Saturday, August 12, 2006

Warning!....ooky medical discussion follows

Every follow up visit with Robb's neurosurgeon is a learning experience.

One lesson that we get to re-learn every single time is that Highland Hospital's medical appointment system is in total disarray; we are never in their computer which means that they have to wedge us into the doctor's schedule. I don't think a visit has ever taken less than three hours. Oh well...

Unlike the last visit where the computer system crashed and only allowed our surgeon the briefest glimpse of Robb's CT scan, we were able to spend a considerable amount of time looking at and discussing Robb's "films." (CT scans and xrays are all digital now but are still printed out on the plastic films that we all think of as "xrays.")

One issue that had been of concern to Dr. Castro-Moure was the proximity of one of the screws to Robb's aorta. Had the screw been too close to the aorta, it would have visibly distorted the blood vessel. As it turns out, the aorta is perfectly round after six months. This indicates that there is plenty of room between the end of the screw and the aorta.

I took the opportunity to ask Dr. Castro-Moure about the procedure of inserting the screws. It turns out that the channel for the screws have to be hand-excavated. The screws themselves are not pointy (so as not to potentially jab anything inside of Robb, like his aorta), so a device is used to "tap" or "thread" the hole that the screws will fit into prior to installing them. The reason that the screws protrude through the bone is that the outer edges of the bone are the bones' strongest parts and this offers more stability to the instrumentation.

We also learned more about the process of (to use a scientific term) un-squashing Robb's damaged vertebra. During surgery, Robb's muscles were separated from his bone and held out of surgeons' way. The screws were installed in the bones above and below the damaged bone and then surgeon grabbed onto the hardware and manually wrenched the surrounding bones apart from the damaged bone. Once the proper distance was re-established, the spreader bars were installed to hold the bones away from the squashed bone, a process called de-compression. This hardware does the work that the damaged bone would normally do in terms of protecting the integrity of Robb's spine. We expect that this hardware will stay inside of Robb forever.

I have described the appearance of Robb's vertebra at the time of the accident as looking like a marshmallow that someone had stomped on. The vertebra was apparently only 30% the height it should have been. It is now about 70% of its original height, which is a vast improvement. And the curve of the spine has been beautifully maintained.

But since the bone is still somewhat compressed, the surgeons opted to perform a laminectomy and remove the back of Robb's spine.. Feel the spiney bumps on the center of your back, and you are feeling what was removed from Robb's body. This was the part that had been smashed into the spinal cord at the time of the injury. Given the distortion of Robb's damaged vertebra the decision was made to leave the back of the vertebra open to give the spinal cord plenty of room. The spinal cord itself is surrounded by a sheath of tissue, and there are plenty of ligaments outside the spine to offer further protection for the spinal cord.

Another procedure that was done during surgery was a bone graft between the T-12, L-1, and L-2 vertebrae. This does essentially the same job as the titanium scaffolding in Robb's back. Dr. Castro-Moure was somewhat concerned because the bone growth is only about 50% of what he would expect at six months past the surgery. Still, he was confident enough to allow Robb to discontinue use of the huge full-torso plastic brace he has been wearing.

If Robb had been more agile I think he would have done a dance of joy. I'm pretty sure that I did one in the examination room!

Robb has just lost six pounds of armor and it is amazing how much easier walking is without the brace. I think he doubled his stair climbing speed.

The next stage will be to discontinue use of the ankle braces.


Anonymous said...

Absolutely fantastic news! I'm glad Robb is doing so much better.

Knit Wit

Anonymous said...

Doing the dance for you guys too!!!


Buxton Boxers said...

Been following this story for a while now, Congrats!!! Send our praises to you both, Hang in there.

mimulus said...

sounds like leaping for joy was definitely the order for the day...what great progress! Isn't orthopedic medicine amazing? That, and trauma/emergency care, is what conventional medicine does best.

Anonymous said...

This is all great news- we are watching and waiting and hoping the best happens for you both. When doing the dance of joy, I recommend doing the Chicken dance for full-on joyous awkardness, that way no matter if someone has a spinal injury or not, you still end up looking silly!

- Annalisa and Gary


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