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Revision Discetomy? Fusion? ADR?

brokenbrianbbrokenbrian Posts: 69
edited 06/11/2012 - 7:50 AM in Back Surgery and Neck Surgery
Ok, Ill try to get right to the point on this one.. I had a micro discetomy in july which failed right away. Still in pain with most of it being in the foot.

My question is should which of those options should I consider? Im looking for kinda of a "what would you do answer". I know I know, talk to my Dr. But I have talked to a few and get different answers. Discemtomy seems like the lowest risk and is the one I would much rather do this than a fusion. But It didnt even work the first time and the MRI of both my lower disc shows black discs. No loss of height, just dead looking discs.

I would much rather do a ADR than fusion, but even then am I getting ahead of my self? I know there are many people out there worse of than I am, and have no choice to get a fusion. But I often wounder if I too should have had the fusion done awhile ago. The pain has been severe in my foot for almost 4 years now. I really need to do something.

So I guess in all my rambling on, what Im trying to ask is with really darkend "dead" looking discs... Does a mircro discetomy still have the 80% chance of working that these doctors are telling me it does? Or should I seriously start to weigh my options on either fusion or adr?

Thanks,

Brian
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Comments

  • My 2 cents worth...understand your options and get a 2nd opinion.

    I was faced with same choice but I also saw it as an opportunity to take my time and make sure I had the right surgeon since I realized lumbar issues could be life-long issues.

    I can't tell you what to do, but I can tell you how I approached it.

    The lumbar fusion scared me. ADR seemed more 'natural' from a body mechanics standpoint. Doing nothing clearly wasn't working (though I did try it). Revision seemed optimistic because of my circumstance - basically failed instantly and my spine was otherwise stable.

    However, my husband and several doctors suggested fusion was the 'best' option. Why? My husband's cousin was 2 very successful cervical fusions. He didn't realize neck and lumbar are very different and he researched the procedure which seemed like a logical way to make sure I didn't lose more disc. He didn't research recovery and success statistics like I did.

    Long story short, I had to find an in-network doctor. I searched for one that both my husband and I liked and could have an open discussion with.

    My surgeon spent time explaining my choices. He told me what his plan was for the pending surgery as well as if things got worse in the future. He wanted to make sure we saw eye-to-eye on my 'condition' and not just the immediate issue.

    I opted for revision.
    ADR wasn't an option because of my age.
    Fusion was extreme in my doctor's mind (and mine too) and he explained why. Fusion was an option but he felt it was a big risk to take without trying the revision first.

    Now, that being said, I know people who were in similar positions and opted for the fusion and I can understand why.

    It's a very personal decision.
    I have to run but I will try to come back and give you some questions to ask the doctor that might help you make the decision.
  • Thanks for the reply. It does seem like a revision is about the only way for me to go. Not ready for fusion and cant afford ADR. I guess I just read too many stories of people having a few discectomys and end up with alot of scar tissue and more problems. I am in my mid 20's and I have to look way into the future too. I dont need to create more problems for myself.

    The main thing is I want some answers from the few Drs I've seen and Im not getting what I believe is a truthful answer. I think that with a disc as dark as mine looks, on the MRI, that there is no chance of another micro-disectomy working. They have told me it still has the same chance of working as the first.

    May I ask you, since you seem to be doing good after a revision, are your discs about the same as far as darkness and dehydrated. Or does anyone have a pretty dead looking disc and a successful discectomy?

    Brian

  • You are lucky to have the choice. For myself since the vertebra slipped over the degenerated discs and cut off nerves and circulation to my legs and feet I did not have any other option but fusion surgery to stabilize spine and vertabra. I have never regretted having it done but I do have alot of muscle pain and nerve damage that is permanent as well as a total lack of movement. I have learned to adapt to it and found new ways of touching the floor etc. Life is a learning curve whether you are healthy or not. Just research all that you can, trust your instinct and ask questions. Good luck.
    4 level posterolateral fusion L2-S1 with rods and screws and cadaver bone. Spondylolisthesis, spinal stenosis, scoliosis, sciatica, DDD, facet disease and arthritis. September 2002
  • Thanks for the reply. I realize I sound whiney in my posts, Im sorry. I have just been doing anything and everything I can think of to make my back better and seems like it just slowly gets worse. Im affraid I will make the wrong decision.
  • Never worry about sounding whiny. We have all been there for sure. You just have to make the best decision for you and nobody else. Follow your instinct and if they are not telling you what is sounding right keep asking and research.
    4 level posterolateral fusion L2-S1 with rods and screws and cadaver bone. Spondylolisthesis, spinal stenosis, scoliosis, sciatica, DDD, facet disease and arthritis. September 2002
  • Thanks for the advice. I will keep researching and try to get a list of questions.

    Take care
  • SpineAZSpineAZ WiscPosts: 1,084
    Perhaps seeing another Orthopedic Spine Surgeon and/or Neurosurgeon will give you additional perspective(s). ADR have not had the success rate many thought they would, so though they work for some please don't see it as the only option. Unfortunately some who have had ADR end up with a fusion. ADR seem to work best when the person has no other spine levels that show any problems whatsoever, and that's rare.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • SpineAZSpineAZ WiscPosts: 1,084
    Duplicate....sorry
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • brokenbrian said:
    ...does anyone have a pretty dead looking disc and a successful discectomy?
    Me.

    My L4-L5 is bbbbblllllack. I had a micro-d on it and it seems to be holding right now . When I had a micro-d on L5-S1 a year later, the surgeons "touched up" L4-L5. That's a direct quote from him.

    I truly believe it is in the technique. I was lucky to find a surgeon with a technique that is really good at keeping scar tissue to a minimum.
    -----------------------------
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • I think if you aren't comfortable with the surgeons, you need to look around a bit and try to find another one. I know most people will think I'm crazy but I met with 6 doctors before finding one I was comfortable with.

    I don't think any surgeon can give you an answer with 100% certainty. The spine is wierd.

    For your question about my disc. My disc isn't great at L5/S1. And the one at L4/L5 is showing signs of degenerative disc disorder and some bulging. In fact, my disc height at L5/S1 was why some doctors said just fuse.

    However, fusion comes with its own risks. Fusions have also advance a great deal in the last several years.

    For me I feel my surgeon gave me an honest answer. He also was able to explain why some surgeons would have said fuse but for him, and he is a NS, he thought it was a major surgery that was not guaranteed to work and felt that for someone at age 40, I would be better off trying the revision.

    I will give you the draw back - my revision might fail at some point. Am I perfectly back to myself? No. I can tell when weather fronts are coming through. I still get stiff and have to watch myself in certain activities. Am I 100%? Will I ever be? No. I had to give up running. I also had to take a break on biking but will be allowed to go back to it this spring but with caution b/c of the position it puts my body in. I still have to watch lifting things.

    I was VERY active. Ran marathons, hike, volunteer at a dog shelter with pretty strong dogs, etc.

    I'm just starting to get my active lifestyle back. Each month I add more. Winter has slowed me down b/c I take extra caution with ice, etc.

    However, I am back hiking on easier hikes, I walk, I do cardio work outs and I can swim (though just haven't much). I hope come spring to be doing even more.

    I will tell you my leg is still numb (back thigh and heel to outer toe) but I notice it less becaue from a body mechanics standpoint, I am doing well.

    It's not an easy thing to deal with and you are doing the right thing taking time on the decision and questioning the answers you are getting.

    Going into surgery #2, I had no doubts I was making the right decision. But it took me a good 2 months to get there.
  • Thanks for all the replies. I have a few oppointments over the next 2 weeks and a long list of questions for each of them. Hopefully I will have some answers soon.

    Brian
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