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Second opinion?

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
Should I get a second opinion?

I know everybody says always get a second opinion. But I think my case is pretty straight forward.

I have had over a year of conservative treatment which has failed, other than medication. I've had an MRI and discogram which has given me the diagnosis of L4/L5 and L5/S1 DDD, no disc herniation or stenosis (no pressure on nerves, visible on the MRI).

My surgeon has recommended 1) two level ALIF, 2) two level minimally invasive TLIF, or 3) hybrid surgery with TDR @ L4/L5 and ALIF @ L5/S1.

I had a very good feeling about this surgeon. He did fellowship training in spine surgery, and has done residencies in both orthopaedics and neurology. His specialty is spine disorders.

I don't feel like another surgeon would have anything different to tell me. They may prefer a different disc replacement type, or maybe suggest 360, but I can't see that they would really have a totally different treatment recommendation. Is it really necessary to go for a second opinion?
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Comments

  • I go by my gut feeling and if you have faith in your instincts then you are probably OK- but this said-your operation is very complex and another opinion is usually warranted for a complex operation.

    I got three opinions the second time (this time) because I didn't like what the first neruosurgeon was telling me and I was right. I found a less invasive operation for my problem. I just had a gut feeling about it.

    The first time I got 2 opinions. Once again my gut feeling told me the 1st neurologist wasn't making sense. I was right-he was totally off base with his diagnosis.

    I am not a smart person-but I try to know my body and learn everything I can about my condition. I want to be a partner in my diagnosis and treatment. Good luck to you and I hope you have a complete recovery!
  • :) why take a chance and later say "i should have gotten that second opinion?" :? you are dealing with surgery, cutting yourself open! it seems like you should do ALL you can to make sure your surgery and recovery is successful. :T part of this is getting that second opinion!! what can it hurt to have his opinion agreed with or not. then you can go into surgery feeling fairly secure that you are doing the right thing. why put so much power into one man's hands? this is your body!!! Jenny :)
  • My boss (a physician) recommended that I get a second opinion from a neurosurgeon (the first one is an orthopaedic surgeon). One of the other physicians in the lab also agreed, and said he would email a neurosurgeon and cc me on the email. So, I may be able to get a second opinion without paying my copay and having to get an appointment (not that that is the reason I wouldn't go for a second opinion).

    They said even if there isn't a question about the diagnosis, that it's good to get another opinion on the prognosis. And that makes sense.
  • Surgeons are like anything else. There are good ones and there are not so good ones.
    I consulted with no fewer than 8.
    Let me tell you, a couple of them seemed like really great surgeons, but when I did some investigating, found out they weren't.
    It may have cost me a few extra bux, but it was worth it to get the different opinions.
    It was important that I not tell each one what the other had said so as not to influence.

    Please don't short-change yourself. What you are proposing is a very intense operation. Get a few other opinions.
    -----------------------------
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • It never hurts to get a second opinion, but that is a decision you need to make for yourself (unless your insurance requires it).

    I didn't get a second opinion and do not regret it. I walked into the surgeon's office saying to myself, I'm ready for anything, but if he says fusion, I'm getting a second opinion.

    I had educated myself ahead of time, including seeing some MRI images online of different spinal issues. As we looked at my MRI, I could clearly see that the disc space had already partially collapsed - when taking the time to study the MRI, I didn't need a surgeon to tell me that something wasn't right with that disc - it was obvious. I knew my only options were:

    1. Discectomy now, fusion later

    2. Disc replacement

    3. Fusion now

    I decided to go ahead with the fusion because its current 95% success rate in the US is better than disc replacements. Add to that, many successful disc replacements are re-done in 5-10 years. I also figured it would be better to let someone mess with my back once instead of twice.

    My surgeon has 28 years of experience and I felt really good about putting myself in his hands. He recommended fusion surgery, but told me I could call his secretary to schedule the procedure when I was ready for it. He said that would give me time to think about my options and possibly get a second opinion.

    Maybe my comfort was due to his not pushing me into the fusion. He gave me time, several options and had no problem with my getting another opinion.

    Should I have gotten a second opinion? Perhaps, but I'm not going to second guess myself now, and I am still comfortable with my decision not to do that.

    Let your conscience be your guide.
  • A friend had ACDF surgery by one surgeon who totally blew it. So he had it repaired by the surgeon I chose (before I chose him) and was very, very impressed. So he recommended him to me. I read up on him and when I had my first meeting, I too was impressed and knew he was the right surgeon for me right then. I have since learned that he has a passion for cervical surgeries and is also on SH referral list. Sometimes you just know.
  • I chose not to get another opinion. I did research quite a bit though and went through 7 years of conservative treatments and therapies to no avail. I basically made the choice to go with fusion after my discogram was done. It was very conclusive that my discs were causing the pain. Go with your gut though. I fired the NS prior to the one who actually did the surgery because my intuition told me to. I do not regret the choices I have made.

    One Love,

    Stephanie
  • Thanks for responding folks.

    My surgeon also was not pushing me, in fact said that I could probably wait for up to a year.

    I am still reading, researching and thinking. And I need to discuss a lot of things with my boyfriend. I also have a list of questions for the surgeon, and hopefully he will call me back next week, though I guess with the holiday's I shouldn't expect an immediate call back.

    But it's good to hear that not everyone is saying absolutely, positively "You need to get a second opinion!". It makes me feel 'not so bad' about thinking I may not want to bother. I really do think that as long as you do your research, and feel good about your decision, that's all that matters.
  • Hi Cathy, I did not get a second opinion either. But, only because by working in the hospital where my NS practices, I was able to get the inside scoop on him. In fact when I was initially referred to someone else, I called a nurse friend who works Neuro ICU, and she told not to go to that other NS and recommended my surgeon or his partner. I called my PMD and got my referral changed. I also inquired of nurses who work in surgery, recovery, neuroscience, and even risk management, and they all said my NS was the best. We do not even have an ortho at my hospital who does spines, so that was never a consideration. I did think of going to UCSF for a second opinion, but the commute was going to be a problem in the long run, so nixed that idea. Good luck with whatever you decide. This surgery is definitely a huge commitment, and you need to feel confident with your decision. >:D< Cali-Sue
  • I'm probably in the minority in my thinking here,but I would stick with conservative treatments as long as possible and put off surgery as far into the future as was safe to do~if I could control my pain.

    But that's just me :)))
  • I have thought about calling the hospital, and trying to ask nurses who they think is best. Unfortunately I don't know any nurses. Is it possible to call the hospital, ask for the neurosurgery floor, or orthopedic floor? Or what department should I ask for?

    I keep going back and forth, trying to decide if I need to have surgery sooner or later. Admittedly my pain is around a 4-5 now, with medication. My surgeon did say that normally the patients he does surgery on have pain that is more like 8.

    It is such a hard decision to make. And I know that it's difficult to judge success rates from the forum, since people who have successfully recovered are no longer posting here. So most of what I see are the people who have either not had pain relief following surgery or those that are even worse off.

    It is so stressful.
  • Cathy,

    Here's a strange-sounding alternative for you ... check with your local Red Cross office to see if they can recommend a good spinal surgeon in your area.

    When I went to my local Red Cross to donate a unit of blood for myself (in prep for my surgery at the surgeon's request), two of the nurses commented that my surgeon was really good. One even said that he is the doctor in my area that other doctors go to see when they have back problems.

    Even though I already knew a bit about my surgeon, those comments made me feel much better about my decision and put me completely at ease.
  • My story is very similar to Mark's, options were -
    -medications and cortisone shots
    -discectomy (if my back pain was manageable)
    -disc replacement (which my surgeon would neither do or recommend but he would refer me to another surgeon if I requested)
    -ALIF

    Surgeon would only do ALIF if I said I was ready, it was my choice. He said "let pain be your guide" and I decided I would not do it until my quality of life was compromised. When I did decide to do it, surgeon would not schedule it until I spoke the words "I am ready to schedule the surgery" not "yes I guess so" or "I think so". He is THAT conservative. He's never "pushed" surgery.

    I've been through a previous surgery with him, and in that situation, I actually called some of his patients who had recently been through the surgery to hear their experience. If that is an option, I highly recommend for a number of obvious reasons.

    So no, I did not get a 2nd opinion, I could see on the MRI for myself, we have been conservatively treating for a year, and my gut tells me that my options are what they are. He's also very honest about why he chose ALIF versus PLIF/TLIF and the risks if he can't get all of the disc matter.

  • That's an interesting idea Mark.
  • One of the questions I have for my surgeon, when he calls me, is can I talk to any patients who have had similar surgeries. I do hope that I can talk to some of his patients, I think that is really important.
  • Hello Cathy,

    YES, do call the hospital and talk with the nurses there. Ask them who they would select as their surgeon for spinal surgery. You may have to "push" them a bit to get a answer, but do it.

    Also, may I suggest that if you live in an area with a professional sports team that you give them a call. Find out which spinal surgeon they use for their valuable players. Then make an appointment to see their recommended doctor(s). I have done this several times and the team trainer is always more than willing to share the name of the doctor they use for spinal issues, AND whether they are pleased with the doc.

    Yep, like Paul, I have been to eight spinal surgeons. Result - they have different opinions on what should or should not be done. Though my back is a mess, the majority have recommended that I not have surgery at this time. Over and over again is the response "surgery is your LAST option". It took awhile for that to sink into my brain. Now I totally agree.

    "It is such a hard decison to make." I totally agree. It took me several months to work through my mind what seemed best for me. To decide which compromises to my life I could accept before going with the knife.

    "I keep going back and forth, trying to decide if I need to have surgery sooner or later." Oh boy Cathy, have I ever dealt with that, and frankly still do. One spinal surgeon said in the summer of '07 that I needed spinal fusion at two places, etc. by the end of the year. The ESIs were working from Apr '07 through Dec '07. In December I saw that same spinal surgeon. After some examination, etc. he said "continue with the ESIs being they are working". I celebrated that evening.

    Another spinal surgeon I saw looked at the same MRIs all the surgeons have seen. Did the usual bend this way and that. His response "NO WAY do you need surgery now. Surgery is the LAST option." I asked him how I would know when to have surgery. His response "When you can't walk across your living room." His words are my guide.

    My "thing" is gardening. I mean serious gardening with heavy lifting twisting bending and all. For me Cathy, as long as I can dig a hole in the ground and plant a tree I'll stay away from the knife.

    ALSO, there are new technologies/devices in clinical studies at this time in which you retain your motion (bending, twisting, etc.). Current "traditional" techniques of fusion do NOT permit the back to move as freely, AND if you do bend too much you will just stress the vertibrae above and below the fusion resulting in the need for more surgery. A lady from our church told me just very recently that since her one level surgery about two years ago she now finds she cannot and should not bend because of concerns about the condition of the vertibrae above and below the fusion. For me, I will try to wait for the new devices to be approved by the FDA.

    Decisions - Each one of us has to make the decision that is best for us. No one, not even a doctor can do that for us. That is why in my mind one needs several "2nd opinions" to help one determine what is the best road to travel.

    AND Cathy, DO have that ESI. They have worked for me since Apr '07 and continue to do so. The first ESI took care of my leg pain (and still does), and subsequent ESIs do help in reducing the inflammation of my lower back with the resulting much lower back pain.

    I wish you the very best as your travel on this road. Many of us have been and still are there with you.

    Take care.

    RichT

    P.S. - I forgot to mention I'm 72. Two medical publications in which the authors reviewed the literature regarding the effect of age on the success or failure of back surgery concluded that age was not a factor.



  • Thanks Rich,

    I have tried ESI's, have had 3 of them plus 1 facet joint injection. None has worked for any more than a week. When I see my PM doc in Jan, I will ask if I should go for another. If there is a possibility, that even though the others did not work, that the next one might, then I will go for it.

    I live in the Raleigh/Durham, NC area, so I could find out what surgeons the University teams go to. I also work at Duke University, and I'm sure that there are top notch surgeons there.

    So, what departments/floors in the hospital do you think I should ask to talk to? Where would patients who are recovering from back surgery be located?
  • I consulted with 2 orthopedic surgeons and 2 neurosurgeons before making my decision to have a fusion..and because of some nerve stuff going on in my right leg, I chose to go with the second neurosurgeon that I met with for my operation next month..and all four said the same for me
  • It was actually his idea - between diagnosis and surgery for my discectomy, it was about 4 weeks. I had no time to do homework, my condition deteriorated SO fast. When he suggested it I jumped at the chance and after talking to them, I knew that not only had I made the right decision re: surgery, but it stepped up my confidence in my surgeon (whom I had just met a couple of weeks prior!) Hope you are able to do the same. Who knows, maybe one of those patients you call will be one of us! :O That would be really ironic.
  • Hello Cathy,

    You are welcome.

    In my opinion the best nurses to talk to are the OR nurses. In other words, the Operating Room nurses. They are the ones who see the doctors in action. They are the ones that to me would be the most knowlegable. If you can't "connect" with an OR nurse, then try to speak with a nurse on the "floor" where the post-op spineys are going to be. Even for that matter ask the nurse/person who originally answers the phone. The important thing is not to say "should I ask this person or that person", but rather ASK. Oh yes, you may need to do a little "gentle" politicaly correct HARD arm twisting. Its a fun game to play.

    Okay, so the lady on the phone won't tell you anything. Then show up at the info desk at the hospital and ask which floor/location the post-op spine patients are located. Zip up there, and start your "conversation" at the nurses "desk" area. Always come across as though you know where you are going. I'm sure you understand what I am trying to say. Oh, and if someone says "Who are you going to see?", or "Why do you want to go there?", just say "I'm considering having spinal surgery here and would like to just see the area in which the patients will be" or something to that effect.

    Back to the ESI injections - Sorry to read that you received no reduction in pain from the previous injections. Did the doctor making the injection use a fluoroscope. If so GREAT, but if no find another doctor. Also ask your doc what his "success" rate is. Yes, yes, find out if the PM unit is certified. If not, find another PM unit/doctor.

    RichT

  • I'm in NC too-near Lexington........land of the BBQ :)))
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