Iíve done all the PT, Epidural shots (5, only lasting 3 wks the 5th not at all) Ė One neurosurgeon says I need a PLIF, if he just cleaned things up he guarantees Iíd be back in a year, Second opinion says I just need a Laminectomy, now I read about a Microdisectomy whatís the difference ? I have severe displacement of the L-4 nerve root, so says the MRI. The Myelogram says Severe facet hypertrophy with narrowing sclerosis, unroofing of the disc and Strong suspicion of the left L4/5 facet related to 10x8x6mm synovial cyst causing left lateral recess stenosis, severe facet hypertrophy noted at this level. I am trying to get a third opinion, it would be nice if 2 Docís agreed!
Iím scared silly of surgery as years ago I broke my upper back in a car accident and had to wear a brace for 6 mos. Now Iím being told a brace will be necessary with the PLIF, I read all about the complications of scar tissue & want to make sure I do whatever right the first time. So Ė is a Microdisectomy close to a PLIF? And why wouldnít one of these Dos suggest that? Sounds a little less invasive.
A microdiscectomy would be much less invasive, but it also would not resolve any of your issues. It is only appropriate when a patient's only problem is a herniated disc that is causing nerve compression.
From a quick reading of your post, it looks like you have degeneration going on at these levels. The surgeon could go in and with some skillful cutting, taking the pressure off the compressed nerve, but due to all the other issues, it would only be a matter of time (maybe weeks, months?) before you'd be right back where you were prior to this surgery. The pain would return, the nerves would once again become compressed and you would be looking for more relief.
If you have only met with a neurosurgeon, I suggest you get another opinion from a fellowship trained orthopedic spine surgeon as well. They have similar training but often have a slightly different surgical approach. Note, this is not a regular ortho doctor, but an ortho spine surgeon who devotes his/her practice to issues of the back and neck.
Once you determine whether fusion is necessary, then you will want to see what type of fusion each doctor would recommend. Some are more invasive than others.
I will write more later, as your post brings up many issues...but I'm off to acupuncture at the moment!
The Following User Says Thank You to teteri66 For This Useful Post: 3313kd (03-09-2011)
Your right, the MRI results say L3/4 level with degenerative disc changes. Moderately-sized lateral protrusions with osteophytes abutting the exiting L-3nerve roots bilaterally. L4/5 mod.-sized lateral disc osteo. complexes causing superior displacement upon exititn L-4 nerve roots. Extensive hypertrophy within the left posterior facet joint & ligamentum flavum causing sign. narrowing of the left lateral recess segment of the spinal canal with mass effect upon the traversing left L-5 nerve root. Multilevel degenerative changes lower lumbar secondary to osteophytes. The Myelogram -evidence suggesting left lateral recess stenosis, left transiting L-5 root impingement. Small anterior extrinsic thecal sac compression at the L4/5 disc level, where there is no retrolisthesis. The CT Scan -Degen. L4/5 anterolisthesis. Combined with strong suspicion of left L4/5 facet related 10x8x5mm synovial cyst, causing left lateral recess stenosis, left L5 root impingement. Severe facet hypertrophy noted at this level. Diffuse disc bulging/disc unroofing.
Lot's going on & lots of pain - I'm crumbling......wouldn't I be putting too much pressure on the above discs going through with a fusion? or am I asking for it by doing a Laminectomy? July & August is the first appointments I can get with more specialists, I've seen 2 Neurosurgeons but both have different approaches, I feel the Laminectomy doc was just trying to pacify me. I think I should call & get an appt. with the first Neurosurgeon & ask more questions bfore I schedule anything.
It's good you are trying to get more than one opinion....I would suggest trying to find an Orthopedic Spine Specialist. This is an ortho with a fellowship whose practice is limited to the spine. They often have a different approach to surgery than a general neurosurgeon.
You have several issues going on and I do think that just a laminectomy will just set you up for more trouble and pain in the future tetonteri has pointed out. It's only natural to want the least invasive surgery but sometimes that isn't possible when you have many problems as you do and as I do.
Be proactive by learning all you can about your condition and the possible options. The internet is loaded with that kind of information and will help you understand your situation as well as help you in your decisions.
Please stay in touch and let us know what the doctors say and how you are doing.
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels