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  • Considering Surgery..READ ME!!!!!!!!!

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    Old 06-14-2004, 09:07 AM   #1
    thalia
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    R U Considering Surgery?..READ ME!!!!!!!!!


    Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery. There is no equivalent term for this in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc). There are a lot of reasons why surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.Spine surgery is only able to accomplish two things:
    1) Decompressing a nerve root that is pinched, or
    2) Stabilizing a painful joint
    Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back must be identified prior to back surgery or spine surgery. The number of reasons back surgery is not effective is because the lesion that was operated on is not in fact the cause of the patient’s pain.
    Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance,
    • A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.
    • A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a spine fusion for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain.
    Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.
    In addition to the above-mentioned cause of failed back surgery syndrome, there are several other potential causes of a failed surgery, or continued pain after surgery:
    • Fusion surgery considerations (such as failure to fuse and/or implant failure, or a transfer lesion to another level after a spine fusion, when the next level degenerates and becomes a pain generator)
    • Lumbar decompression back surgery considerations (such as recurrent stenosis or disc herniation, inadequate decompression of a nerve root, preoperative nerve damage that does not heal after a decompressive surgery, or nerve damage that occurs during the surgery)
    • Scar tissue considerations
    • Postoperative rehabilitation (continued pain from a secondary pain generator)

    Last edited by thalia; 06-15-2004 at 11:53 AM. Reason: need more replies. need catchy title

     
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    Old 06-14-2004, 03:51 PM   #2
    microwave
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    Re: Considering Surgery..READ ME!!!!!!!!!

    Okay. So if surgery isn't the answer, what is?

     
    Old 06-15-2004, 08:24 AM   #3
    thalia
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    Post Re: Considering Surgery..READ ME!!!!!!!!!

    Dont get me wrong, I am not saying that surgery is not the answer, I am simply putting some thought into perspective. Surgery is to reduce your pain, or to obstruct your anatomy.
    Exp. You go to the doctor because of severe back pain. You dont know how it happened or where it could have came from. All you know is that you are in PAIN! So, you get an X-Ray done to confirm if what the doctors observe is true. To find that your Spine is tumbling down. Slippage from your S1-L5 vertebrae is very severe. Docs say that the pain will only get worse. Your nerve compression is positive, and an MRI/CT Scan also confirms that you have degenerative Disk Disease at this level. So....What do you do.
    1.Let the pain and anatomy of your spine continue to get worse
    2.Take pain meds and stay in bed for the [U]rest of your life[/U]
    3.Consider surgery, all of the outcomes, and possible downfalls.
    What would you do?

    The doctors tell you that you cannott wait anymore, you have already went to physical therapy, the therapist says your pain has decreased less than 5% in a 6 month period. So, you decide to go for surgery.

    The Fusion.
    You will use artificial bone (note that bone that comes from a bone bank is less likely to fuse due to the compatibility percentage) that will be pressed against the vertebrae that is slipping. Hopefully this will stop the slippage. Pray that the pressure from your body weight alone will not move the technique.

    Last edited by thalia; 06-15-2004 at 08:25 AM.

     
    Old 06-15-2004, 08:28 AM   #4
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    Continued:
    After surgery, you wake up to find you have no excruciating pain runnning down your legs, and the only pain you do have is that from the incisions that will heal. "This is wonderful" you think to yourself. I am pain free!

     
    Old 06-15-2004, 08:38 AM   #5
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    A month goes by. You still need help getting dresses, bathing, etc. But, your back pain and leg pain, numbness, etc, has been releived. At last PAIN FREE!

    After a while, about 6 months later, your pain has returned. Oh NO! How could this be? Did my surgery fail, if so, how? I was soo careful, as to make one fall and that will be the end.
    So, you go back to MR.DOC. You say "My back is still hurting, I still have a lot of pain in my legs, and feet. What happened?"
    Of course Mr.Doc does not want to say "Oh, well Mr.......or Mrs.........., the surgery has failed, I could not guarantee you anything from the start, I was just trying to help you for a while"
    Instead he says, "Hmmmm...I am unsure of why your pain has returned, maybe you just have some scar tissue around the inscision, which is normal"
    What are you thinking?
    A.Maybe I just have to live with this pain. It was meant to be.
    B.Is he trying to cover up something?
    C.If my pain is coming from scar tissue, shouldn't I have felt tis months ago?
    D.All of the above.

    Recommendations from MR.Surgeon
    "Get an MRI, CT SCAN, AND MYELOGRAM. We need to find out what is the problem. If we get all these test, we will know for sure"
    Sure enough, the Myelogram picked up what the MRI, & CT Scan missed.

     
    Old 06-15-2004, 08:41 AM   #6
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    Results
    We see a slippage of S1-L5 Vertebrae. Grade 2 Spondylothesis. Also, there is alot of broken bone around this level. We also see Degenerative Disk Disease around this level. Not to exclude positive nerve compression. The fusion mass is negitive. This fusion has failed.

     
    Old 06-15-2004, 08:43 AM   #7
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    What do you do?
    A. Leave it the way it is. Your pain is back to the way it was at the beggining.
    B. Consider another surgery with hardware. Also a disk replacemant, & bone stimulator.
    C. Get a second opinion

     
    Old 06-15-2004, 09:17 AM   #8
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    You choose to get a second opinion.
    This new ortho tells you that it would be better judgement to get the second surgery.

     
    Old 06-15-2004, 09:57 AM   #9
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    Now, you are left with one reasonable decision. SURGERY AGAIN!!
    This will not be just any old surgery, a cut here, a cut there. The surgerons have sat you down and explained what they beleive to be the most positive outcome of surgerys yet.
    They tell you " We will perform an anterior/posterior fusion"
    You ask" what is that?"
    "We will re-open your existing surgery site on your lower back, but we will also make an incision on your stomach. We will get to your spine from the front and the back. This will allow us to see from all angles. The probabability of this fusion failing will be less than that of Posterior fusion"

     
    Old 06-15-2004, 10:19 AM   #10
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    "We will also make an incision on you side to remove some bone from your pelvis" (I do beleive that this should have been done in the 1st surgery. But hey, whos the doc) " We will also remove your disk that is between S1-L5. This disk is almost totally deteriated.We will put an artificial disk at this level.The material that is used " "We will fuse your back again, but we will not remove the broken up bone, maybe this will help the new fusion some how later down the line. We will use a metal plate and screw to hold this fusion together. Also, if its allright with you, we would like to put a bone stimulator in your back. Hopefully this will help the bone fuse also."

     
    Old 06-15-2004, 10:20 AM   #11
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    "wahts That?"

     
    Old 06-15-2004, 10:23 AM   #12
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    "A bone stimulator looks similiar to a 9V battery. We will place this beside your spine, and there will be some wiring connecting the two. (your spine and the stimulator)"

     
    Old 06-15-2004, 10:27 AM   #13
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    To deal with the above problems, 'anterior' fusion is done (in addition to posterior fusion or instead of it- as need demands). The larger and better kind of bone in the frontal vertebral bodies makes that a better place to gain not only fusion but immediate stability.

     
    Old 06-15-2004, 10:37 AM   #14
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    So, after hearing all of this, do you really want to get the surgery done?
    If not, the following are predictions of what might happen
    1. Your Spine will slip further and damage your spinal cord.
    2. More nerve damage
    3. The problem will persist and cause the same slippage to perform at above levels.

    Do you get the surgery?
    HELL Yeah. Waht do you have to lose....NOTHING!

     
    Old 06-15-2004, 10:39 AM   #15
    thalia
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    Re: Considering Surgery..READ ME!!!!!!!!!

    Okay, okay, okay, before I continue, LET me know what you think. Should I finish or leave this post as is?

     
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