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Two surgeons, two vastly different routes to fusion

CityLifeCCityLife Posts: 10
edited 06/11/2012 - 8:36 AM in Back Surgery and Neck Surgery
Hi, Everyone. Until four months ago, I had my problems (arthritis) but I wouldn't have said I have back problems. Then I started having numbness and tingling in a leg, then I could only walk shorter and shorter distances (before pain in my rear hip area would stop me).

I have spondylolisthesis, grade 1. I'm fortunate enough to live near two major medical centers. My rheumatologist recommended a spine guy and knowing I'd want a second opinion, found the other after an exhaustive web search.

Both agree I am a candidate for spinal fusion of L4-5.

Doctor One presented me with a large incision, 4-hour operation, roughly half spent on a laminectomy and the other half on the spinal fusion. I'd be in the hospital about 4-5 days.

Doctor Two presented me with a 4-hour operation but using XLIF -- and a minimally invasive approach. Minor incisions, screws and other additional hardware, 1-2 days in the hospital and NO laminectomy.

Both doctors know each other. Both are highly regarded. Both are XLIF certified.

But Dr. Two feels the compression will be relieved by correcting and fusing the affected vertebrae.

In this city, at these medical centers at any rate, there's no chance to re-question the surgeon. One meeting, one conversation, that's it until the day before the surgery. So I can't really go back and even ASK Dr. One why he feels a laminectomy is necessary and why he felt I was not a candidate for XLIF. I even tried to set up another appointment but the guy was so booked it was a full month from the surgery date they'd given.

Talk about feeling like cattle. Clearly, I'd rather preserve my lamina and have the less-invasive procedure with the shorter recovery.

Dr. One was highly recommended but the whole practice seemed overworked and I started to get the uncomfortable feeling that maybe the doctor was recommending the procedure that was easiest on HIM, not me -- a terrible thought, I know.

Does anyone been in a similar situation or had a similar experience?





  • I would suggest getting another opinion unless you think you know which surgery you'd prefer. Are the docs neurosurgeons or orthopedic spine surgeons, or one of each? I got eight opinions before I decided on my fusion, which also was at L4-5 for spondylolisthesis and stenosis. (I know, perhaps a tad excessive...I kept hoping someone would tell me something other than fusion. @) )

    One thing I would pass on to you is to not make your decision based on what you perceive the healing time to be. There are a number of people on this board right now who have had XLIF and for a variety of reasons, had the surgery and recovery take longer than anticipated.

    That is quite amazing that the surgeons cannot see you again prior to surgery. Will this also be the case afterward? One or two post-surgery visits and they cut you loose? Sometimes the surgeon who comes "highly recommended" is not always the best choice.

    I would listen to that reaction you had that the one practice seemed rushed and over-worked. I rejected one of my possible surgeons just because I didn't like the way the office was run. The doctor had fabulous credentials, but there were too many things that bugged me...so I kept looking.

    It is difficult to make a decision. I wish you the best of luck. Part of this whole process is a crap-shoot, IMHO.

    xx Gwennie

  • Hi, Gwennie,

    Dr One wouldn't see me until SIX WEEKS post-op!! Maybe so he wouldn't have to hear me complain. ;)

    Dr. Two would see me after two weeks.

    It's incredible that they expect you to take such a huge leap with minimal chance for questions, isn't it? They're both orthopedic spine surgeons, btw.

    I have been seeing some negative stories on XLIF but Dr. Two was extremely positive about my case.

    Thank you for your input!

  • I just recently had laminectomy/fusion surgery performed by one of the best neurosurgeons in the country with not so good results. I am in fairly good shape with a very positive attitude and I normally bounce back from things very quickly (3 C-Sections and a laminectomy). You just never know.
    I know you are facing a very difficult decision. I highly recommend that you get another opionion, this time from a neurosurgeon. It won't hurt to see what he has to say.
    I wish you the best of luck in your decision, and your surgery if that is the route you go. You will find alot of good information on this site. Lots of very caring and informative people.
  • I had grade 4 spondy I was born with and had first surgery at age 14. I had just a fusion to hold my spine in place so it wouldn't sever my spine.nothing but downhill. About 4years ago I had a 2nd surgery that the dr was able to clean everything out from the first one and was able to jack my spine up an inch and pulled in about 50% and place 3spacers in between l/5 and s/1 and placed rods and 12 screws and did 3 fusions. After the recovery time I had to have ESI's for the nerve damage. They help the pain that ran below the surgery site down hip into legs. I also since surgery have more upper back and neck pain. Had first neck surgery a year to date of back surgery and then another level in neck a yr after that. The only part of my spine that doesn't hurt is where I had the spondy surgery. All above and all below hurt way bad. I'm in need of another ESI series and that will give me relief in hips and legs for a yr or little longer. But the upper back nothing seems to help much at all. My neorosurgeon is great, I did have back relief and relief after first neck surgery, but the second neck surgery was a failed surgery. I trust my surgeon and think the pain is just that.. Failed surgery, on top of ddd&jd,spinal arthritis,spurs,chronic nerve and muscle pain. Failed scs implant,and whatever they can't figure out yet on top of it all. It happens! I would refer u to see a nerosurgeon. For that 3rd opinion. This stuff is too serious for bad gut feelings. Listen to those feelings!
    Goodluck to you!!!
    PS. My son is 18 and diagnosed at age 10 with stage 1 spondy which is in the exact spot as mine and was a birth defect as mine, and also schnorls node all the way down his spine. He has only complained a couple of times of hip locking up but knows how to adjust it. He's always played basketball and is very athletic. He's been seen once a year with xrays and MRI each time and has been lucky to have it going good so far! Dr says he could be one to never have problems or start suffering later in life. He's made through the most part of puberty with no problems and that's what I pray for, they he at least quit growing before something could happen. I can't imagine him in the pain I'm in.
    And just pray everyday he gets another year after each of them visits to the dr. each year!
    Again, goodluck to you! Feel free to pm me anytime, I'll help in anyway I can!
  • You have come to a very supportive site. I had the same condition as you. I too highly recommend an opinion from a neurosurgeon. I am curious as to what your symptoms are at this time and have you had any conservative therapy. Yes, fusion is the standard treatment for spondylolisthesis, but sometimes Grade I can be tolerated for a while. Unfortunately, despite therapy and injections, my Grade I caused significant spinal instability, one wrong move, and I was laid up for several days with horrible spasms, etc.

    Best wishes to you,

  • Thank you all for the responses and advice!

    Marianne, I've done over a year and a half of PT and until May had no symptoms (other than a lot of clicking). Then I started getting numbness and tingling in one leg. That progressed down to the calf and at the same time, I started getting pain in my lower back that's really cut into what I can do. I was in agony after a 3 block walk a couple weeks ago; I can't make it through the supermarket without leaning on the shopping cart. It happened very quickly. On the other hand, the numbness and pain are intermittent. Not doing any one thing too long seems to help. Sometimes I feel so good I think I must be nuts to think about surgery. Then I remember I can't make it through the supermarket....

  • I live in a medical center too.I don't care how highly regarded a doctor is, if he/she can't take the time to really talk in depth with you about a very serious, expensive, painful, life changing surgery where your quality of life is at stake,or see you until 6 weeks after surgery, then that doctor is not a quality doctor. Sounds to me as if this doctor is running a "surgery factory"- see as many patients and schedule as many surgeries as possible. Shove'em in, get them out and move on to the next. My surgeon as well as the other doctor in the practice, answers my questions, discusses options and procedures in detail and when necesary, do phone consults in emergencies. In fact, my surgeon told me when I initially went to him 5 years ago, he would not reccomend surgery because he said, it would not help me with the problems I was experiencing at the time. I really respected him for that. Truth and patient welfare over profit. So, now, I know if he recommended MI TLIF and total joint removal, I really need it. I truly trust him. Actions speak volumes!
  • And 6 Wk visit after any surgery is too long!!!!
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