How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Mark Your Own Question

Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience:  U.S. Physician/Surgeon in Neurosurgery
206912
Type Your Health Question Here...
Dr. Mark is online now
A new question is answered every 9 seconds

need an answer from a neo-natal specialist or infant ortho

Resolved Question:

need an answer from a neo-natal specialist or infant ortho spine specialist well versed in congenital kyphosis diagnosed via CT and MRI in 19 week fetus. It involves L2 and L3. Surgery or surgeries (number not known) is said to be the only treatment but no one will commit to the outcome of the surgery or surgeries.
This is my neice who is pregnant and they have been asked if they want to terminate the pregnancy. Since this was discussed, are these doctors indicating that the outcome at best is not good ? No one will give them the "real" prognosis here. They use words such as Manageable, treatable but what does that mean. Can someone spell it out here on what the reality will be for this child. No other complications are seen at this time. Can this get worse as pregnancy progesses ? The docs say they don't know.

L2 and L3 have no bone surrounding them and are seen in a "V" shape protruding outward from the spine . . . they are talking about fusing 4 vertebrae . . . someone needs to tell the real deal here so an informed decision can be made
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Mark replied 4 years ago.

Unfortunately, this is difficult situation here because no one really can predict the future, especially with a 19 week old fetus.

 

When they say that there is an issue with L2 and L3 and kyphosis -- it appears that the spine itself did not form correctly at this level, which can be an issue related to "spina bifida".

 

Unfortunately, at this time, it would be impossible to know if the nerves themselves were formed correctly, and if they would be functional below this level in the spine.

 

If the nerves did not function -- this would mean minimal movement in the hips, but no movement in the lower legs, leaving someone without the ability to walk, have sensation in the legs, or have bowel or bladder control. And that is an IF -- IF the nerves did not work below this area.

 

Surgeries can be done to "fuse" any abnormally formed bone -- but surgeries do not reverse nerve injuries, and that is what cannot be predicted. And they won't be able to predict what will happen as the pregnancy progresses.

 

So it is a tough decision, and one that can only be made after considering the risks and benefits and potential disability that this child may face during their lifetime.

Customer: replied 4 years ago.

they have been told that the bone did not form at L2 and L3 and that there is a protrusion in an outward "V" shape. They were told that they baby is moving around alot and kicking.

 

They were told that all other functions "appear" normal and that although there are no guarantees, it is unilkely that the current condition as they see it now would change.


They are to go back at 28 weeks which is a long way off and too late to terminate in Massacusetts as far as I understand.

 

If the baby is kicking, does that mean that there is nerve that has formed correctly ?

 

They were seen by a neurologist and by an orthopedic spine specialist but not the one who is the expert in the infant spinal fusion. This ortho spine specialist handles legs and feet as they relate to the the spine but presumbably this guy knows plenty about this condition. He is the one who asked them if they considered terminating the pregnancy . . . I think he was trying to send them a message as he was very non-commital in the remainder of the discussion about worst and best case scenarios. I know that u said that it is impossible to tell at 19 weeks.

 

Is it normal for a 19 week fetus to be moving to that degree or might the fetus be in some distress . . .

Expert:  Dr. Mark replied 4 years ago.
Well, the movement of the legs is a relatively good sign that the nerve function to at least some of the legs is intact, but it simply isn't possible to know if all the nerves are functioning.

And there are some issues with fusing the spine this early in life as well, as it can stunt the growth of the spinal segments that are fused.

I'm not an Obstetrician, but movement in a 19 week old fetus should be relatively normal.
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience: U.S. Physician/Surgeon in Neurosurgery
Dr. Mark and 2 other Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery
 
 
 

Related Health Questions