Responses: Hemipelvectomy spinal fusion

Responses: Hemipelvectomy spinal fusion

zach harvey

8/20/2008

Thank you, everyone who responded. Your input was invaluable to helping in decision making with this individual. It was decided by the patient not to perform the lumbar fusion, at least not now for a number of reasons. First, and foremost was the risk of an additional surgery with regard to the cancer. Second, was the potential for functional loss and problems that could occur at proximal joint levels to compensate for a locked lumbar spine.

From a rehab perspective, we've attempted all possible ways to reduce low back pain and provide a supportive prosthetic design. An in-prosthesis, standing x-ray revealed only a slight thoraco-lumbar curve with the current socket. A sitting prosthetic socket was also provided for use during activities when the prosthetic leg is not being used. We're currently working on designs/ component selections to improve suspension and hopefully restore normal gait biomechanics....Special thanks to Dr. Christina Skoski, Kevin Carroll, CP, Craig Jackman, CPO, and Brian Pinkman, CP.

Zach Harvey, CPO
Walter Reed Army Medical Center
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Original Post:

I'm working with a 22 yom, recent hemipelvectomy second cancer. Doctors are proposing fusing the lumbar spine to treat low back pain and for long term prevention of scoliosis....
Weighing the pros and cons of surgery, we're looking for experience treating this select patient population to help with our decision making.
Specifically, I'd be interested in hearing from anyone who's worked with a patient with hemipelvectomy with lumbar fusion, how it affected walking ability, low back pain, and if there were complications following surgery.
Interestingly, we've done gait analysis and may compare pre/ post gait patterns if the fusion is performed.
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Responses:


I have never worked with a HP that had a fused spine however I am a hemi
of 40 years,am currently 50 years old and I have developed severe
scoliosis in the thorasic-lumbar region with significant pain. The
scoliosis began developing shortly after the amputation and it was
determined at that time that spinal fusion should not be done because it
would prevent pelvic tilting which would restrict my ability to ambulate
with a prosthesis. Over the years the scoliosis has progressed radically
and the pain levels have greatly effected my quality of life. This does
not offer any answers just another perspective. Good luck.


Brian K. Pinkston C.P. / L.P.
Shriners Hospital for Children
St. Louis, Mo. 63131
314-872-7891
<Email Address Redacted>
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Somehow I missed your msg on the oandp last week. I'm a
hemipelvectomy amp, 47+ years, also a doctor....and yes I have a
significant scoliosis. I'm very interested in this subject and have
done a lot of researching the medical literature and talking to
Orthopedic surgeons, Prosthetists. To the best of my knowledge no
one does lumbar fusions for prevention of scoliosis for a variety of
reasons.....even the thought of it is scary. There are many aspects
to consider

It would be so much easier if I spoke to you by phone, there is way
too much to write. If you want to follow up, best thing is to give
me a call. 714-963-9264 PST. Best time to reach me is late
afternoon or early evening.
check out my web site: www.hphdhelp.org

Regards,
Christina Skoski MD
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Treating Hipdisarticulation and hemipelvectomy borders on proverbial inqusition and is based on nothing but falacies right from Canadian type hip disarticulation prosthesis to present day. I have been there from very beginning when I did my practicum in l970 on hip disarticulation and hemipelvectomy and pointed out how Canadian type or for that matter any of the other styles did more harm than good to the patients. Whole prosthetic profession was so taken by the Canadian type hipdsarticulation and hemmipelvectomy that pointing out the shortcomings was nothing short of highest form of blasphemy.
 
In your patient's case fusion will limit him more than any thing. I have treated hemipelvectomy patients from England and Holland and these patients could do every thing including doing concrete work and build garden walls without missing a beat.
 
At present my computer is kind of messed due to hurricane in this area once I get up and running I will send you pictures of patients that will astound you.
Lady patient from England lives on a hilly estate and she does not even use a cane and can go up and down hill with dog on one side and shopping bag on the other hand.
 
Dr. who plans to do the fusion needs to understand that scoliosis is not because of hemipelvectomy but because of faulty physical therapy and socket design. This patient came off the addiction of pain killers of 16 years.
 
Patients who I fitted actually lost almost all of their scoliosis reverted to normal spinal angle I will try to attach a letter of appreciation from one of our expert to convince you that I know what I am talking about. Incidently this expert did not hesitate to write about hipdisarticulation and hemipelvectomy in the Atlas of Prosthetics without even acknowledging what I had done for him when he was in a jam.
 
In my experience fusion probably be a bigger limiting factor than his amputation.
 
Amongst my patient was a Physician who was a hip disarticulation patient himself.
 
One of my hip disarticulation used to water ski with prosthesis and then loose it to earn a living
performing stunt of loosing prosthesis while skiing.
 
IF YOU WANT TO TALK SEND ME A PERSONAL E MAIL WITH PHONE NO. AND i WOULD NOT MIND TALKING ABOUT YOU.
 
V.K. SHARMA
LPO(TX), RPOA(ABC), BOCOP, CP(C)
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I worked with one Hemipelvectomy client in my career due to the same reason as yours and we had a good result.

How many lumbar vertebra does this person still have?

The client I worked with was amputated between L 2 & L3. I designed a bucket type socket with an inner and outer socket. The prosthesis supported his spine in all three dimensions, I don't believe it would have made a difference if his spine was fused since the lumbar spine was well within the socket and I basically fused his spine whenever he was in the socket.

What is the mechanism that causes your client lumbar pain? Is it vertical loading? If so, design the socket to unweight the distal end.

I also designed a separate socket attached to a wheelchair, so that he would be secure in a wheelchair in an upright position.

My client was able to stand securely, ambulate short distances, sit down and stand up. He was around 60 years old.

I used to and still may have a video of him walking, sitting and standing.

I hope this helps, good luck,

Marmaduke Loke
DynamicBracingSolutions
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just a little info here, I have no experience with the fusion part but for gait improvement and to reduce the need for pelvic thrust to initiate swing, the new Otto Bock Helix hydraulic swing and stance hip joint is fabulous!
Lane Ferrin CP
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Hi Zach,
Long ago, we used to put patients with LBP in a body cast to determine the efficacy of the proposed surgery reducing / eliminating pain. If the immobilization removed or significantly reduced the associated pain with movement of the affected area then the surgical board approved the fusion. Could you not use the same theory with this gent? Possibly you could fashion a chairback style lumbar orthosis to the socket and compare the results in the gait lab to determine the possibilities??
That's all from an old used up prac.....
Take care,
John