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Need Advice - Please?

flanhamfflanham Posts: 1
edited 02/28/2013 - 8:00 AM in Back Surgery and Neck Surgery
Need advice…. 2 procedures same diagnosis
Hi, short history… I am 40 yrs old male, with type 2 diabetes, otherwise fairly healthy. I have had back pain for 2 years now…. Pain for 2 years with no known injuries to cause the condition. Burning down my left leg, pins and needles, jolts of pain if aggravated. Pain down the back of my right leg now also, stops about mid thigh. Can sleep at night, can’t walk long distances without increased pain, numbness, etc…. Having problems now doing every day normal things….
Previous Treatment: 4 ESI (epidural steroid injections) over the last 18 months, physical therapy, and narcotics and muscle relaxers for pain management. (they don’t provide much relief anymore)
I’ve been to two surgeons and the diagnosis is consistent but the treatment plan is not. I have congenital stenosis (narrowing of the spinal passage way). A bulging disc at the L4/5 that is caused by degeneration. Pinched nerves on both the right and left causing the sciatica problems.
Doctor 1 recommends limited laminotomy L4/5 and discectomy L4/5. Out patient procedure with 2-3 week recovery expectation.
Doctor 2 recommends laminectomy L4/5, Discectomy L4/5, Peek Cage Implant, Pedicle Screw Implant (bond together vertebrae L4/5) and Autologous Bone Graft Fusion. Inpatient 5 days, 4 week recovery (out of work) and up to 3 months recovery for the fusion to heal.
Doctor 1’s approach sounds less scary but from reading it sounds like I could be back in for another surgery soon because the bone grows back, or the disk bulges again.
Doctor 2’s approach is a major surgery and sounds more long term, I wouldn’t be back in for another surgery soon…. But research indicates the pedicle screw implant could speed up degeneration in other areas… and I’m worried about heeling/fusing properly because of the diabetes….
Thoughts? Looking for advice… anyone been in a similar situation?


  • As you already know, only you can decide. There are lots of people who do option #1 and get YEARS of mileage out of it. #2 is certainly more "permanent" and doesn't guarentee that you won't need future surgeries on adjacent areas. I'd think about which doctor I had the most confidence in and think about it for awhile.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • PaulPPaul Posts: 730
    edited 02/28/2013 - 4:09 PM
    Sometimes a discogram is performed to pinpoint the offending level. They try to replicate your pain by testing discs in the vicinity until they find it.

    It sounds like doctor #1 wants to leave you with your natural disc. He will grasp out the nucleus material that has squeezed out of the disc. Also, he'll snip out some bone from the vertebra making a small "window" to create an escape route for the disc should it bulge/herniate again.

    Doctor #2 wants to do a full blown fusion. He will remove your natural disc and replace it with what you typed. If he uses screws, I would think he would want more bone in the vertebrate for the screws to thread into and a more stable vertebrate. Since there will be no more disc to worry about squishing out, it kinda doesn't make sense to do a laminectomy at that level then.

    Find out which approach he proposes: Anterior (from the front) or posterior (from the back) or both (a 360 degree).

    As you can surmise, #2 is a huge operation that sometimes spans across years to get over.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
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