MRI Results in ... Looks bad at L5S1 ... but I'm ready... I think.
Appt on 4/24 with first Neurosurgeon. Trying to line up a second one for another opinion. After talking with phys. therapist, looking at the MRI myself and reading the results I think I will need a fusion at L5S1.
A bit scary but I'm tired of the pain and ready.
Now I am just trying to find the best procedure and the best Dr. I am thinking that PLIF is the way to go. Thoughts?
What's the average surgery time? How do I pick the right doctor?!?!?
The MRI image looks overall pretty good, I guess I should be happy its just L5S1.
The L5S1 disc has a major herniation 15mm+. Also it shows considerable degeneration (thinning). Shows very dark on MRI also, very low moisture.
While I have not talked to the Neuro Doc yet and he very well may something different, my primary Dr. and my PT both said its most likely.
I wouldn't be worrying about what type of fusion would be best at this point. The surgeon may have other plans. If everything else looks good, maybe you would be a candidate for artificial disc replacement. Otherwise, they may be able to deal with it with a discectomy -- fusion is usually reserved for a situation where there is instability, and is done when no other lesser procedure will resolve the issue.
Fusion is not normally performed for a disc herniation. In most cases it would be "overkill."
It is always a good idea to get at least one more opinion before agreeing to surgery. It is a big decision...and the most important one is the selection of the surgeon.
Thanks for the reply. Very true. I have one doctor that I hear is great and very conservative with surgery. So you may very well be right. Trying to find another for a second opinion. Very hard to do.
Thanks for the reply. Very true. I have one doctor that I hear is great and very conservative with surgery. So you may very well be right. Trying to find another for a second opinion. Very hard to do.
In the days of managed care and HMO's it's very hard to get a second opinion, especially when they are all in the same group. There are ways to get the second opinion though.
Try and find a separate group of doctors that are covered by your insurance, but not part of the same clinic. Often there will be a spine group or orthopedic group that are covered by the insurance, but not directly affiliated with the main hospital. Maybe your insurance company can help you with that.
Had my appt today with the surgeon. As expected he says I need a TLIF to fuse L5/S1. I liked him a lot. Feel very comfortable with the idea of having him do the surgery. I have a second opinion in a few days.
One thing that kind of spooked me is that he said I am at risk for cauda equina syndrome. Sounded scary. I am now wanting to get the procedure done soon.
Two questions:
1. I am calling tomorrow to ask about his surgery schedule, but how long does someone typically have to wait to have surgery?
2. I have some twitching in my right calf, hamstring at times. Is that a warning site for cauda equina or just part of the general herniation problems. Just wondering how much I should push for a fast surgery.
Thanks so much everyone for guidance. This forum is great and I been so relieved to have found so much information here!
Anyone with issues in the lower lumbar area needs to be aware of the symptoms for cauda equina syndrome. Statistically it doesn't happen all that often, but it is one of the few lumbar spine issues that is considered a medical emergency. If you develop bladder or bowel issues such as incontinence, or suddenly develop a loss of muscle strength as in foot drop, you will want to call your doctor ASAP, or go to the nearest emergency room if you are traveling or the doctor is not available.
Chances are that you could afford to wait quite a while to have surgery. What you are describing in your hamstring and calf are just normal symptoms of an L5 or D1 nerve compression. You may feel symptoms anywhere along the length of the nerve and it could be anything from a dull ache, to a sudden, sharp, stabbing pain. You might feel tingling, or an electrical impulse or sting; you might even feel like you have water running down your leg, causing you to think you have had an accident until you realize what is going on. Any or all of these symptoms are possible, as well as others I have forgotten to mention.
Can't really guess what this surgeon's schedule is like. Some devote more days of the week to surgery than others...some have a bigger caseload, etc. I've always been able to book surgery within 4-6 weeks, but some people have to wait months -- (I'm assuming you are in the U.S.)
Unless something else is going on that you haven't mentioned, you can afford to wait a bit for the surgery. A disc herniation, although sometimes very painful, is not going to cause further harm. It doesn't appear that you have severe nerve compression...so unless you would suddenly develop problems with the bladder or bowel, etc. you should not worry about not getting in right away.
Be sure to read up on Cauda Equina Syndrome (CES) so you are familiar with all the symptoms. There are a couple good support groups online that have informative websites, as well as the government's NIH site.
I'm glad you liked your surgeon. Have you checked him out as to his training and experience? Did you check to see what else you can find out about him from online resources? Did you ask how many TLIFs he has performed? What is the statistical success rate for this type of surgery, and what is your rate of success with it? You might want to ask if he has any patients who have had the procedure that would be willing to talk with you.
Some people don't care to go all through this and choose a surgeon using other criteria. I just thought I'd throw out a couple things you might want to think about. I still think it is a very good idea to consult with at least one more spine surgeon before making a decision.
I have checked out the Dr quite a bit and feel real lucky to have been able to see him so soon. I talked to the scheduling staff today and it sounds like about 4-6 weeks to wait for surgery unless there is a cancellation or he thinks it warrants getting done sooner. Waiting until my second opinion next Tuesday before deciding for sure on which Dr.
I hate to wait. No only because I'm worried about more damage but also that right now I am working from home on the floor. Only able to stand for a few minutes at a time. At least when I'm on the floor I'm pretty much pain free. But the thought of being on the floor for another 4-6 weeks sounds terrible.
Right now i am only taking ibuprofen and flexeril (which doesn't do much). Is there anything else I should ask for?
Unfortunatey, there isn't a whole lot that effects nerve pain. Neurontin or Lyrica is given for it but it takes several weeks to get into the system and often people don't get much effect at the beginning. So if you're having surgery in 4 to 6 weeks, it probably isn't worth the trouble or the possible side effects.
I would just suggest icing for pain and trying to take several short walks each day to build up a little bit of stamina for the surgery. Eat well and stay away from people who have colds or viruses, if possible!
Did the surgeon indicate why he is recommending fusion rather than another, smaller procedure?
The following user gives a hug of support to teteri66: MikeLite (04-20-2012)
I agree with teteri66, fusion will be last ditch effort if others means don't work. I too had 11mm herniation. Did discectimy. Herniation still present after surgery 10 post op, now after many of tests, last being discogram showing positive. I am looking at fusion...drs must first what is the pain generator. And then try lesser means of help before doing fusion..I hope this helps
Forgot to mention, my accident happened, within dive weeks of injury was doing directory...only reason was foot drop, no dorsal flexion...to this day still have that issue, but have learned to compensate walking...second opinion may be great..that way you are totally convinced what route to go, whether it is injections, directory, disc replacement....so many choices that may help you...good luck
The report and MRI showed the disc was pretty degenerated. Compressed thin and dark on the MRI (no fluid). Plus herniation, spondylolisthesis and stenosis. The Dr said I could do a micro/discectomy but I would be back for a fusion shortly anyway. It is a last ditch effort at this point.
Luckily the rest of the MRI looked good. I am keeping an open mind and feel very fortunate to have found what I think are two really good Drs. My second opinion is said to be very good and very conservative (not one to push surgery unless absolutely necessary). So that will most likely confirm if a fusion is really needed. I have that appt on 4/23.
My hope is to have the surgery, if necessary, as soon as possible. I don't have much muscle weakness yet so I am hoping to avoid any measurable permanent nerve damage.
I just wish I could get over this latest flare up so I could exist a bit more normally while waiting for the surgery. I have the pain pretty centralized to my left hip. Very much like a nerve pinch. Strange since usually my pain is very much sciatica on my right side.
Still taking lots of iburprofen, flexeril and ice. I guess I'm managing.
First Dr said TLIF. Second doctor said Microdiscectomy. Now I'm thrilled at the thought of not have a fusion but I also want to make sure I am solving the problem. With stenosis and herniated disc and that the disc is thin and dark, what should i do?
The second doctor seem to think I should be fine with the Microdiscectomy. He said he might have to do two, one on either side if he can't get everything on just the right side. He also said IF at a later time I need the fusion I could have it with no problems due to having already had the Microdiscectomy.
Can a Microdiscectomy really take care of the stenosis and herniation?
Is there really no downside to having the Microdiscectomy. He thinks the disc, while thin and dark, would be fine.
First Dr said TLIF. Second doctor said Microdiscectomy. Now I'm thrilled at the thought of not have a fusion but I also want to make sure I am solving the problem. With stenosis and herniated disc and that the disc is thin and dark, what should i do?
The second doctor seem to think I should be fine with the Microdiscectomy. He said he might have to do two, one on either side if he can't get everything on just the right side. He also said IF at a later time I need the fusion I could have it with no problems due to having already had the Microdiscectomy.
Can a Microdiscectomy really take care of the stenosis and herniation?
Is there really no downside to having the Microdiscectomy. He thinks the disc, while thin and dark, would be fine.
