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Sacamuelas · 03-08-2005, 16:54

Kim-
I am coming at this from the angle as an educated patient, not as a member of your healthcare team. It is VERY important for you to understand the context this is written in as well as its intended purpose. No one on the internet could or should try to diagnose/recommend treatment of conditions as potentially serious as your current ailment. With that in mind, please understand that only you and your team of healthcare providers can properly evaluate your ability to be a good candidate for this type surgery. Another important point to address in your consults is to verbalize exactly what “clinical success” of the surgery means to you, and the actual surgeon’s idea of acceptable clinical success.

One thing I have found is that it is very difficult to ask good questions unless you know a little about the topic. Therefore, to help you out I thought I would give a little basic information. This information below needs to be used only as a guide for you to ask questions. The answers from your Doc based on your specific situation can then be used to ask more pointed and detailed questions. As has been posted already, those Doctors work for you. This doesn’t mean you are precluded from showing the proper respect for them due to their education/experience/expertise. It means that you should expect honest and complete answers to your questions and have a right to be informed of your current medical situation. I have always found, the more knowledge a patient has- the more specific an answer can be provided due to their already existing background knowledge. Therefore, this is the intention of these posts - to give you a little background knowledge. Forgive me if you already knew/researched all of this.

First, you need to grasp the basics and terminology. When you read the MRI report you have, do you understand what it says? Do you know what each word means in the context of this situation? If not, then we should go over what isn’t clear to you.
Here are two VERY basic multimedia presentations designed for patient education. I thought they might give you an introductory understanding.

http://www.drdillin.com/education/an...n_cervdisc.htm

http://www.drdillin.com/education/an...niateddisc.htm

As far as questions I would ask- There are lots of them. I would break things down into sections and write them down. FWIW, most surgeons will recommend specific procedures and not give much choice to the patient on the specifics of the surgery. However, there are a few things in these type surgeries that are "clinician preference" type choices based on that particular surgeons experiences, training,etc. These are the things that I would really focus in on in my questions when comparing different surgeons during your consults. For example:

On the particular aspect of the fusion of the cervical vertebrae.. I would ask specifically what type of grafting is to be done. I would also ask whether any instrumentation was to be performed (ex. Plating with screws to fix the vertebrae together after the graft is placed). Here is a little background info to help you decide which option might be preferable to you.
For the type procedure that was recommended to you, there are two commonly used types of grafts.
Autografts (ex. harvested bone from the inner aspect of your iliac crest) or allografts (human bone harvested from cadavers, etc and then prepared for use later) are the two main types.

Autograft:
There are three main types of Autografts that can be harvested.
1. Autogenous cancellous bone represents the most effective graft material for achieving spinal fusion. It possesses all 3 necessary graft properties: osteogenic potential by transplanting bone and marrow cells, an osteoconductive matrix, and osteoinductive matrix bound proteins. Cancellous bone also has a large trabecular surface area for new bone formation.
2. Autogenous cortical bone offers the advantage of greater mechanical strength, which may be desirable in situations such as anterior cervical fusion. Cortical bone, however, has fewer osteogenic cells, less surface area for new bone formation, and is more resistant to vascular ingrowth and remodeling compared with cancellous bone.
3. ***Combined corticocancellous grafts from the iliac crests are commonly used. This type of graft contains a mix of the best properties of both types above. Note: The mechanical strength of anterior iliac crest grafts has been reported to be greater than that of posterior grafts.
The major disadvantage of autogenous grafting is related to the morbidity associated with graft harvesting such as donor site pain, increased operative time, cost, blood loss, and potential for infection. In addition, the limited supply of graft material available may be insufficient for long multisegmental fusions. Vascularized autografts may be useful to span large defects and in areas of radiation induced fibrosis or previous infection. Autogenous bone marrow is also a valuable source of osteogenic cells commonly used by surgeons as an adjuvant to allograft bone grafts.
Allograft:
Allograft bone is an attractive alternative to autograft bone for many reasons. Allograft bone negates donor site morbidity, comes in a wide variety of shapes and sizes, and is a potentially unlimited source of grafting material. In addition, cortical allografts provide the surgeon access to grafts whose mechanical strength is superior to autograft.
Autograft bone is nonetheless the gold standard of comparison for bone grafting and the preferred choice for graft material in almost all circumstances. It has a higher healing rate compared with allograft bone and carries no risk of disease transmission.
The risk of disease associated with allograft bone is actually quite low. Including the risk of receiving a graft from an HIV-positive donor, the risk of disease transmission due to allograft bone is estimated to be well over 1 in 1 million.

(continued below due to size)

I have been extraordinarily busy at work this week and keep getting interrupted trying to type this up... was this what you are looking for Kim? Just trying to help the Blademaster's friend out.

03-08-2005, 16:54	#6
Sacamuelas JAWBREAKER Join Date: Jan 2004 Location: Gulf coast Posts: 1,906	Kim- I am coming at this from the angle as an educated patient, not as a member of your healthcare team. It is VERY important for you to understand the context this is written in as well as its intended purpose. No one on the internet could or should try to diagnose/recommend treatment of conditions as potentially serious as your current ailment. With that in mind, please understand that only you and your team of healthcare providers can properly evaluate your ability to be a good candidate for this type surgery. Another important point to address in your consults is to verbalize exactly what “clinical success” of the surgery means to you, and the actual surgeon’s idea of acceptable clinical success. One thing I have found is that it is very difficult to ask good questions unless you know a little about the topic. Therefore, to help you out I thought I would give a little basic information. This information below needs to be used only as a guide for you to ask questions. The answers from your Doc based on your specific situation can then be used to ask more pointed and detailed questions. As has been posted already, those Doctors work for you. This doesn’t mean you are precluded from showing the proper respect for them due to their education/experience/expertise. It means that you should expect honest and complete answers to your questions and have a right to be informed of your current medical situation. I have always found, the more knowledge a patient has- the more specific an answer can be provided due to their already existing background knowledge. Therefore, this is the intention of these posts - to give you a little background knowledge. Forgive me if you already knew/researched all of this. First, you need to grasp the basics and terminology. When you read the MRI report you have, do you understand what it says? Do you know what each word means in the context of this situation? If not, then we should go over what isn’t clear to you. Here are two VERY basic multimedia presentations designed for patient education. I thought they might give you an introductory understanding. http://www.drdillin.com/education/an...n_cervdisc.htm http://www.drdillin.com/education/an...niateddisc.htm As far as questions I would ask- There are lots of them. I would break things down into sections and write them down. FWIW, most surgeons will recommend specific procedures and not give much choice to the patient on the specifics of the surgery. However, there are a few things in these type surgeries that are "clinician preference" type choices based on that particular surgeons experiences, training,etc. These are the things that I would really focus in on in my questions when comparing different surgeons during your consults. For example: On the particular aspect of the fusion of the cervical vertebrae.. I would ask specifically what type of grafting is to be done. I would also ask whether any instrumentation was to be performed (ex. Plating with screws to fix the vertebrae together after the graft is placed). Here is a little background info to help you decide which option might be preferable to you. For the type procedure that was recommended to you, there are two commonly used types of grafts. Autografts (ex. harvested bone from the inner aspect of your iliac crest) or allografts (human bone harvested from cadavers, etc and then prepared for use later) are the two main types. Autograft: There are three main types of Autografts that can be harvested. 1. Autogenous cancellous bone represents the most effective graft material for achieving spinal fusion. It possesses all 3 necessary graft properties: osteogenic potential by transplanting bone and marrow cells, an osteoconductive matrix, and osteoinductive matrix bound proteins. Cancellous bone also has a large trabecular surface area for new bone formation. 2. Autogenous cortical bone offers the advantage of greater mechanical strength, which may be desirable in situations such as anterior cervical fusion. Cortical bone, however, has fewer osteogenic cells, less surface area for new bone formation, and is more resistant to vascular ingrowth and remodeling compared with cancellous bone. 3. *Combined corticocancellous grafts from the iliac crests are commonly used. This type of graft contains a mix of the best properties of both types above. Note: The mechanical strength of anterior iliac crest grafts has been reported to be greater than that of posterior grafts. The major disadvantage of autogenous grafting is related to the morbidity associated with graft harvesting such as donor site pain, increased operative time, cost, blood loss, and potential for infection. In addition, the limited supply of graft material available may be insufficient for long multisegmental fusions. Vascularized autografts may be useful to span large defects and in areas of radiation induced fibrosis or previous infection. Autogenous bone marrow is also a valuable source of osteogenic cells commonly used by surgeons as an adjuvant to allograft bone grafts. Allograft:** Allograft bone is an attractive alternative to autograft bone for many reasons. Allograft bone negates donor site morbidity, comes in a wide variety of shapes and sizes, and is a potentially unlimited source of grafting material. In addition, cortical allografts provide the surgeon access to grafts whose mechanical strength is superior to autograft. Autograft bone is nonetheless the gold standard of comparison for bone grafting and the preferred choice for graft material in almost all circumstances. It has a higher healing rate compared with allograft bone and carries no risk of disease transmission. The risk of disease associated with allograft bone is actually quite low. Including the risk of receiving a graft from an HIV-positive donor, the risk of disease transmission due to allograft bone is estimated to be well over 1 in 1 million. (continued below due to size) I have been extraordinarily busy at work this week and keep getting interrupted trying to type this up... was this what you are looking for Kim? Just trying to help the Blademaster's friend out. Last edited by Sacamuelas; 03-09-2005 at 13:55. Reason: typo removal....
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