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Decision Time

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Old 09-28-2012, 02:20 PM   #1
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Decision Time

I saw surgeon one on Tuesday. After reviewing my MRI, x-rays, examining me and talking about my pain levels and limitations he suggested a laminectomy and a fusion of L3 and L4. A six hour procedure. I've had surgery before, but none of the procedures lasted that long. I'm a little fearful of being under for that long. He did say that a laminectomy, about two hours, would only serve to relieve the pain of compressed nerves, while doing nothing for the herniated discs. I will see surgeon two on Monday for a second opinion. Has anyone opted for a laminectomy and left herniated discs alone? What was your result?
Has anyone had the laminectomy and fusion at the same time? What was your result? Feedback please!

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Old 09-28-2012, 06:10 PM   #2
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Re: Decision Time

Hi here is my story. Hope it is of some help.

I have spine issues since 1988, which started off as bullging discs. At that time the treatment was traction; then physical therapy.

Ultimately my bulging discs became herniated. Thus the 1st of many surgeries. The first surgery was of the lumbar spine for herniated discs. The surgery went well, in hospital for 3 days or so then home and physical therapy.

Next surgery was for cervical stenosis of the foramen, which was a difficult surgery for me.

The 3rd surgery was for flatback syndrome which required a fusion and harrington rods of the lumbar spine. Overall it was a an easy surgery after being in the hospital for about a week I guess then home and physical therapy.

The worse surgery I was in for was a cervical sugery which originally was supposed to be a 1 day surgery of about 6 to 8 hours. It turned out to be a 2 day surgery of about 12 hours which required a bone graft from the hip then a fusioin done anterior and harrington rods posteriorly from C3 to T4 levels. A terrible surgery and terrible recovery time.

I am sure with the last surgeries and the fusion there must have been a laminectomy involved since a fusion was required as well.

With all the surgeries that I have been thru I have always recovered from the surgery that was done. I eventually was up and about.

But the issue that I have now is not that there was an issue with the surgeries or what the surgeons did. I always would recover and a new problem would arise. Nothing related to the surgery.

all my problems are degenerative in nature in that it was not the result of any accident or trauma. My issues now are that I develped nerve damage in the neck and lumbar area; arthritis and peripheral nueropathy. This has caused difficulty in getting around and I am now living on pain medications.

Not sure if this has answered your question or not. Just wanted to share my experiences withs urgery.

It is always a great idea to get a 2nd or 3rd opinion if necessary. Good luck

Old 09-28-2012, 08:28 PM   #3
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Re: Decision Time

It is always a good idea to get several opinions before proceeding with surgery. I couldn't tell from your post if you have been going through conservative treatments prior to seeing surgeon # 1. What is your diagnosis and how long have you been having "back" problems?

Surgeons operate at different speeds. My neighbor is an anesthesiologist and I have talked with him quite a lot about various surgeries. Several years ago when I began contemplating my first spine surgery, I asked him about a surgeon who worked at the same hospital and asked him if he was familiar with him. His only comment was "He works fast."

At the time, I didn't really understand his comment, so he explained a bit more. Obviously you don't want someone who operates faster than his abilities and makes mistakes...but, there are real advantages to a surgeon who works quickly.

My current spine surgeon was a trauma surgeon for ten years before he decided to train to be a spine surgeon. I think his past experience is what makes him so talented as a spine surgeon.

One never knows what problems may arise during the operation. If this surgeon #1 routinely takes 6 hours to perform a one level fusion, I can't imagine how long the patient would be on the table if there were some unexpected findings.

My last surgery was a 3 level revision. I had been having pain that had everyone mystified as everything looked clear and open on the MRIs. When he got in there, he discovered that the facets at L3 had worn away to little nubs, leaving me with a lot of instability....He did a bit of reconstruction at this level, removed the hardware at L4-L5 because it was not compatible with the new, then he performed the fusion and attached pedicle screws and longer rods so that I was connected from L3 to S1. I was on the table 2 hours 15 minutes total.

I do know this is a bit faster than most 3 level fusions...but I really can't imagine how it could take surgeon #1 six hours....

It would be possible to do a laminectomy without addressing the disc problems, but I would assume your herniated discs are contributing to the pain issues. Do you have stenosis? If you are having a fusion from the posterior, part of the lamina would have to be removed in order to gain access to the discs. If the surgery were done from the anterior or from the side, the lamina could be left intact and avoided, unless it is contributing to nerve which case you'd have to have the surgery from the back...(at least this is how I understand it...but obviously none of us are doctors!)

Are you seeing an orthopedic spine surgeon or a neurosurgeon or one of each?

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Old 10-04-2012, 06:17 AM   #4
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Re: Decision Time

I saw a neurosurgeon on Monday, for a second opinion. After reviewing MRI / X-rays, examination and discussion he agreed with the first surgeon in that surgery might be necessary, but he suggested waiting at least until the end of the year or until my pain level reaches a point that I decide for myself that surgery is my only remaining option. His strategy is physical therapy and steroid injections. (L4/L5/S1) I have my first PT session today and I will see the pain management doctor on the 25th. I wanted to put a little space between the two events so I can judge for myself which has the most effect or if neither has any effect. Has anyone gone this route and found that surgery was no longer needed? Has this route allowed anyone to put off surgery for a few years?

Old 10-04-2012, 07:40 AM   #5
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Re: Decision Time

Hmmm. I guess I have two things to say. First, I would agree that you definitely do not want to have surgery until all conservative methods have been tried and have failed AND the pain is significantly altering your life and lifestyle. You can read stories on this board and others of people who have ended up worse off or in more pain than prior to surgery. Usually when contemplating surgery, this doesn't occur to us, I think because we find it hard to believe that anything could be more painful or worse than what we are already experiencing.

I'm not talking about a catastrophic event either...but small, unintended things can occur that the surgeon has no control over...waking up with foot drop for example....or nerve damage that leaves a patient in more pain than before, etc.

So, one needs to think long and hard if surgery is needed...and only you can make that determination.

Now, here's the flip side of the coin: for those that wait, and the surgery goes as expected and the pain is significantly reduced or completely taken care of, the patient wonders why on earth he/she waited as long as he/she did. Why did they put up with the pain all those additional months or years?

And, also there is the very real concern that the longer one leaves a nerve compressed, the greater the chance for permanent nerve there is a lot to consider.

I think you don't want to just do a laminectomy as it will end up just being a temporary fix if the discs are degenerating.

Old 10-04-2012, 12:28 PM   #6
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Re: Decision Time


I am going to jump in here because I am in the same situation. teteri66 have offered valuable things to think about.

I too have a herniated disc at L5/S1 that is severly impinging the nerve root. I have bulges at L4/L5, and other degenerative issues that are common with aging. I'm 59.

I have had steriord injections that helped me for as much as a 5 year stretch. A few wrong moves threw me back into excruitiating pain in Dec. 2011. 3 injections later and 6 weeks of PT, and I was good to go....for awhile. I had a small flare-up which I got through in the summer, and then during the fall, when my job responsibilities are at their peek(consulting and road warrior status)....I tripped on my patio, and a a couple other minor movements, and I was back where I was in Dec.

I have posted on the board a few times as I knew my doctor would likley think that a microdiscectomy was finally in order. He discussed it with me in Dec. The new Sept. 2012 MRI showed the herniation to be larger and I started having a new symptom, numbness and tingling, all the way down the left leg and into the outside of the foot and two smallest toes.

I was not able to do most of the exercises that I generally kept as part of my own routine at home. My doctor ordered another injection however, to see if it would help.

I had the injection just yesterday and I feel better today than I have in six weeks. I am able to do my exercises today. The numbness and tingling are less. I have feared that I might be at that last, but as long as I continue to get better, I will avoid it.

So I take one day at a time right now. I am however, hopeful. I think talking to a surgeon or getting a second opinion is appropriate, even when you are not sure if you are at that point. However, if I can pull through again, and get back to work (hoping to negotiate a part time position) and have a little life.....then I will continue to go this route.

This is only my story. I do know it might change tomorrow. But, if injections are helpful and you are diligent about not let down on them....and you can maintain, then my opinion at least for myself, is that this is the best option.

I may not quite understand the difference between laminectomy and microdiscectomy, although I have read much about both. But ....I'm holding on for the injections and PT to bring me out of this again.

I too appreciate all positive stories here. I would encourage you to try both Edify....but of course, your pain level and the quality of your life will determine your final decision. You have nothing to lose by trying the injections now and my opinion.

I'll post in a week as an update to my progress. I am so hopeful.....:-)

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