T10-Pelvis fusion and posterior column osteotomies surgery robotic arm

Posted by mbessie @mbessie, Aug 3 5:26pm

Has anyone had this kind of surgery? A T10-pelvis fusion and an Posterior column osteotomies? About a month ago, I saw a surgeon in NYC who was one of the first to use a robotic arm in spine surgery. After looking at x-ray, CT scans & MRI, My L 1-5 discs are basically crushed and C 4-5 compromized and my scoliosis at 45degree angle, T10- pelvis fusion: 8 level fusion to take pressure off the bottom four - five levels where the decompressions are levels L1 - S1. Put cages at L5-S1 at the bottom level, L 2-3 and L4-5. Then do a Posterior column osteotomies which is to help loosen up the spine, help straighten it and take more pressure off of the nerves to so they have a better chance at adapting to a more straightened out spine. Surgery 4-5 hours.
Any ideas, thoughts are welcomed! Txs

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Is this the procedure you saw ? It sounds like it is a bit more than what you were referring to?

A Vertebral Column Resection (VCR) is a type of osteotomy that is used to correct severe cases of spinal deformity. Osteotomy simply means that your doctor will remove bone. However, a VCR takes this one step further.
During a VCR, your doctor will remove or “resect” one or more vertebrae from your spine. A fancier phrase for your spine is “vertebral column.” This refers to the fact that the vertebrae in your spine are stacked like a pillar. Hence, the term: Vertebral Column Resection.

Milder forms of osteotomy do not remove entire vertebrae. These include the Posterior Column Osteotomy (PCO) and the Pedicle Subtraction Osteotomy (PSO). Instead, these procedures resect tiny sections of bone on the back side of your spine.
However, if you have >100 degrees of curvature, then removing small sections of bone just won’t cut it. You’ll need a VCR to fix your spinal alignment.
But first, let’s revisit a “healthy” spine. A healthy spine isn’t ramrod straight. Instead, it contains gentle inward arcs (known as lordosis) and subtle forward curves (known as kyphosis). If too much kyphosis occurs, the shoulders round and the head pitches forward. You may hear of this referred to as a sagittal imbalance because the head is no longer balanced over the pelvis.
When viewed from the front, however, the spine should seem straight. If the spine juts outward to the side, scoliosis (a form of coronal imbalance) occurs.
Severe scoliosis or kyphosis (>100 degrees) can cause pain, lung and heart problems, issues with walking, and loss of confidence. A VCR can permanently reverse these symptoms.
If you need a VCR, your surgeon will position you face-down on a Jackson frame. This operating table contains a gentle slope that exposes the back side of your spine.
Depending on your situation, your doctor will enter your back from a posterior (back) or anterior (front) approach. Sometimes, a surgeon can achieve best results by using a combined, or anterior and posterior, approach. However, entry from the back is the most common.
Next, your surgeon will fasten pedicle screws to your vertebrae. These will attach to the vertebrae above and below the resection area. Then, your surgeon will remove the back portion of the targeted vertebrae. This will include your;

Spinous Process: The three bony points on the back side of your vertebrae
Lamina: The bony shell that guards your spinal cord
Facet Joints: The joint where two vertebrae come together
Pedicles: The swatch of bone that joins the vertebral body to the processes

With these items removed, your surgeon can now see your spinal cord and the round front half of your vertebra, known as the vertebral body. After removing the left side of the vertebral body, your surgeon will add rods to each screw. This crucial step in the surgical procedure protects your fragile spinal cord, which is now exposed.
Finally, the problematic vertebra can be excised. If more than one resection is needed, your surgeon will repeat the steps above. In addition, your surgeon may remove ribs, if your thoracic spine is the target of the procedure. With all vertebrae removed, a wedge-shaped gap will remain in the back side of the spine. Your doctor will then realign the spine and close this gap. Closing this hinge folds the spine backward onto itself and into a more ideal shape.
Your surgeon will use a combination of implants and bone grafts to support your spine as it heals.
Specifically, graft material can be sourced from your hip or a donor supply. If needed, your surgeon may even opt to use a cage–a metal device filled with bone graft material. As the bone tissue matures, it will grow through the “bars” of the cage to fuse to your spine.
In addition, your doctor will add extra rods to brace your spine.
The ultimate goal of these last steps is to create a spine that is stable, durable, and pain-free. With the final pieces of hardware in place, the osteotomy procedure is now complete.

I really hope I don't need this but my thoracic spine has a big curve in it.

REPLY
Profile picture for rwdixon4 @rwdixon4

Is this the procedure you saw ? It sounds like it is a bit more than what you were referring to?

A Vertebral Column Resection (VCR) is a type of osteotomy that is used to correct severe cases of spinal deformity. Osteotomy simply means that your doctor will remove bone. However, a VCR takes this one step further.
During a VCR, your doctor will remove or “resect” one or more vertebrae from your spine. A fancier phrase for your spine is “vertebral column.” This refers to the fact that the vertebrae in your spine are stacked like a pillar. Hence, the term: Vertebral Column Resection.

Milder forms of osteotomy do not remove entire vertebrae. These include the Posterior Column Osteotomy (PCO) and the Pedicle Subtraction Osteotomy (PSO). Instead, these procedures resect tiny sections of bone on the back side of your spine.
However, if you have >100 degrees of curvature, then removing small sections of bone just won’t cut it. You’ll need a VCR to fix your spinal alignment.
But first, let’s revisit a “healthy” spine. A healthy spine isn’t ramrod straight. Instead, it contains gentle inward arcs (known as lordosis) and subtle forward curves (known as kyphosis). If too much kyphosis occurs, the shoulders round and the head pitches forward. You may hear of this referred to as a sagittal imbalance because the head is no longer balanced over the pelvis.
When viewed from the front, however, the spine should seem straight. If the spine juts outward to the side, scoliosis (a form of coronal imbalance) occurs.
Severe scoliosis or kyphosis (>100 degrees) can cause pain, lung and heart problems, issues with walking, and loss of confidence. A VCR can permanently reverse these symptoms.
If you need a VCR, your surgeon will position you face-down on a Jackson frame. This operating table contains a gentle slope that exposes the back side of your spine.
Depending on your situation, your doctor will enter your back from a posterior (back) or anterior (front) approach. Sometimes, a surgeon can achieve best results by using a combined, or anterior and posterior, approach. However, entry from the back is the most common.
Next, your surgeon will fasten pedicle screws to your vertebrae. These will attach to the vertebrae above and below the resection area. Then, your surgeon will remove the back portion of the targeted vertebrae. This will include your;

Spinous Process: The three bony points on the back side of your vertebrae
Lamina: The bony shell that guards your spinal cord
Facet Joints: The joint where two vertebrae come together
Pedicles: The swatch of bone that joins the vertebral body to the processes

With these items removed, your surgeon can now see your spinal cord and the round front half of your vertebra, known as the vertebral body. After removing the left side of the vertebral body, your surgeon will add rods to each screw. This crucial step in the surgical procedure protects your fragile spinal cord, which is now exposed.
Finally, the problematic vertebra can be excised. If more than one resection is needed, your surgeon will repeat the steps above. In addition, your surgeon may remove ribs, if your thoracic spine is the target of the procedure. With all vertebrae removed, a wedge-shaped gap will remain in the back side of the spine. Your doctor will then realign the spine and close this gap. Closing this hinge folds the spine backward onto itself and into a more ideal shape.
Your surgeon will use a combination of implants and bone grafts to support your spine as it heals.
Specifically, graft material can be sourced from your hip or a donor supply. If needed, your surgeon may even opt to use a cage–a metal device filled with bone graft material. As the bone tissue matures, it will grow through the “bars” of the cage to fuse to your spine.
In addition, your doctor will add extra rods to brace your spine.
The ultimate goal of these last steps is to create a spine that is stable, durable, and pain-free. With the final pieces of hardware in place, the osteotomy procedure is now complete.

I really hope I don't need this but my thoracic spine has a big curve in it.

Jump to this post

Thank you, my curve is 47 degrees. Its a PCO that he wants to do.
L1-5 discs are crumbling-Surgeon’s words. Wants to put titanium cages.
All is hear from those who had this kind of fusion are comments that are negative. Is there another opinion…surgeon says if I don’t do anything, my curve will get worse, and running risk of permanent nerve damage.
X ray from last month and the other from 2020. Ugh.

REPLY
Profile picture for mbessie @mbessie

Thank you, my curve is 47 degrees. Its a PCO that he wants to do.
L1-5 discs are crumbling-Surgeon’s words. Wants to put titanium cages.
All is hear from those who had this kind of fusion are comments that are negative. Is there another opinion…surgeon says if I don’t do anything, my curve will get worse, and running risk of permanent nerve damage.
X ray from last month and the other from 2020. Ugh.

Jump to this post

You have not done anything to repair your 47 degree curve. You should get another opinion if you are not comfortable withe what you have been told. If you have the opportunity to get L1-5 discs replaced and the surgeon says it needs to be caged at Mayo I would do it But there are allot of surgeons see what another one says. Were all the negative comments that heard about this from people that had titanium cages from Mayo ?

REPLY
Profile picture for rwdixon4 @rwdixon4

Is this the procedure you saw ? It sounds like it is a bit more than what you were referring to?

A Vertebral Column Resection (VCR) is a type of osteotomy that is used to correct severe cases of spinal deformity. Osteotomy simply means that your doctor will remove bone. However, a VCR takes this one step further.
During a VCR, your doctor will remove or “resect” one or more vertebrae from your spine. A fancier phrase for your spine is “vertebral column.” This refers to the fact that the vertebrae in your spine are stacked like a pillar. Hence, the term: Vertebral Column Resection.

Milder forms of osteotomy do not remove entire vertebrae. These include the Posterior Column Osteotomy (PCO) and the Pedicle Subtraction Osteotomy (PSO). Instead, these procedures resect tiny sections of bone on the back side of your spine.
However, if you have >100 degrees of curvature, then removing small sections of bone just won’t cut it. You’ll need a VCR to fix your spinal alignment.
But first, let’s revisit a “healthy” spine. A healthy spine isn’t ramrod straight. Instead, it contains gentle inward arcs (known as lordosis) and subtle forward curves (known as kyphosis). If too much kyphosis occurs, the shoulders round and the head pitches forward. You may hear of this referred to as a sagittal imbalance because the head is no longer balanced over the pelvis.
When viewed from the front, however, the spine should seem straight. If the spine juts outward to the side, scoliosis (a form of coronal imbalance) occurs.
Severe scoliosis or kyphosis (>100 degrees) can cause pain, lung and heart problems, issues with walking, and loss of confidence. A VCR can permanently reverse these symptoms.
If you need a VCR, your surgeon will position you face-down on a Jackson frame. This operating table contains a gentle slope that exposes the back side of your spine.
Depending on your situation, your doctor will enter your back from a posterior (back) or anterior (front) approach. Sometimes, a surgeon can achieve best results by using a combined, or anterior and posterior, approach. However, entry from the back is the most common.
Next, your surgeon will fasten pedicle screws to your vertebrae. These will attach to the vertebrae above and below the resection area. Then, your surgeon will remove the back portion of the targeted vertebrae. This will include your;

Spinous Process: The three bony points on the back side of your vertebrae
Lamina: The bony shell that guards your spinal cord
Facet Joints: The joint where two vertebrae come together
Pedicles: The swatch of bone that joins the vertebral body to the processes

With these items removed, your surgeon can now see your spinal cord and the round front half of your vertebra, known as the vertebral body. After removing the left side of the vertebral body, your surgeon will add rods to each screw. This crucial step in the surgical procedure protects your fragile spinal cord, which is now exposed.
Finally, the problematic vertebra can be excised. If more than one resection is needed, your surgeon will repeat the steps above. In addition, your surgeon may remove ribs, if your thoracic spine is the target of the procedure. With all vertebrae removed, a wedge-shaped gap will remain in the back side of the spine. Your doctor will then realign the spine and close this gap. Closing this hinge folds the spine backward onto itself and into a more ideal shape.
Your surgeon will use a combination of implants and bone grafts to support your spine as it heals.
Specifically, graft material can be sourced from your hip or a donor supply. If needed, your surgeon may even opt to use a cage–a metal device filled with bone graft material. As the bone tissue matures, it will grow through the “bars” of the cage to fuse to your spine.
In addition, your doctor will add extra rods to brace your spine.
The ultimate goal of these last steps is to create a spine that is stable, durable, and pain-free. With the final pieces of hardware in place, the osteotomy procedure is now complete.

I really hope I don't need this but my thoracic spine has a big curve in it.

Jump to this post

@rwdixon4. it looks like you may have copied this information from a website. When citing information please also include the link.

I think I found it. Is this the source?
- What is a Vertebral Column Resection? https://jasonlowensteinmd.com/treatments/vertebral-column-resection/

REPLY
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