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    Old 04-19-2005, 12:28 PM   #1
    SMike
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    Laminectomy versus Fusion

    [POSTSCRIPT, Dated June 1, 2005—This is written to clarify some of what follows below in this thread I started a couple of months ago. I understand people come to this site seeking help, just as I did, and I want to make certain I haven’t muddied the waters for anyone. This thread, as it develops, became not about a laminectomy versus fusion; rather, it is about a foraminotomy (or in my case, a laminotomy and facetectomy) versus fusion. Or, it might be called “Surgeries Through the Back of the Neck Without Fusion Versus the Surgery Through the Front of the Neck that does Include Removing the Disc and Fusing.” I encourage you to read what everyone has written here, for I find it has merit. But for my postings, if you want to skip through the posts where I gradually learned a laminectomy was not necessary for me, and where I eventually selected my surgeon from among a total of seven, go to posting #33, where I have just had my operation and strive to clarify things. Immediately following this note is my first post, which was put up in April 2005. Good luck to all—Smike]

    Hello Everyone,

    I'm new to this site, and I really appreciate everyone's input and support.

    I have small herniations at C5-6 and C6-7, causing pain down my right arm, and also near my right shoulder blade. Mercifully, the pain goes away when I am lying down (my heartfelt prayers go to all of you at this board who are suffering far more than me), but I certainly cannot hold down my job in my present state; I cannot concentrate because of the pain. I have consulted with 4 neurosurgeons and 1 orthopedic surgeon to date, and they all have a little something different to say. I am trying desperately to avoid surgery, for many (including my family physician) have advised me to have surgery only as a last resort.

    A highly recommended NS in Nashville told me he thought I would get well without surgery, and prescribed taking Mobic and walking 5-6 miles per day. That was 4.5 months ago, and after walking over 500 miles, with the pain still persisting, I can only conclude he was wrong. (My pain started Sept. 6, 2004, so I have had it 7.5 months now)

    Now I am seeing other surgeons, and the question arises as to whether to go with a laminectomy or for a discectomy and fusion.

    I cannot see the drawbacks to a laminectomy, if it indeed works--except one NS told me there may be some residual mechanical neck pain afterwards.

    Anyone out there have knowledge of the differences in the two procedures? I have heard the laminectomy is much less common than the discectomy. But why--if it preserves the discs and still gets results?

    Any comments would be appreciated.

    SMike

    Last edited by SMike; 06-01-2005 at 12:02 PM.

     
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    Old 04-19-2005, 08:05 PM   #2
    NecknNeck
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    Smile Re: Laminectomy versus Fusion

    Hi there,
    I can offer some insight on why laminectomies are performed less than discectomies -- a laminectomy is a much tougher surgery, and an even tougher recovery. All of the muscles in back of your neck are cut, which is a very BIG deal. The recovery time is much longer. Also, having a laminectomy does not mean you won't be fused. On the contrary, when a multi-level lami is done, fusion is a necessity. I have had a four-level laminectomy with fusion (almost four years ago). Very tough recovery, and I considered myself to be an athlete prior to surgery. I would not recommend a laminectomy unless it was absolutely necessary, as mine was done as emergency surgery because my spinal cord was dangerously compressed, making it extremely hard for me to breathe (diaphragm). My laminectomy was from C3,4,5,6. Future surgery for me will include a discectomy, which my surgeon (top neuro in Manhattan) says will be a "piece of cake" compared to what I had done. So, fusion is involved in both surgeries. Should you have any more ?'s, feel free to ask! Good luck!

     
    Old 04-19-2005, 09:41 PM   #3
    wimpette
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    Re: Laminectomy versus Fusion

    Sounds like you've been through a lot over the past 7 months. Unfortunately although many cervical disc problems resolve over time on their own you might be joining those of us in the minority.

    There are a couple of things you might want to consider to help you that are non-surgical. Firstly, have you had any epidural steroid injections? In some people they can provide relief of the pain and, if so, can be done in a series of three, each one providing a longer period of pain relief. The other is seeing a good physical therapist for specific back exercises and therapy. Both of these together might help you avoid surgery. I assume from what you say that you have not experienced significant or progressive weakness in either arm or in your legs - that might indicate more or a need to proceed with surgery if steroids don't help.

    Hope things resolve without surgery, keep us updated.

    W

     
    Old 04-20-2005, 08:30 AM   #4
    SMike
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    Re: Laminectomy versus Fusion

    Thank you NecknNeck, and wimpette for your replies.

    Still another neurosurgeon in Nashville (that I've seen since my last post) said it takes longer to heal with a laminectomy (At the time I thought laminectomy was just another term for the posterior surgery, but I have since learned that is not necessarily true), but a woman I met here locally (near Crossville) told me she had a posterior surgery (although she doesn't know exactly what is was) and she was up and about and back at work in a couple of weeks. In her experience, it was no big deal at all.

    I just saw her surgeon, Dr. Thomas D. Fulbritht, and we liked him a lot. He talked with us about the posterior approach that does not involve a discectomy or fusion. He was intelligent, clear, and communicative. When I pressed him as to why fewer surgeons do the posterior (no discectomy, no fusion) surgery, he told us something surprising: he said it is conceivable some surgeons are influenced (whether directly or indirectly) to do the more common anterior approach (discectomy and fusion) because it is a more costly operation. For example, the metal plate they use with screws to secure the vertebrae is about the size of a postage stamp and costs $1000. He also said he debates with other medical professionals about the advantages of the two operations, and he is still convinced a posterior approach (no discectomy, no fusion) has more advantages than surgeons generally credit it. Those he debates with have not convinced him otherwise. They usually just reply that "the literature does not support" his position.

    He told me if I had only 1 disc causing my problem, it would be more debatable as to whether to go in the front and fuse, or to have a posterior surgery without fusion. But he said if a new MRI (the one I had to show him is too old to be depended upon) indicates 2 discs are causing the problem, if it was his neck, he would not have it fused.

    In such a situation, at both levels involved, the posterior surgery he favors would remove any material compressing the nerve roots, and would also enlarge the path in the vertebrae for the nerve roots exit. This would help in decompressing the nerve roots causing me so much pain. He did say there is the possibility of residual mechanical neck pain, and this concerned me a little. But the woman I talked with who had him operate on her has none whatsoever.

    He also said my case appears "pretty straight forward" and he seems confident it can be rectified. This made us feel very good about him.

    Up to this point I have had physical therapy and it was an utter waste of time; I got zero benefit. I would come by to see the therapist in the morning when my discomfort was at a low level, and he would ask me to rate the pain at that moment. I would reply that it was about a 1 on a scale of 10--which it is in the morning, but it cranks up to a 5,6, or 7 as the day progresses. I explained that to him, but there was still some communication breakdown between him and the neurosurgeon in Nashville he had highly recommended.

    So afterwards, when I went for my appointment with that neurosurgeon, he walked in and had my MRI (which he handed back to me) and announced that the PT's report revealed I could not be doing better with my progress! My wife was with me and tried to interject that my pain is still high as the day progresses, but the doctor brushed her off by getting up to leave the office while she was still talking. I just happened to be having a pretty good day when we were visiting him, so I didn't protest. At that time I actually believed I might be getting better. In the weeks to come, I therefore continued to walk 5-6 miles per day.

    But I have not gotten better--in fact, I now believe I have tricep weakness I didn't have earlier. So now it appears I have wasted much time.

    My family physician has lined me up to get the opinions of still two more neurosurgeons. I will go ahead and see them, and then make a decision.

    SMike

    Last edited by SMike; 05-31-2005 at 09:22 PM.

     
    Old 04-20-2005, 08:59 AM   #5
    Cindee 2
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    Re: Laminectomy versus Fusion

    Just wanted to say hi. I also have bulges at C5-6 & C6-7 and have the same symptoms as you. I start out as a 1 and progress to a 6 or 7 some days.

    Conservative measures should be tried first. Anti-inflammatories, therapy, ESI, at that point if it hasn't improved surgery might be indicated.

    I have done this since Sept 03. I am currently scheduling surgery in July, ACDF C6-7.

    You might want to do a search on the net for Understand Spine Surgery... This will list the different types of surgery procedures and give you a better understanding.

    Good Luck,
    Cindee

     
    Old 04-20-2005, 09:05 AM   #6
    wimpette
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    Re: Laminectomy versus Fusion

    Smike,
    Sounds like you found a neurosurgeon who has a sensible down to earth approach and is willing to talk. From what I understand, if you can avoid another fusion and it is an issue of decompressing one level only I would opt for the laminectomy even if it involves more potential muscle damage initially. Even though many surgeons claim patients recover quickly from an ACDF the reality is that any form of surgery is an insult to your body which only time can heal. The most important, regardless your decision, is to trust your surgeon, take his advice and listen to your body so as to not overdo things.
    Sounds as though you're on the right track!
    W

     
    Old 04-20-2005, 09:14 AM   #7
    flyonthewall
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    Re: Laminectomy versus Fusion

    Quote:
    Originally Posted by SMike
    The problem now is which NS to go with.
    Which one has a spine fellowship? Check out spine.org. I have an ortho with a fellowship.
    fly

     
    Old 04-20-2005, 01:38 PM   #8
    SMike
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    Re: Laminectomy versus Fusion

    Thank you Cindee for your thoughtful comments.

    I looked at some of your other postings and saw where your brother evidently got permanent relief from ESI, although you did not. That may be what I try next, for I have gone the gambit otherwise.

    It seems your surgery being put off until July would be an inconvenience for you. Why such a delay?


    SMike

    Last edited by SMike; 05-31-2005 at 09:25 PM.

     
    Old 04-20-2005, 04:54 PM   #9
    NecknNeck
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    Re: Laminectomy versus Fusion

    Hi Again,
    Wow!!! A cervical laminectomy and back to work in a couple of weeks!!!!! Was it only one level? I really find that hard to believe. I'm no wimp, trust me. Have been an athlete all my life, have had three children NATURALLY (NO pain meds), and the surgery and recovery was the worst pain I've ever endured. Not to say it wasn't worth it. I'm wondering if it was because of the # of levels I had done. Four is a lot, and much too much to do from the front, according to my neuro. I researched neurosurgeons in Manhattan (close to my home), and found the very best. My case was so severe it always unnerved me to see the faces of the neuros when they looked at my MRI films. So, maybe that is why my experience was so different from the woman you mention. I only want to give you my honest experience, so that you can make a well-informed decision. A multi-level laminectomy is not for the faint-of-heart. I was a runner prior, and it took me about 3 weeks before I could even think of walking any distance. I did not return to work (special ed t.a.) for over three months, and it was excrutiating at first. My scar is approx. 7" long, and since I'm fused on four levels, I do have a limited range-of-motion. I continue to improve that even to this day, but still need to take Ultram for some nerve damage and for the strain that is put on my neck each day bending over students at their desks. I would do all I could to avoid surgery if I were you. However, should that day come, do your research on both the procedure and the neurosurgeon, and get the very best, even if it means traveling. Of course, you should also check out the hospital. Find out how many of your particular kind of surgery your surgeon has performed, success rates, etc. I'm sure you already know this. Best of luck and health to you, and keep reading this board, as it was so helpful to me when first diagnosed. Take care

     
    Old 04-20-2005, 06:01 PM   #10
    SMike
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    Re: Laminectomy versus Fusion

    Thank you flyonthewall--you are right, that is a good website.

    Thanks Cindee for your comments--I hope you are correct and that I am on the right track.

    NecknNeck, the woman I mentioned may have only had a problem with one disc (she doesn't know). She told me her injury happened this way: she had stooped over to pick something up, and as she raised up, her head hit a fire extinguisher. At that moment, her disc disintegrated. (Probably just the straw that broke the camel's back) She was in intense pain 24/7 for 2 weeks.

    She is not sure what the doctor did, but he did operate through the back of her neck. She said the operation took place while she was seated, although she was unconscious. Her scar looks to be about 3 inches long.

    I met her at my dentists' office, and have talked with her by phone several times. She insists her operation was not bad at all. Her being a nurse at Erlanger hospital in Chattanooga, where her surgery took place, she was able to talk with other nurses and they all agreed the surgeon she chose, Dr. Thomas Fulbright, was excellent.

    However, your comments, NecknNeck, certainly have my attention. I will ask the doctor about the pain and recovery of a laminectomy. I don't mind some short term pain for good long-term results.

    I did, by the way, go to the Bone and Joint Clinic in Franklin, TN. They are only one of 10 facilities in the USA doing replacement discs. The doctor there told me I would not be a candidate, however, because my MRI showed 2 discs herniated. One is the limit to be eligible for the study.

    With the fusion, I am just worried other discs will go out, and I will have to have repeat operations. But if the doctor I chose directs me to go that route, then I will.

    SMike

    Last edited by SMike; 05-31-2005 at 09:33 PM.

     
    Old 04-20-2005, 06:22 PM   #11
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    Re: Laminectomy versus Fusion

    I wanted to let you know it was my decision to wait til July. I live in Wyoming and my family lives in Texas. I only get to go home once a year and my OSS didn't approve of traveling that far after sugery. Well he said it would be very uncomfortable. I figure I've waited this long I can wait a few more months.

    I also talked with a family friend a few weeks ago about her ACDF. She had her 5-6 fixed 15 years ago. She used her on bone and no plate. She also told me she couldn't walk for 2 days due to the harvest site. The harvest site was worse than the actual surgery. She currently has a problem with another level but not enough to warrent surgery. She visits a accupucturist(sp) about 3 times a year for her pain. 15 years doesn't sound to bad to me. I will definately use a doner bone and plate. You don't need a collar nearly at long either.

     
    Old 04-22-2005, 10:11 AM   #12
    SMike
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    Re: Laminectomy versus Fusion

    Hello Cindee,

    I've talked to several people who had the ACDF, and none had bone taken from a donor site. I did read somewhere that sometimes the donor site has residual pain that will not go away. For those who smoke, I believe I read somewhere, it might be better to use their own bone, and age might be a consideration.

    Sounds like you and I got this ailment within 3 days of each other. I understand your situation in wanting to wait; my only concern would be the possibility of nerve damage due to the delay. I've noticed a decay in my reflexes and also in my strength; I only hope it is reversible or doesn't get worse between now and when I get treatment. However, my wife's cousin had numbness, pain, and loss of strength for a year, then had the ACDF and his arm returned to its normal health and vitality instantly.

    I'm seeing still another neurosurgeon Monday, and will post back here what I learn.

    SMike

    Last edited by SMike; 05-31-2005 at 09:37 PM.

     
    Old 04-22-2005, 10:59 AM   #13
    chitowngl
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    Re: Laminectomy versus Fusion

    SMike--
    I had a ACDF at c5-6 with my own bone and plating on Jan 6. I wore a collar for about one month after and then underwent pt for about 6 weeks. EVERYONE is different as far as their recoveries go. I feel that 3 1/2 months later I am pretty much back to normal. I had the surgery because I had extreme left arm weakness. Tried everything--pt,shots,traction, medication, you name it. I chose to do the surgery because my orthopaedic surgeon thought that if I didn't I might have permanent nerve damage. That made the decision easy for me. I actually did see a neuro for a 2nd opinion and he recommended the posterior (back of neck) approach. He said that it would be more painful than an anterior (front of neck) approach because of all the muscles he would have to cut. I elected to do what my ortho suggested and have not regretted it. But please keep in mind that everyone is different. Just thought I would throw my two cents in.
    Carrie

     
    Old 04-22-2005, 02:43 PM   #14
    SMike
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    Re: Laminectomy versus Fusion

    Hello Carrie (cmoreland),

    Thanks for your post. I'm glad you got positive results--we all appreciate hearing about good outcome like yours.

    What did your NS say was the reason he would have done a posterier approach? If it was going to take longer to heal, was there any upside? Was it in fact going to be a laminectomy, and one in which he would not have had to do fusion?

    As most of us at this site have read, once fusion is done, the adjacent discs are then at higher risk of herniating--and in fact I read that in 30% of the patients over 10 years, that is what indeed happens.

    It's interesting your having an OS do the surgery. I understand they are of course qualified, but most everyone has sent me to a NS. The one OS I did see, did not build my confidence in him. He did not talk with me over my MRI or even the X-Rays they had done of me in his office that day. He just said he would fuse C5-6 and C6-7 (mine both showed as having mild herniations) and that was that.

    I surely don't like having 2 discs removed, but I like even less this pain. We are going to have to do something, and soon.

    SMike

    Last edited by SMike; 05-31-2005 at 09:40 PM.

     
    Old 04-23-2005, 10:57 AM   #15
    cardinal
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    Re: Laminectomy versus Fusion

    Oh boy, my l5 discectomy did help, but now its "collapsed" and the 3 above are bulging as of my last mri a few yrs ago. My cervical got bad and 3 more herniated up there and had fusion 2yrs ago. Well, now fusion did not take on 5/6. If I could go back, well, would have tried non surgery!! I think once you disrupt the back with surgeries they all start going? I did get much relief after my first l5 surgery in 99 but now having troubles with it, I was flat out last week with just pulling a bag to my garden. I totally understand where your coming from, wondering how I would be today if I never underwent these surgeries? I'm in a holding pattern right now, for the new mri. I know my body and feel there are many more herniations. Now to redo the non fusion or not? Quality of life, hmm, not good but worried about opening me up again? Also, fuse the lumbar? or just let it go? Nerve damage, its there and has been for over 20 yrs so that's not gonna change. My fear is not doing any more damage by pushing myself. Don't know, just going to get this mri asap and try to figure it out? I opted for the ist surgery out of 25yrs of suffering and never getting better, but now, not sure what to do?
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