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JulieAJJulieA Posts: 1,420
edited 06/11/2012 - 8:56 AM in Upper Back Pain, Thoracic
I met with the 2nd opinion NS today. She thought I would be a simple case until she loaded the MRI. She said I am a highly unusual patient. She had never seen anyone with as many disc protrusions on the thoracic spine. She had read some notes from the nurse and thought for sure this would be lumbar... until the MRI changed her mind.

She said she would first like to see my ESI notes and possibly do one more -just to make sure we are at the right level (either facets or disk depending on the injections notes from my PM). After that cinched it up (thinks T7/8) is my worst problem. She would then do a XLIF (extreme lateral interbody fusion). She uses this method a lot. They go in from a spot on the side about 1-2 inches (very minimally invasive) and remove the old disc, then place a peek cage filled with BMP and no hardware (T spine is supposed to be more stable so no hardware). She would only do the one level.

I will be seeing my NS on the 26th of September and discuss what he would do again. He said before it would be thoracotamy (collapsed lung/rib resection/hardware etc) how many levels is the big question.

Since I think I am having symptoms from multiple levels I wonder if they can do multilevel XLIF? The new NS said they use this method alot to add a level in the lumbar area....

I have a lot to think about and research. I don't want to rush anyting but the right leg started with myelopathy on Tuesday. She also said I had a lot of end plate edema at the worst level (think it is 7/8 but it could be another level).

That is it in a nutshell :)



  • julie,
    I think everybody, particularly people with thoracic spine problems, hope minimally invasive surgery will become the norm in the not too distant future.
    I've had mine "done", but you know how these spine problems have a way of coming back to haunt you, so I like to keep my eye on developments "just in case".

    I have to say I don't envy you in your situation. I don't think anyone who has not been through the pain, constant discomfort and stress that goes with having a serious spine problem can ever appreciate how tough it is. I'ts a real test of endurance with only big surgery and an uncertain outcome to look forward to.

    I'm lucky, my nightmare is over - for now.
    My heart goes out to you - and everyone suffering at this time and I pray you will all come through it as well as I have.

    As Churchill said "...If you are going through hell, don't stop, keep going..."

    I'm not young enough to know everything - Oscar Wilde
  • I am in a similar position in that I have multiple herniations throughout my t-spine, from T5-6 down to T10-11. I had T8-9-10 operated on...a two-level thoracic discectomy done completely posteriorly. Now I'm having problems with T7-8. I'm having another ESI done next week, and if that doesn't work, we're going to talk about another surgery. It'll be another discectomy and he'll try to do it posteriorly again. I really think it depends on the surgeon. Make sure your surgeon is associated with a large, teaching hospital, as they tend to be more up to date with their approach. The thoracotomy is really the older approach, but it depends on how bad the herniations are. What I did to find my NS was do a google search for the top hospitals in the US based on their dept of NS. I saw that UPenn, which is only an hour and a half from me, was #14 in the country, so I decided to go there. Plus, the surgeon I'm seeing specializes in the t-spine. While the recovery was no walk in the park, I'm sure it was a hell of a lot better than the thoracotomy.

    As I said before, T7-8 is now getting worse. My NS said he'd try to do it posteriorly but it's possible he'd have to convert to the anterior approach.
  • Both of the surgeons are good. My old surgeon used to teach at Cornel and this new one was also at UPenn until a couple years ago when she moved here. Kim, living in Anchorage Alaska makes it hard to be overly picky. I feel like both are adequate. My pm and I will be talking about it again shortly. I like to ask her questions and pick her mind.

    Mick I know exactly what you saying. I am afraid of the minimal failing as much asni am afraid that the big fusion will hurt... I will be talking to my old NS about why he thinks I need the full Monty before I make any choices.

    Thanks :)
  • Yeah, that's totally understandable. It's a good idea to go back to your first NS and see what he thinks about the second opinion's idea. In my case, both my first and second opinion proposed the same surgery. The deciding factor for me was which NS I felt more connected to and which I felt was more adequately trained to do the surgery. I liked the first NS a lot. He is the chief of NS at a local hospital, and he really took his time with me. However, knowing that the t-spine is more delicate, I decided to go with the second opinion, as he specializes in the t-spine and is associated with UPenn.

    In any case, definitely weigh the pros and cons of both surgeries. It's a tough decision to make, I'm sure.
  • Thanks Anslen, I did just have a new MRI. My second opinion neusurgon is known to be very conservative. She is not a heavy cutter. The fact that the bad disc is now migrating heavily and I have edema on both vertebral endplates is why she wants to do fusion. She said this will heal fairly quickly and can add levels iAd we need it.

    I am supposed to see my old ns later this month he had previously said thoracotmy ..... The XLIF is much less invasive. I will be talking to my old ns about the pros & cons about the XLIF .

    Incidentally I did read on a website what you posted "mark, stay away from spine surgeons". Do you have your own webiste or blog now?


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