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lbpenigma 05-24-2022 09:09 AM

Lumbar Surgery Ė to cut or not to cut, thatís the question.
Iím struggling with this decision, and Iím looking for new ways to address the problem. I donít expect anyone to provide me with a solution. Apologies in advance for the length of this message.

So, some background: 67-year-old male here, in generally good health. Reasonably active, but not an athlete. No meds. About 10 months ago (last July), I was doing some casual stretching exercises, and the next day I had pain radiating through my tush and groin, and down my legs. I gave it a few weeks to abate and then went to the local urgent care place. They did an x-ray and diagnosed arthritis and scoliosis in the L3-L4-L5 region Ė that the stretch triggered something that had been building for a while, and itís not like I did any direct damage.

Since then, Iíve done physical therapy (no improvement), acupuncture (no improvement), and cortisone injections (facet, branch block, and epidural). Only the epidural injections helped, only for a few months, and not completely effectively. So got more X-rays and an MRI, and started talking to surgeons. So far, Iíve talked to three.

Dr. A was an orthopedic surgeon. He wanted to do a laminectomy and fusion of L3-L4-L5, and allowed as to how I could do only the laminectomy, but Iíd probably be back for the fusion.

Dr. B was a neurosurgeon. She wanted to do just the laminectomy, at L3-L4-L5, thinking it would probably be sufficient; she saw the fusion as a thing of last resort, and since it canít be undone, why do it unless necessary?

Dr. C was a neurosurgeon, specializing in minimally invasive techniques. He thought that if we were to do anything, it would only be L3-L4, but he thought that I was not ďreadyĒ for surgery, if I was, I would know Ė call back when Iím ready.

This left me confused. I tend to tolerate pain reasonably well, if itís for reasonable periods of time. Except for long walks, I can get through my daily life fairly well, though in pain ranging from non-existent to severe enough to stop what Iím doing and sit down. I found myself thinking the rather cynical thought that Dr. C was saying I havenít suffered sufficiently yet to be a candidate for surgery.

So part of me is thinking about hunting down a Dr. D, willing to do the minimally invasive procedure, With just 30 minutes of surgery and only 2 weeks of recovery, starting with just L3-L4 seems pretty reasonable Ė going back for another helping would not be onerous.

But Iím also thinking that doctor-shopping is really not the best way to approach this Ė Iím sure if I look hard enough I can find a doctor who will agree to do anything I ask for.

I can continue getting cortisone injections regularly and suffering intermittent pain. But after ten months, the mental health aspects of being in constant low-grade pain are something Iím starting to think about.

So, my question to the group is, what part of the big picture am I missing? What factors should I consider before making my decision? Is this really a case of educating myself as best I can, deciding what to do, and then finding a doctor who will do it?

Titchou 05-24-2022 03:02 PM

Re: Lumbar Surgery Ė to cut or not to cut, thatís the question.
I'm going thru something very similar. Age 76, long time runner. Scoliosis, stenosis, arthritis and at least one displaced vertebra due to the scoliosis. After seeing the top stenosis guy in town, he sent me to scoliosis doc (actually called adult deformity) because doing a laminectomy might make fusing the vertebra impossible due to the hardware. I have had 2 general epidurals aimed at the stenosis. Didn't really work. Had two aimed at the nerve being compressed by the displaced vertebra at the direction of the scoliosis guy. The first one of those 2 worked. Talking with the pain med doc, I learned that the sciatica is probably caused by the vertebra issue as the one targeted shot worked. The rest of the pain I'm feeling is from the arthritis. They can do an ablation for that. I'm in the process of working toward that. At the same time. I am doing specific stretching routines at the gym with my trainer in order to try and get some movement from the vertebra so the part pressing on the nerve can be surgically handled by surgery. I am also going to a chiropractor in order to get more separation. I urge you to find a neuro who specializes in each area and go from there. This process, while very frustrating at times, has been very informative and has let me determine what I want to do to proceed. Obviously, I'm never getting a 1st place blue ribbon in any race...but I had a good run there for about 30 years and beat a lot of women than I. My cardiovascular system is in great shape. I'm aiming for surgery after the first of the year. I'm sure you can find excellent specialized neuros in Boston. Let me know if you want more info.

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