New Back Surgery Technologies

I have in the past had a decompression/lamenectomy @ l5-s1. That was in dec of 2000. I since had 2 have another exact surgery @ l3-l4. That was in 2004. Doc has since disowned me because I am still complaining pain meds noy working. He wants 2 put me on Opana. Has any one heard of this med? Thanks Robbie

I am a 31 year old woman and have just had my fourth back operation. The first op was in 2001 and was a microdiscetomy at L5-S1. In 2002 I had the fusion done at that level. In 2005 after a positive discogram for L4-L5 I had that level fused. After this I was still in so much pain and my surgeon was no longer able to help me (I live in Port Elizabeth, South Africa) I found a surgeon in Cape town who then discovered that the second fusion at L4-L5 was unstable as my body had absorbed the donor bone the surgeon had used instead of my own bone. (Without informing me proir to doing this or without having me consent to have donor bone used). In June 2007 I had all my instrumentation removed, a cage inserted between L4-L5 and larger screws inserted with rods from S1-L4. The new surgeon used a mixture of donor bone and bone from my pelvis. It has been 5 and a half months and I am still in so much pain. I have tried everything I can think of. Physiotherapy, chiropractor, spinologist, lumbar corset, a very large variety of pills. Nothing works. If anyone has a suggestion please contact me: wendymorgan007@hotmail.com Any advice would be appreciated.

I recently underwent an L3-4,L4-5 Laminectomy;L5-S1 Posterior Lumbar Interbody Fusion;Right L4-5 Posterior lumbar Interbody Fusion;L3-4,L4-5,L5-S1 Fusion with Pedicle Screws,Autograft and Bone Morphogenic Protien. I have never known such pain could exist. I am also a Registered Nurse who has worked in Orthopedics. I am now having a problem with a great deal of edema in bilateral lower extremities which is generally at 3 plus and pitting. Is this a side effect of the surgery? I am very careful with added sodium in my diet. My surgery was September 5, 2007, and have not started Physical Therapy yet. I don't have any shoes that my feet fit in at this point. My Surgeon sent me home on 2mg or Dilaudid every 4-6 hrs prn. I asked him to change this to a Duragesic patch which worked wonders following a previous back surgery which was not nearly as extensive as this. He finally relented and changed the Dilaudid to Duragesic. The pain was so severe I could barely get out of bed and actually felt like death was around the corner. I know that may physicians under medicate patients for fear of addiction,etc. In this day and time there is no excuse for any patient to be in this kind of pain. He even sent me to a pain management physician who said the dose of Dilaudid was entirely inapproptiate for the pain I was experiencing. He did nothing to change the med or the dose. Thanks for listening. Please let me know about this edema. Sincerely: Pat Bond 757-934-2258 2845 Kings Fork Rd. Suffolk,Va 23434 bondsfunnyfarm@aol.com 23434

Everything you said was right on, But you left out what Beth said in her first sentance. Maybe some space should be directed towards that. Sure would help the patients and physicians at the end game. Kenny 2

In responce to Beth B. Beth, it would appear that you have been through enough conservative therapy to consider spinal surgery. As you are aware, in the absence of severe neurological sequellae, the decision to proceed with spinal surgery essentially comes down to several questions. 1) Is you pain severe enough to significantly disrupt your ability to function in everday life ? It is my opinion that when considering spinal fusion, pain assessment should probably be based on how you generally feel with narcotic analgesics. (i.e. narcotic pain management has in many ways received an unfair rap.) Clinical research demonstrates a risk of addiction amoungs those undergoing the management of chronic pain utilizing narcotics is @ 3.4 %. Of course, every person responds somewhat differently to medication and ideally, your pain is controlled without impairing your cognitive function. Obviously, this type of pain management is typically best handled by an interventional pain management specialist. While it is most certainly true that narcotics have no curative effect, ideally, they buy time which enables a person to perform the specific rehabilitative exercise protocol, modify activities of daily living, avoid aggravating activities and maintain proper spinal hygeine. Additionally, it should be noted that if a patient can tolerate narcotic pain management and do not fall into addiction, social decline, etc., more aggressive medications may be considered such as Fentanyl patches, perhaps with hydrocodone for break through pain. Again, always keep in mind that you are only buying time to rehabilitate your injury and you must be commited. 2. Has the pain generator or pain generators been accurately identified. In your case, a skilled discographer should have been able to ascertain the discs which are pain generators. Discography is only as good as the examiner. Additionally, the basic criteria of identifying pain generators must be closely adhered to. They include: 1. The injection of no more than 3 cc's of contrast, antibiotic and solution; 2 ) Pain must be concordant (i.e.- Where you pint is where you are being injected; 3 ) End feel should be accurately identified as firm, boggy, etc.: 4) CT scan (Not merely flouroscopy), must demonstate nuclear tears in the discs of question. If you really want to be sure and don't mind the pain, myelography remains a valuable tool. Diagnostic facet blocks never hurt and often provide valuable information. The same can be said for SI joint blocks. Keep in mind that MR can often be quite ineffective in predicting pain generators, especially when the findings are not severe. 3) Finally, it is imperative for a patient to understand their condition. Additionally, orthopedic spinal surgeons and neurosurgeons are FAR from created equally. Thouroughly research your surgeon. Ask others who have had THE SAME procedure performed by the surgeon. Do not be afraid to travel if necessary. DO NOT rely on the opinion of other physicians. Chances are, while they may recommend a good surgeon, all to often you can be more certain that they recommending a good friend. So, Beth, in your case, I would question if the discogram really did reveal a "false negative". Remeber, large tears alone by no means guarantee that the disc is a pain generator. (It is complex, and most likely, the pain caused by internal disc disruption (IDD) is chemically mediated. So, sometimes tiny tears can result in tremendous pain and massive tears in little to none. Accordingly, although this is probably the ;ast thing that you wish to hear, I would recommend a repeat discogram by a different Interventional Pain Management physician. I would again very carefully research the clinical efficacy of the physician. If the results are the same as the first discogram (And you must keep in mind that it is imperative that you be totally unaware of which disc is being tested because the fact that you are aware of the tear could could result in you subconsciously causing a "false positive finding" (Keeping in mind that simply because you are aware of the location of the tear, you alone could control the entire outcome of the test, simply because if you were to point to the site of the injected disc and state that it was excruciatingly painful, all of the criteria have been met). I guess what I am saying is that the mind can be a powerful and influential tool. Ideally, you would have the same results as found by the initial physician and my huch is that may very well be the case. (Additionally, for future reference, although on paper, endoscopic repair of a torn disc seems to make sense, I am not a strong advocate of the procedure. I'm not going to go as far as calling it the next IDET (A procedure that appeared promising, but is essentially useless, but results are often less than stellar, especially 5 years post.)) Myelography would be of no value because you already know that the torm disc will leak. So, in summary, assuming that you have exhausted all of your conservative resourses and your functional capacity is reduced to the point that the quality of your life is affected to an extent beyond which you can tolerate; That diagnostic facet blocks and SI blocks have not yielded any valuable insight; and you are mentally prepared to do the research, fully understand the pros and cons and are commited to post surgical P.T. and a lifetime of back exercises, I would procede with a second discogram. I would also consider a little utilized diagnostic tool which is as simple as having 3 lumbar x-rays taken (A lateral, a flexion and an extension view). Radiographs must then be sent to a reputable medical radiological diagnostic centure which utilizes accurate softerware to enable for the precise measurement of what is called a "loss of motion segment integrity". Specifically, my interest would be to assess in you have excessive "translational motion (i.e. 4.5 mm or greater) of the same segment or segments in which the discogram is positive. (This is only a "re-inforcing" tool, but if for example, you have a repeat discogram, the same findings as the initial are ascertained and there is additionally a loss of motion segment integrity at this level, while no abnormality is found at the previous level of endoscopic repair, you can be exceptionally sure of the precise level requiring the fusion. Additionally, you could be resonably certain that a single level fusion will suffice. Conversely, other scenarios could arise which would require additional research). You may require a two level fusion. (Obviously, you chances of a positive outcome are reduced somewhat significantly with a two level fusion, but with the right surgeon and rehab, you still have the odds in your favor. Never consider a 3 level fusion. Finally, the fact the one disc is mildly herniated and the other is bulging essentially is of no consequence in determining your pain generator. So, I wish it was easier, but when dealing with the decision to proceed with a single or double lumbar fusion, all of the following must be considered. This is a MAJOR decision in your life. Obviously a poor outcome is always a possibility, regardless of how you address this, but you are playing the odds. And, if you choose to enter into this lightly the odds are far greater that you will have a less than favorable result. Conservsely, if you follow the above stated paradigm, the odds of a positive outcome can be dramatically higher.

1. Go to www.feldenkrais.com, click on 'Find a practitioner', find a Feldenkrais practitioner in your area and take some Functional Integration lessons 2. Read John E. Sarno, M.D.: 'The Mindbody Prescription'

I could not agree with you more, and getting a doc to agree and to continue to research, and question to find the cause of pain is difficult, if not impossible. I have 2 discs with grade V tears in them (per discogram) and 1 with a smaller tear. One is "herniated," but not much, and one is bulging. I have done exercise, stretching, heat, cold, all kinds of injections, and finally in July had a selective endoscopic discectomy based on a "false negative" discogram in which the doc decided that, correlated w/ my MRI, that disc must be causing my pain (the tear was so big that when he attempted to pressurize it he couldn't, b/c the dye just leaked out too fast). He was able to close the tear only about 50%. So now it has not worked and I am here wondering, every day, as I sit in constant pain, what is it that is causing my pain? Is it one of those other 2 discs? Is it the one we operated on, but couldn't close the tear all the way? My mind is just boggled and I really, really, really wish I could find a physician who was as interested in finding out what is causing my pain as I am, and not just saying, "Well, fusion seems to be the only option." What in the heck level would we fuse!!!!!!!!!!!!!