter&oly_enc_id=8964C3039334A2C

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Thank you for your indepth thoughts. I am 75 years old in November and want to maintain an active lifestyle. When I had the neurology consult with the Mayo PA she was pretty adamant that I would need 2 disks (C5-6 and C6-7) and some hardware with screws. Your mobility sounds excellent. I listened to Dr. Cantor's YouTubes and he indicated that with the Misonix (there are other ultrasonic bone scalpels - this seems to be the latest version with a curved head for better control). The ultrasonic scalpel permits bone work with less blood loss and it does not affect the soft tissue such as nerves, muscle, etc. - less post-op pain and better healing.
I agree that YouTubes and testimonials may not give an accurate picture of a specific individual's scenario. I have not heard from the website after uploading the MRI. I also plan to check with Hopkins and HSS about their protocols. I am not in a huge rush and have travel planned in the spring, so unless healing and recovery would be possible in a matter of weeks, this will have to wait until later and i will have to be careful with my neck and avoid further injury.

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@cbove2 You cannot recover from spine surgery in a few weeks. At age 75, your recovery will likely be slower, and dependent on your health and bone quality. This is something that takes some planning for your care after surgery as you may need help. Major surgery takes a lot of stamina out of you. I slept a lot for 3 months. It may take a year for complete recovery. That is an excellent question to ask the spine specialists that you will be consulting.

Spine surgery is a big surgery and it normally takes about 6 weeks to heal the incision, and bone fusion takes a lot longer. For me the bones were not fusing until 3 months post op when X-rays were taken and no movement was detected in the measurements. As for changes in motion of the cervical spine, your case is similar to mine in that turning your head is done by C1 & C2 mostly, and with help from C3 & C4, and very little from levels below that. You could have muscle tightness that will restrict movement, but physical therapy often helps that.

When a disc is removed during a fusion, it is done with a tool like a pair of nippers. The disc is flexible cartilage. If there are also bone spurs, the surgeon can clean those out. The surfaces of the vertebrae that were in contact with the disc also have to be prepared to accept either a bone spacer or an implant like a cage. The surgeon will grind them flat or shape them to match an implant before putting this together. There can also be arthritic bone growth in the foramen (spaces between vertebrae) where the nerve roots exit the spinal cord that will be opened up by removing extra bone.

You never want to be in a rush to do spine surgery unless it is an emergency situation to save function and prevent disability. One question I asked spine specialists was if they were using neuro-monitoring during the procedure. This is electric nerve impulse feedback so they know that the nerves are working and were not damaged during surgery. I hope that gives you a sense of trends in spine surgery. These are things a surgeon can explain during a consult, but they may not want to worry you with details that could be stressful. I had a single level fusion without hardware and stayed in a neck brace 3 months and that was worth it. You certainly can ask about that if you do decide on a fusion.

Many people don't qualify for an artificial disc because of some spine instability. Are you also a candidate for an artificial disc?

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@cbove2 I looked this up and this device is kind of like putting an elastic band around the bone spineous process in the lumbar spine to keep one vertebrae from slipping forward over the other in what they call a Grade 1 listhesis which means that the part of the vertebrae extending past the other is less than 25% of the diameter. This also presumes that the disc is intact enough between these vertebrae. As you can see, this is a very specific application and the way it preserves motion is because the disc is not removed and it gives a bit of stability, kind of like a brace would do. There are also artificial lumbar discs that allow some motion for situations when a disc cannot be saved. Here are links to information about the Limiflex Paraspineous tension band. https://www.limiflex.com/

This explains the grades of listhesis or slipping between vertebrae.
https://www.orthobullets.com/spine/2039/degenerative-spondylolisthesis

Do you have listhesis in your lumbar spine?

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Thank you for your indepth thoughts. I am 75 years old in November and want to maintain an active lifestyle. When I had the neurology consult with the Mayo PA she was pretty adamant that I would need 2 disks (C5-6 and C6-7) and some hardware with screws. Your mobility sounds excellent. I listened to Dr. Cantor's YouTubes and he indicated that with the Misonix (there are other ultrasonic bone scalpels - this seems to be the latest version with a curved head for better control). The ultrasonic scalpel permits bone work with less blood loss and it does not affect the soft tissue such as nerves, muscle, etc. - less post-op pain and better healing.
I agree that YouTubes and testimonials may not give an accurate picture of a specific individual's scenario. I have not heard from the website after uploading the MRI. I also plan to check with Hopkins and HSS about their protocols. I am not in a huge rush and have travel planned in the spring, so unless healing and recovery would be possible in a matter of weeks, this will have to wait until later and i will have to be careful with my neck and avoid further injury.

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BTW - I saw an article last year that you may or may/not know about -
"California neurosurgeon reverses 3-level cervical fusion with artificial discs" Alan Condon - Thursday, August 19th, 2021
https://www.beckersspine.com/spine/item/52499-california-neurosurgeon-reverses-3-level-cervical-fusion-with-artificial-discs.html

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@cbove2 Thanks for sharing the information. I searched for it and found it in Becker's Spine Review and they do deserve credit for their copyrighted information.

Becker's Spine Review policies on reproducing their material can be found at this link:
https://www.beckershospitalreview.com/linking-and-reprinting-policy.html

In compliance with Becker's policies, the correct way to share the information is to share their link to the original article, the title of the article, and to put quotes around the text you have copied and pasted, and only quote the first paragraph.

Mayo Connect also asks that material is properly credited with a link to the original article because that respects the copyright on the information.

The Connect Community Guidelines state the following about copyrighted material:

No copyrighted postings.
Do not post copyrighted information. Copyrighted material (text or images), private email text and other privileged information may not be posted without prior written permission from the original author.
Acknowledge the original source when quoting content from elsewhere.

Please do share material that is relevant to the discussion and respect the owner's rights.

The article in Becker's Spine Review may be found at this link: https://www.beckersspine.com/spine/item/52499-california-neurosurgeon-reverses-3-level-cervical-fusion-with-artificial-discs.html

My comments regarding the article on Dr. Lanman and his procedure are:

This is an example of a doctor owned surgical facility that is marketing their targeted services in a wealthy area. To be fair, patients should also get other opinions elsewhere because their doctors may be biased because it is a surgery center for profit. They may not be interested in complex cases that don't fit their interests. There will still be risks involving their surgery, and this is a procedure that they want to do as a re-operation for spine surgery patients. They will need to saw through a fused area to insert an artificial disc into it and make sure that they don't damage the spinal cord in doing that. Patients need to advocate for their own best interests and understand the benefits as well as the risks. Artificial discs can also fail, and the body can have an immune response to foreign materials in the implant, and bone growth can occur around the artificial disc in an attempt to stabilize the motion. There really isn't a one procedure that is best for all patients and patients need to learn about different procedures that can address the problem before making a decision.

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