This appears to be a non-stop topic. I'll dispel a few myths with my OPINION.
1 - No, it probably doesn't matter in most cases.
If you have already had surgery, you've jumped the biggest hurdle.
Individual circumstances are just that.
The best surgeon for you may be either a NS or an Ortho. The individual condition in need of treatment may require one over the other. There any of innumerable factors to be weighed, often very personal ones. Orthos perform thousands of very successful ACDFs each year and are among the best.
But, sorry, YES, there are HUGE differences between the two specialties.
Do they matter to you? Only you can decide.
This does NOT mean that one type of surgeon is better than the other.
2 - "Spinal Specialist" is not a recognized specialty.
The American Board of Medical Specialties awards the board certifications of Orthopaedic Surgeon, Neurosurgeon, and other such areas of specialty to physicians. Neither the category of "Spinal Specialist" nor "Miniminally Invasive XYZ" are recognized. Nonrecognized claimed areas of specialty are nothing more than marketing tools. Period.
Yes, I know all about the web sites promoting yada, yada and suggesting that it doesn't make a difference as long as your surgeon is a "Spinal Specialist." Again, there is no such thing. It's a marketing schtick. Note that the phrase does not refer to the spinal cord or the nerves themselves. There is a reason.
If such a subspecialty is created it would only be as a subspecialty for Orthos because Neurosurgeons are already spinal (cord and nerves) specialists by virtue of being Neurosurgeons. A Neurosurgeon pursuing a subspecialty of "Spinal Specialist" would be redundant.
Orthopaedics has to do with bones. Any "Spinal Specialist" subspecialty granted to Orthos would simply reflect surgery specific to the spinal bones.
Keep in mind, any physician Board Certified in Internal Medicine (or whatever specialty) is currently free to refer to him/herself as a "Spinal Specialist" and perform surgeries. The term is meaningless.
3 - Yes, there are HUGE differences between a NS and an Ortho.
The training of the two specialties is entirely different.
Bones and the nervous system are two different areas of medicine.
NSs are the best of the best in medical school and require two more years of training than Orthos. NSs can perform certain procedures during surgery that an Ortho cannot. i.e. if a problem develops within the dura while a patient is on the table an Ortho CANNOT address it other than to page a NS.
Neurosurgeons are held to a different standard than Orthos, legally.
A NS doesn't need to perform any kind of Spinal Fellowship because his/her training has already been in that very specialty and for a longer period of years. If a surgeon is trying to sell me on his/her Fellowships, past speaking engagements, "special" training that is not widely available, or published scientific articles, I'd run - not walk - right out the door.
Nerves responsible for the most critical bodily functions exit the brain via the neck (the cranial nerves). This is why some of us have a change in voice or hoarseness for a while. The nerve controlling larynx function is retracted and compressed during surgery. It is the temporary inflammation of this NERVE which causes this condition.
The most critical nerve in the human body is the vagus nerve. It branches out and controls many functions, including the beating of your heart and blood pressure. This nerve descends from your brain, branches out down through the neck, and actually reconnects to the spinal cord at C8.
And that's why you'll never hear about a C8 surgery.
One specialty involves surgery of and around these critical nerves.
Does it make a difference in your case? Again, only you will know.
4 - Minimally Invasive Options
Anything that works is great. If it's for you, have at it. Personally, I would never have such a procedure unless it was performed at a non-profit or university hospital (and it is).
MY CAVEATS: beware of self-marketing surgeons running for-profit institutes or centers. Typically, these surgeons self-market (most medical care is by referral), do not have traditional relationships with health insurers, tend to list all sorts of silly accomplishments and accreditations, often from nonrecognized organizations, and perform a GREAT job of selling you on just what you want to hear. Read the terms and conditions/disclaimer section of any such web site and you'll know right away whether you are dealing with a surgeon or the latest incarnation of P.T. Barnum.
That's my .02 on the topic.
"Use your health, even to the point of wearing it out. That is what it is for." George Bernard Shaw
Last edited by ThoreauFan; 02-02-2007 at 10:32 PM.
Have you heard of the LaserSpine Institute? Just curious because you seem to be pretty knowledgable.
I'll throw in a caveat because I believe these decisions are deeply personal. As my grandpa used to say, "If everybody wanted the same thing they'd all be chasing grandma." LSI may be the right choice for you.
There are many options out there and no one size fits all solution.
My opinion is just that; ONE person's opinion.
I had not heard of LSI.
I did a search, though, and one of their click ads showed up on Google; they know how to use modern marketing tools very well. The web site is pretty and professionally designed. LSI is in FL which just happens to be the state where I would open up such a center because of the aging, wealthy retired population (it provides a wonderful market opportunity $).
The lead surgeon is a Doctor of Osteopathy, not an M.D.
I can't tell what governing body "Board Certifed" the surgeon.
I particularly enjoyed the "Chief Spine Surgeon" prominently displaying having had received the 2005 "Physician of the Year" award for Orthopaedic Surgery from the American Association of Physician Specialists.
The designating body's requirements?
"The Physician of the Year award may be presented by each academy of medicine to a member who has contributed to the growth, recognition, and leadership of the academy." In 2006, the body's Orthopaedic Surgery "academy" did not even award such a designation to anyone.
I downloaded the organization's "Degree of Fellow" application, BTW.
What exactly is a "Diplomat" or "Fellow" of the American Academy of Neurologic and Orthopaedic Surgeons? You would have to visit the web site of the "Academy" to find out. They provide "Board Certification" for their members. Being a "Fellow" International College of Surgeons is even more impressive; their dues may be paid via credit card using PayPal.
Curiously, the "Chief Spine Surgeon" of the institute does not mention where his internship or residency were performed. But why would he need to with all those impressive credentials?
Apparently, LSI does not have relationships with insurers.
I'm sure LSI helps many people and its personnel are qualified.
Having viewed the web site, my opinion is that someone saw an opportunity to make a whole lot of money outside the coventional system of medical care and gave birth to LSI. Personally, I would not use any physician who has an outside financial interest; labs, outpatient centers, etc.
FYI: Minimally invasive options are widely available.
I'm curious, did you pick LSI because of its location?
"Use your health, even to the point of wearing it out. That is what it is for." George Bernard Shaw
Last edited by ThoreauFan; 02-04-2007 at 11:47 AM.
For the Laser Spine Institute - I had recently posted information about looking up doctors in Florida to see their profile, lawsuits, etc. I always start here researching a doctor I am about to visit. In a search engine search for Florida Dept of Health. At the top center of the page pull down the list and select practioner/physician profiling. Then select use Profile Search System. From there you can enter the physicians' name. This is a state government run site. It won't tell you everything about a doctor but it is a good place to start. Good Luck
I love the "everybody would be chasing grandma" line, must be (or have been) a very cool grandpa! This is what is so great about this board...your first post on this subject was perfect (also VERY informative, thank you!)...it's everybody's own decision. People give advice and OPINIONS on the board, people can take it or leave it, pursue it or not. Isn't that the point of the board? That was my impression anyway and so far it has been very supportive and useful to me. At a time when you physcially and often mentally feel so screwed up, it's nice to get support, advice, OPINIONS, etc. from people who have been there (or are there) in one way or another. Again, just my 2 cents (AKA: my opinion).
HI guys hope everyone is doing well... I know sometimes there may be feelings hurt because someone disagrees with someones opinion about choices they have made, but remember we are all going through a traumatic time that not many people understand and it is so nice to be able to give and receive advice and support with that being said..... I feel sometimes there seems to be a negative trend against orthopedic surgeons... believe me as a hand therapist working with them on a daily basis I have many stories to tell.. about egos and surgeries, but funny thing... I chose one for this surgery! Not because he was a specifically an ortho..I went to a neurosurgeon first but as I researched physicians in and around NYC (where I live) the one I found with credentials I wanted at the hospital I wanted was orthopedic with spine specialty (he does nothing else but spinal surgeries) so everyone has a different situation...and must do the best they can for themselves... Just my opinion bdancer
bdancer, I so agree with each situation being different.
Personally, I would want the surgeon with whom I feel most comfortable with as my #1 criterion. The condition in need of treatment and the best surgeon available to treat that condition in a particular region can each be mammoth considerations in and of themselves.
As for a negative trend regarding certain specialists? Dunno 'bout that.
What I have seen is people claiming that there are no differences.
Orthos, NS, Osteopaths, Internists, herbal remedies, minimally invasive options, chiropracty, etc. are each different from one another. Pretending that there is no difference as long as XY & Z is just silly.
There are differences and being informed is a good thing.
"Use your health, even to the point of wearing it out. That is what it is for." George Bernard Shaw
Last edited by ThoreauFan; 02-04-2007 at 07:42 PM.
I haven't chosen any place to have my surgery yet...I didn't chose LSI because of it's location. It is located in Tampa, FL and I am in Ohio. I am trying to find the best method of surgery for me. I'm not sold on this bone fusion thing. NS are telling me I have to have a bone fusion for my C5/6 level. I am only 36 years old, and the idea of fusing my bones together at this point is very scary. The information of the adjacent theory is very scary. I am told that 10-15% of people develop this adjacent theory. I know that disc replacement is right around the corner. It may be a year or 5 years, but it is close. They have been doing disc replacements in Europe and Germany for 15 years. I looked into LSI because it doesn't perform bone fusion. Instead, they take out the part of the disc that is protruding, colderize the disc that's still good so it doesn't protrude out again, remove bone spurs, and alleviate the nerves that are being affected. They go in through the back of the neck, very minimal scarring, and you are up and moving within a half hour of the surgery. Now a NS told me that he wouldn't let an ortho near his spine, and that going in the back of the neck is extremely dangerous, and my problem is in the front of the neck. Now, my concern with LSI is that they are not doing anything to support my neck. I'm no doctor but I am thinking that if I lose a part of my disc (the part that is protruding) then I wouldn't have the strength/stability that I would need in case of a car accident or a fall or something like that. I am so confused. On top of all of this, they have told me that I might have MS. I am going to the Cleveland Clinic at the end of the month for appointments with Neurosurgen and Neurologist. Any advice, and/or opinions would be greatly appreciated.
You seem to be doing a good job of going through this decision process.. these are the same decisions we have all made at one time.. I am only 43 years old, not so much older than you, and thought the exact same thing!! Only you will know when the time is right, if it ever is, to do the surgery.. I myself fought it for two and half years, hoping that things would get better, and knowing they were getting worse... but fortunately, I caught it before permanent damage to my cord was done... and I can't tell you the difference it has made! I am two weeks postop tomorrow and almost pain free (only take pain meds at night now and one during day) I told my husband as soon as came to after the surgery that the pressure was off my neck.. I feel my left leg normally ... now I don't have bathroom problems anymore... no painful hot wax feeling... I felt like before that I was slowing disappearing now I know where my body is again!! My problem now is that since I am feeling so good that I'll do something stupid (ie pick up something heavy etc) and screw things up!! The clinic is a good place... ( I used to live outside CLeveland) good luck with your decision.. bdancer
I was rear ended while sitting at a traffic light kid was going around 50mph... had herniation at c5-6 and L4-5... went though all the regular stuff...PT etc massage therapy (which helped quite a bit with pain) saw about 5 orthos, 1 neurologist, 1 neurosurgeon over 2 and half years... I was determined to avoid surgery at all costs but realized things were getting worse... not so much pain although at times it was pretty severe.. but the cord compression was getting worse with bone spur and curve issues developed so I had proprioception, sensation, weakness and bladder control issues in lower left extremity so I knew I had to do something.. I knew what hospital I wanted, did quite a bit of research .. on-line and in person and went about finding the surgeon I wanted... so far it is great...I am very pleased just can't wait to lose this collar and drive again but I am not going to risk re-injury so I am being very good!! I was very active before this happened.. I am a bellydancer (thus my name) yoga, scuba hiking and traveling etc and I got to a point where I wasn't able to do anything anymore so I didn't want to live like this anymore... hope this helps bdancer!!
well yes..but since I am only two weeks out I don't think it has "fused" much yet...still mostly the plate holding everything in place but I take my calcium everyday hoping to make bone...also I had the bone matrix, they took my own bone marrow and mixed it with a matrix to make bone.. well yes I wont lie there was pain but that was also because I have a bad reaction to morphin so I refused the drip... and that just threw them for a loop and they left me without pain meds for 24 hours post op also my throat was really sore (like worst kind of strep throat ) but day after it was sooo much better just like a normal sore throat...day after just scratchy etc etc now it is fine...I dont have much pain now some spasms some pain at hip donor site much better now... really it is so much better than I was before...numbness is also better although not 100% complete it has only been two weeks tonight... I would say about 75% of lost sensation came back immediately and I'll probably be working on the 25% for the next year... but my balance is so much better I am walking better because I can feel my left leg.. no pain in left arm..etc Qtant I was REALLY scared before surgery do a search here and you'll see but even with the scar on my neck (I just took off the steri strips tonight) It has been worth it.. hope this helps bdancer
BDancer: bought that stuff called SCAR THERAPY by Curad. I started using it as soon as my steri-strips came off (day 13). I have already noticed a difference in the scar. It was kind of raised before and now its totally flat. I am totally SOLD on that stuff!
Bdancer-thank you so much for sharing your story. It really does help me. I am not in much pain though. I just have a hard time walking long distances, legs feel very weak, stiff, and heavy. They are not sure if it is my neck causing this or possibly MS. I wasn't having any neck/shoulder pain, and very little tingling in my fingers until I started looking into all of this. Then came some pain and tingling. I know most of it is stress. I started down this path of looking into everything because of my legs, and since I did, then my neck and shoulders started hurting me, but now that I have calmed myself down a bit, that pain is going away.
theres just one big thing you need to remeber here Q,if they do indeed go thru the back of your neck,you WILL lose some stability since they would,in order to do the lamenectomy,they have to remove some of those boney prominences off the back of your c spine.otherwise they cannot do the lami.this will decrease your neck stability since those bones will no longer be there to interlock with one anohter.i lost three backs with my tri level lami when they had to go into my spinal cord,and it definitely does make a difference.even without one of hose support bones,they will not connect for the best support like they would with them,do you know what i mean?just another thing to consider when making your final decision.just keep asking questions for the best informed decision possible.marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Bdancer--curious, you said that you had problems in your neck and lumbar (L something), was it your lumbar issue causing the problems in your legs? Have you had a surgery on your lumbar? I know you just had your neck surgery and you stated that you got 75% mobility back in your left leg I thought...Was that a result of your neck surgery? The doctors I have seen so far are not convinced that my neck issue (C5/6) is what is causing my leg issue.
Well I have L4-5 herniation with minimal cord compression.. it is definitely not the size that the cervical 5-6 was.. if you study the dermatomes and myotomes for L4-5 you will see specific areas of the leg..sensation of top of big toe and foot and ankle dorsiflexion...etc that are controlled by L4-5 anyway I was getting to the point of having my whole leg weak, cold, knee buckling etc etc and that wasn't all from that... I still have a tingling big toe and weaker ankle so now I know that is what I am feeling from lumbar.. definitely something I can live with..I also think that having my cord compressed at top and bottom (plus a bulging disk at t10 from pregnancy) was aggravating things..i.e. cerebralspinal fluid flow and pressure and tension on cord. I do NOT plan on having lumbar worked on unless things get really bad..overall it is a little trickier than cervical.. funny thing MS was one of the things that was originally thought of for my some of my problems..however,, I believe the majority of people get eye symptoms/weakness and I didn't have that.. but as I said before I did have bladder issues with the "moderate" cord compression... bdancer
Docs didn't really know if my leg symptoms were from cervical or lumbar.. so they were really wishy washy with it... neurologist ordered an eeg (nerve conduction) to see what was coming from where...you can suggest that if you want it may answer some questions and is non-invasive relatively inexpensive..... but the neuro surgeon turned around and cancelled mine because "what does it matter if you are going to get the acdf anyway?? you'll find out afterwards.".. I wasn't that happy with that attitude...he really likes to jump to surgery option quickly.. we have a saying with surgeons... when you have a hammer the whole world looks like a nail.... anyway he turned me off so much (and I didn't like hospital he was affiliated with so I found another surgeon) I hope you find your answers with your legs and walking problems.. It is awful not to be able to walk without pain and difficulty..wish you the best..