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  • Why No Surgery?

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    Old 12-13-2005, 08:53 PM   #1
    wolfmarket
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    Why No Surgery?

    Met with my surgeon today and he did a simple X-Ray and of course, he found 3 damaged discs. Last MRI was coming up to 2 years ago and so is CT scan. So, he ordered a new MRI for back and one for neck because of the numbness I am getting in my hand.

    He said that the CT scan reference to sclerosis meant I had arthritis in my back and he seemed non plussed about the stenosis.

    He said unless the MRI is much worse, I am not surgical.

    I don't understand. I spoke to a patient of his in waiting room and she had problem with just one disc and he did fusion on her.

    Don't get me wrong, I am not trying to get cut open. I just don't understand why one patient with 1 disc gets fused and I am not surgical.

    My CT scan and MRI refer to thecal sac impingement on multi levels and he does not want to cut. I don't get it.

    DOES THE FACT THAT I AM NON SURGICAL MEAN I AM BEING A CRYBABY ABOUT MY PAIN?


    Alan

    Last edited by wolfmarket; 12-13-2005 at 10:18 PM.

     
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    Old 12-13-2005, 09:56 PM   #2
    Fibbles
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    Re: Why No Surgery?

    I had a C Spine fusion on C5 and C6 2.5 years ago. Since about 2001 I had been having really bad neck pain. It went from occasional to chronic and kept increasing in severity.

    A week after I met with my doctor, I had an MRI. On the next visit a week later, he said that the vertebrae were pushing on my spinal cord and I needed surgery ASAP. I had my fusion 2 weeks later (June 23rd 2003).

    I would bet it depends on the severity and how your disks are interacting with the rest of the spine. If there's no immediate cause for concern, then it might not need surgery.

     
    Old 12-13-2005, 10:15 PM   #3
    wolfmarket
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    Re: Why No Surgery?

    Well, I guess I can consider the severity of the pain to be important. If I am in severe pain, isn't the problem severe enough for repair?

    Don't get me wrong, I do not want surgery, but I am a bit confused about this.

    I have multi level thecal sac impingement and severe pain in that area. Wouldn't a surgeon look at least at doing a microdisectomy?

    Does the fact that I am not surgical mean that I am being a crybaby about my pain?

    Alan

     
    Old 12-14-2005, 04:47 AM   #4
    RobinD21283
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    Re: Why No Surgery?

    Not be rude, but have you asked why not?

    Currently, I have 1 herniated disc causing lots of problems, but b/c I'm 22, unless my insurance approves ADR, a fusion would only make things worse, because I have so much longer to live. Also, I have maxed out all other options, PT, injections, accupuncture...etc.

    It seams like the Dr. may be a decent guy, not jumping to perform surgery when it is at all justafiable, but maybe not the right thing.

    I think the best thing to to is ask the Dr. why he hasn't reccomended surgery for you, what are some other thing you can try etc.


    Robin

     
    Old 12-14-2005, 06:42 AM   #5
    feelbad
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    Re: Why No Surgery?

    This is why god invented second opinions,you DO need one and as soon as possible.from what you have stated,you are having impingement onto a nerve somewhere tha if it is not relieved,the damage could be permanent.honestly,i saw three seperate(not related to the same practice in any way)NSs before i knew that my cavernoma surgery was pretty much a must have situation.you DO have the right to a second opinion despite what some docs may tell you,I had this problem when I was attempting number two.my referral person set her straight big time,and i was able to actually see doc no two.i did however end up going to the U of M here in mn for the third one and he is the NS(he was at that time,the head of neurosurgery)that I let do my spinal cord surgery.if you live by any sort of a teaching hosp this would be my recomendation,really.they are used to dealing with everything neuro ya know?I think quite frankly that this type of NS would be much more frankwith you about what you really do need.Personally(i am no doc,believe me)i would see at least one more NS as it really does sound from what you have stated that some sort of surgical intervention is really needed.Just my opinion.but whatever you do,don't make any decisions til you have seen at least one more NS,really.i know where you are at with wanting the surgery but not wanting it?it does suck to be in that position.hopefully you can get to another NS for a much better opinion.good luck and please keep us posted,K?marcia
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    3-22-01,herniated C-6-7
    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.

     
    Old 12-14-2005, 09:37 AM   #6
    Shoreline
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    Re: Why No Surgery?

    Hi Allen, I've been through the same run around with surgery, to have or not to have. basically an impinged thecal sac is just a physical abnormality,or structural defect, the pain may or may not be from the impinged sac,It may be entirely disco geneic an the you have to find a doc willing to fuse you to relive pressure on a ruptured discs. A disco gram would determine the extent of the damag e to the disc, or a mylogram CT in which you flex and extend. But the fact they can see the a sac impingement dosn't mean that surgery would relieve your pain.

    The criteria to have surgery has more to do with damage being done by not correcting it. I have had several surgeons tell me that nobody ever died from pain, personally I don't agree but that's anothr topic. The types of things that determine the need for surgery is first, a clear mechanincal problem that can be coralated to the symptoms you have, again, pain isn't one of the symptoms they look for or give much creadence too. It's more of a guide to where the problem is. They aren't fixing pain, they need to fix the generator. They look for neurologic impairment like loss of reflexess, loss of strength, loss of coridiantion, loss of bowel and bladder control, muscle atrophy and other visable and measurable neurological symptoms that continue to get worse.

    If you have back surgery or neck surgery solely because you have back or neck pain without the neuro problems like loss of strength, muscle and reflexes, surgery on your spine to reduce spine pain is rarely succesful and more often creates more pain. Docs don't want to perform a surgery that isn't going to be succesful by the standards and meaures they use.

    They measure success by a differnt standard. If you had an EMG that was totallly wacky from a nerve compression in your neck, had muscle atrophy in your arm and loss of strength and coordination, those are the things they look to correct with surgery. If you had a fusion and those things were corected but you were left with more neck pain that you ever had before, your surgery would still be considered a success and the pain just a consequence from needed surgery to prevent further neuro damage. If the muscle grows and your hand strengthens and your reflexes return, than the surgery is a succes despite any compliant of debilitating neck or back pain.

    The goal of surgery was to correct neuro defects. Pain isn't a visable defect they can pinpoint and isn't used for sole critieria for surgery.

    It's certainly not all in your head, He just doesn't see the benefit or value in taking a risk at worsening your pain if your goal is to reduce your pain.If you have surgery and end up in more pain, there isn't a pain relieving surgery. You might be a better candidate for nerve blocks, ESI, RFA or nerve destruction to ease the pain through interventional therapies, but open spine surgery rarely decreases pain if that's your chief complaint.

    I've been through this with every surgery an it wasn't untill I lost reflexes, couldn't lift my toes, had hardware snap and impinge nerves that caused bowel and bladder problems before anyone would even consider surgery. Pain reduction is a secondary goal of surgery and relieving pain alone isn't worth the risk of making things worse.

    Sorry Allen, I wish I had a beter answer, but you really don't want to have surgery unless the poblem is clear cut "mechanical defect" and the benefit is clear cut and the surgeon knows that by relieving an impinged nerve it will likely restore neurologic function. An Impinged thecal sac really doesn't have a dermatome to folllow or have a direct coralation to any specific area or problem.

    Untill an impinged sac progresses to an impinged cord and major stenosis that causes you to wake up or rapidly develop a cord compression and you have a mirad of neurological symptoms and possible paralysis. I don't think an impinged thecal sac has been directly limnked to pain generation, It may predict future risk but It's really a roll of the dice if that's even what's causing pain and surgery to fix, is extremely invasive in your cervicle spine.

    Instability is anther reason for surgery, If you have spondylothesis grade 1,2,3 or 4 the hhigher number being the greater degree of slippage. This is where the vertabrea shift upon flexion and extension an that cause a thecal sac compression which could lead to cord compression and wose case sveering to a degree is another reason to operate, but pain itself is very iffy? Without the major neuro problems, altered sensation is a problem but at what risk is altered senasation put you at Vs surgery.

    By alterered sensation that caould be anything from pain, to feeling likje it on fire to nuumbness or feeling it's in a bucket of Ice, The nerves can be prettyt creative.

    You may have to wait untill you have a clear cut need that they see and believe can be corrected or an impinged nerve from a disc would be something obvious that can relieve radiculopothy/ when severe enough causes all those major symptoms.

    THere are also docs that will cut on anyone desperate enough to have it done, That may not be the best way to go and the advice to keep getting opinions untill your convinced this should or can't be fixed and th odds are in your favor. It may be a good thing when someone first apt with a surgeon says wait and follow the standards of care, anti inflamatories, PT, and pain relief. Already being a CP atient may be what's stopping trying PT ito see if it can help? There are more than one kind of PT's. Some were great at masssage and and hands on, there is scarr management, myofacial release and trigger point pressure, the Mcekenzie method, core stabilization and excercisse to correct posture and strength.

    Have you tried anything lately like that or the way they would treat an acute injury in a non CP patient? I would love to get back into PT, but they have to be able show functional and measurable improvement and I keep hitting the same wall as far as endurance or standing and sitting, I do a lot of posture and core strengthening at home which helps but a massage sure would be nice.

    Good luck and keep us posted. I would definitely get other opinions though, It's not insulting, When you have een everyone in a particluar loop of docs that don't like to disagree and sometimes you have to get an Indepenent medical eval, with a nurosurgeon that starts fresh and isn't influenced by their buddies opinion. Sometimes leaving the area is a must and a med school dept of NS or ortho would be the place to go.

    Hang in there, Dave

    Last edited by Shoreline; 12-14-2005 at 09:40 PM.

     
    Old 12-14-2005, 10:40 AM   #7
    curiousforever
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    Re: Why No Surgery?

    Shoreline is right-it might cause more damage to have the surgery than not.

    But you have every right to ask for, and get a second opinion. And it would probably be inwise not to.

    And from now on, don't leave the doc's office without finding out the "Why's". That is really the only way you can really be proactive with your healthcare.

     
    Old 12-15-2005, 06:40 AM   #8
    feelbad
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    Re: Why No Surgery?

    the best way to actually find just how and what this surgeon is thinking about your situation would be to obtain his clinic notes he made on you when you left his office that day,you DO have a right to all medical records and i would get his and have a read and still get that second opinion.just to see what another ns feels about your overall condition.marcia
    __________________
    3-22-01,herniated C-6-7
    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.

     
    Old 12-15-2005, 01:17 PM   #9
    momchelle
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    Re: Why No Surgery?

    Quote:
    Originally Posted by Shoreline
    The criteria to have surgery has more to do with damage being done by not correcting it. I have had several surgeons tell me that nobody ever died from pain, personally I don't agree but that's anothr topic. The types of things that determine the need for surgery is first, a clear mechanincal problem that can be coralated to the symptoms you have, again, pain isn't one of the symptoms they look for or give much creadence too. It's more of a guide to where the problem is. They aren't fixing pain, they need to fix the generator. They look for neurologic impairment like loss of reflexess, loss of strength, loss of coridiantion, loss of bowel and bladder control, muscle atrophy and other visable and measurable neurological symptoms that continue to get worse.

    If you have back surgery or neck surgery solely because you have back or neck pain without the neuro problems like loss of strength, muscle and reflexes, surgery on your spine to reduce spine pain is rarely succesful and more often creates more pain. Docs don't want to perform a surgery that isn't going to be succesful by the standards and meaures they use.

    They measure success by a differnt standard. If you had an EMG that was totallly wacky from a nerve compression in your neck, had muscle atrophy in your arm and loss of strength and coordination, those are the things they look to correct with surgery. If you had a fusion and those things were corected but you were left with more neck pain that you ever had before, your surgery would still be considered a success and the pain just a consequence from needed surgery to prevent further neuro damage. If the muscle grows and your hand strengthens and your reflexes return, than the surgery is a succes despite any compliant of debilitating neck or back pain.

    The goal of surgery was to correct neuro defects. Pain isn't a visable defect they can pinpoint and isn't used for sole critieria for surgery.
    Wow, thank you so much for posting this--it made me look at things a whole new way. I'm not angling for surgery, either, but I have wondered why it wasn't even considered. This pretty much answers my question, so thanks for explaining it. I don't know if this was helpful to the original poster, but it sure was to me.

    To the original poster (sorry I don't know your name), I do agree that a second opinion would be a good idea for you if you are uncertain in your doctor's decision. If you don't have complete confidence that your doctor has made the correct decision, then you should get another opinion. You don't want to be thinking a few years down the road that you wish you had/hadn't had the surgery, so it is best to be as certain as possible that it is what you need. My doctor has told me that surgery would more than likely make things worse for me and, at this point, I believe him. But, if he were to suggest surgery, you can bet that I would get a second opinion just to be sure, you know?

    I hope things work out for you!

    Michelle

     
    Old 12-15-2005, 09:17 PM   #10
    wolfmarket
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    Re: Why No Surgery?

    Thanks all for your comments. Yes, I should have asked the Surgeon directly. And yes, I can (and have before) get a second opinion.

    But you know, I would prefer not to be cut open yet and know that I see that pain is unrelated to whether or not I am surgical, I do feel better about the Doc's decision.

    Thanks again!
    Alan

     
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