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Really confused and asking for imput

Dava AnneDDava Anne Posts: 28
edited 06/11/2012 - 8:36 AM in Back Surgery and Neck Surgery
I know nobody can tell me what I should do but I could really use some input right now. I have had back problems for years and had a diskectomy/laminectomy x2 on L5S1 back in 2001 and was pain free until the pain came back in 2006. Since then I have done spinal decompression which helped for awhile, PT/massage/accupuncture which also gives just some temporary relief for a couple of months but then things flare back up again.
In the past my flare would be the typical sciatic pain down the legs which you all know is miserable, but for the last few months my pain is different in that I don't have the shooting pains (Thank God) going down the legs but more of an aching/soreness/burning only in spots on the legs (butt/back of thigh/calf) that is really bad when standing/walking, not as bad sitting, and is relieved when laying down. My muscles are always tight and knotted and that is what my PT works on and after a session all feels good the rest of that day but is back the next day. I have been seeing my regular neuro yearly since he did my surgeries in 2001.
When things flared up again in 2006 he told me that I would eventually need fusion but put it off as long as possible because it would probably cause me more problems in the future by putting more strain on the upper levels and mine are already not great. I do have DDD, stenosis, and according to my last MRI a herniated disk at L4-L5 and L5-S1 impinging on the nerve roots. I go back to my neuro next month but I did speak to him and he told me things haven't changed much and fusion would still be my only option. When I saw him last year and he told me he would do an ALIF rather than a PLIF because he has much better results with this type of surgery and the recovery time is better and easier.
Now fast forward to last week, I decided I would get a couple of other opinions so I saw another neuro and an ortho spine specialist and that is where the confusion comes in. The new neuro I saw told me things are pretty much bone on bone and he would do a PLIF fusion. When I told him that my neuro had said he recommended an ALIF fusion but to hold off as long as possible this neuro sat there a minute and said "now that you mention it an ALIF would be a better way to go". (Who's the Dr. here?) He went out of the room and just started scheduling everything but I told his nurse I would let them know. He is a very good surgeon but it worries me how he changed his type of surgery on what I said.
Now it was off to see the ortho who did a full exam (the other neuro did nothing) and after going over my films he says " I really don't see anything wrong" so there is nothing I can do for you. What! I have had 4 MRI's since 2006 and all the reports say the same things and the last one was an upright one that showed even more wrong. How can nothing be wrong?
So now I will wait until I see my regular neuro in a couple of weeks. I was hoping since my latest MRI showed the herniations that maybe I could get away with another disectomy before going with the fusion.
So first has anyone experienced this type of change in their pain and such totally opposite opinions from Drs? Thanks, Dava
Thaks, Dava


  • Well, that is an interesting story! @) The second neuro just kind of reiterated what your surgeon told you. I'm not sure why he changed his mind on the type of procedure, but to me it isn't that big a deal. Often when several levels are being fused, they will go in from the front and the back as that will give the greatest amount of stability. Otherwise it is a toss-up as to which procedure is "best." It depends on the type of hardware they use, what your specific needs are, the size of the discs, etc. There are advantages and disadvantages to both in terms of recovery.

    I cannot explain the ortho's thinking...especially since he examined you, looked at the imaging, etc. I am surprised he didn't recommend a fusion. Perhaps he meant that he did not see anything sufficiently wrong that he would operate on you. Did you ask him why he said he could not do anything for you? Usually orthos love to operate! And you don't mention any disqualifying factors, so I really do not understand what he told you.

    Generally speaking, most of us have a number of discs that have slight bulges that show up in MRI imaging. Unless it is causing pain, it is nothing to worry about it. Having a compressed nerve is, of course, something else!! It sounds like you are getting good advice from your neurosurgeon.

    Did the standing MRI reveal anything that was not shown on the lying down MRI? When are you planning on having fusion?

    Take good care,
  • Gwennie: As far as I know I don't have anything that would disquaify me from surgery. I don't know why the ortho said he didn't see anything wrong. Maybe he didn't see anything on the films but I would have thought he would have also read the reports. I took the last 3 into him and the other neuro. The ortho also did an x-ray while I was there which I've neveer had done before (only MRI's).

    The ortho did seem to spend alot of time going over my neck for some reason though and did an x-ray of that and the spine also. He has a fellowship in spine so I thought he was a good choice for another opinion.

    The new neuro, when he decided to go with the ALIF, just said he would put a spacer in at L5S1 only (no hardware), maybe trim alittle at L4L5, and I would be in a brace for atleast 3 months. My regular neuro told me last year that he would do the ALIF at L5S1 only, put in a cage with no hardware and I wouldn't need a brace (go figure). He did say that if he got in there and it looked worse, then he might have to put a couple of screws in from the back but he wasn't expecting that.

    I will see if my neuro has a change of opinion when I go back. The upright MRI did seem to show more going on further up my spine and it also showed the herniated disks with nerve impingement which my others did not mention. I had my prior MRI in 2/09 when this new type pain started and the upright one was last month. I haven't decided on fusion yet as I am to worried that I will end up worse and it will mean more surgery in the future. It just seems like a no win situation.

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