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    Old 04-19-2014, 06:34 PM   #1
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    3 neurosurgeons, 3 opinions

    Been experiencing lower back and leg pain since last fall. X ray showed arthritis in the facet joints and the MRI showed L3 - L4 spinal stenosis. PCP gave me oxycontin and oxycodone and sent me to physicist who did spinal epidural injections with no affect (February). Pain specialist says 10mg oxycontin, 3 x day, and neurontin, 300 mg 3 x day. Still hurts plenty.

    Neurosurgeon 1 says fusion of L3 - L4. Neurosurgeon 2 says laminectomy. Neurosurgeon 3 says XLIF fusion w/ laminectomy. He also said I should not be taking oxycontin at all.

    I don't know what to do. Anyone?

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    Old 04-20-2014, 09:47 AM   #2
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    Re: 3 neurosurgeons, 3 opinions

    Which one has the best reputation and training? Ask other doctors which one they would use. Do any of them work on athletes or former athletes? Research all 3 and go from there.

    And ask all 3 of them if they know Dr. Najeeb Thomas in New Orleans and if they use his procedure for the laminectomy. If not, find someone else.

    Last edited by Titchou; 04-20-2014 at 09:51 AM.

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    Old 04-20-2014, 01:40 PM   #3
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    Re: 3 neurosurgeons, 3 opinions

    Started having laminectomies at the young age of 14. Congenital lower spine problems
    Resulted in me having four done by age thirty. They all did the trick, no more back or leg pain. Don't know about fusions, but I wish you the best of luck!

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    Old 04-20-2014, 02:00 PM   #4
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    Re: 3 neurosurgeons, 3 opinions

    Welcome to the board. The opinions of the three surgeons is not all that different. Two want to do a fusion; the only difference may be in the approach to the surgical site: ALIF,
    PLIF, XLIF, etc. The surgeries seek to accomplish the same thing. The only difference is the way the surgeon gets into the surgical site. The laminectomy, I would assume, would be done with either of the fusions (it almost always is a part of a fusion surgery if there is stenosis). Sometimes a surgeon doesn't mention it, but it will show up on the forms sent to the insurance carrier for approval.

    The surgeon who suggests doing the laminectomy only is basically saying "Let's do the least amount of surgery necessary and hope that it resolves the issues. We can always add the fusion later IF it becomes necessary." If he thinks he can decompress the nerve and not remove too much of the lamina so as to create some instability, it may not be necessary to have the fusion.

    The other two are thinking that as long as they have you open, they might as well go ahead and fuse the segment because chances are good that it will become necessary in the future...and it could be six months or six years...maybe never. There is no crystal ball to be able to tell.

    Frankly, if I were in your position, I would also get an opinion from a fellowship-trained orthopedic spine surgeon. Their training is similar to the neurosurgeon but sometimes have a slightly different way of diagnosing and treating.

    So, how to decide? I could make a case for proceeding with laminectomy only or with fusion. It is a matter of the surgeon you feel most comfortable with and trust the most, who has the best credentials and experience and I would also look at the rate of infection in the operating rooms of the hospitals where surgery would be performed. Try to gather information from where ever you can. Talk to people, other patients, Physical therapists are often a good source of information. Read reviews. Check with state medical boards, etc. Before you go through all this, I would be sure that surgery is absolutely necessary and that you have exhausted all less invasive options. Surgery should be the last resort.

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    Jfriccca1 (04-21-2014)
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    fusion, laminectomy, laminectomy & fusion, xlif

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