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Seriously Considering Coflex Surgery at L4/L5

cabinmanccabinman Posts: 3
edited 08/10/2015 - 8:20 PM in Back Surgery and Neck Surgery
Hi Everyone,

First time poster but like many I have been reading so many stories here on the forums for some time.

I have been having on again off again lower back pain for 7 years and for the past year it's been an everyday thing. Over the past few months it's gotten pretty bad. A MRI in April 2015 showed a 6mm herniation and mild stenosis. A bad sneeze in July 2015 caused a flare-up and new MRI which shows the same herniation, now much worse. The daily pain is pretty bad and it's hard to stand/walk for more than a few minutes at a time. I've tried chiro care, physical therapy and did a course of oral prednisone. The herniation is big enough and enough time has passed that the surgeons's I've been consulting are OK with going right to surgery.

I have 3 opinions so far. Two recommend an open discectomy, laminotomy and insertion of a Coflex device at L4/L5 (both are orthopedic surgeons). The 2nd Dr agreeing to do a Coflex procedure wasn't so much as his own conclusion as agreeing with the first doctor. They both cited similar reasons (age, spinal stability, prevention of a fusion in someone younger).

A differing option is from a well respected neurosurgeon who wants to preform a laminotomy, 2 microdiscecectomies, one on the left one on the right, both focusing on L4/L5. The reason for 2 is that the broadness of the herniation would be hard to get coming in from only one side. Both would be done at the same time. He disagrees with the Coflex insertion but says there is a decent possibility I may need a fusion in the 8+ year range. His aversion to the Coflex insertion is that he feels they are hyped up and in his experience they don't provide much.

All three doctors have done Coflex surgeries. The 2nd Ortho Dr claims to have done about 75+, the first ortho claims to have done around 8.

I am a 35 year old male with a generally sedentary lifestyle and job. I try to be a weekend warrior as much as possible but M-F I'm either sitting or standing at my desk for 8+ hours.

My question is does anyone have experience or found research with a Coflex implantation and found a way to isolate the fact that the Coflex is helping, not just the decompression? I know it's new and it's impossible to get real long term stats on this but in my mind the idea that doing a discectomy just to prevent needing a fusion in time doesn't sound as appealing as doing the discectomy and Coflex implantation. Even if it's not a life-long solution it seems it would certainly buy more time than the discectomy & laminotomy alone. I've done very extensive Google searching and as some have mentioned the lack of data sure is frustrating :-/

Thanks everyone for any help!!

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  • Hi Cabinman,

    I dint have coflex surgery and I am not a medical professional but in my quest for my back problem(severe spinal stenosis, have surgery 4 months ago) I come on very good eastern Europe back problem forum (in my opinion like spine health in my native language).
    I saw many topics about coflex there and it is looks like they using it a lot. From curiosity checked about coflex as I can not find many stories about it in English forums. I did not find something bad about coflex, good aether.
    I remember a post from neurosurgeon(on this forum physicians sometime posting in topics) explaining that at symple microdiskcectomy ,at young age coflex das not do anything, only foreign body. He mentioned that coflex will not eliminate fusion in the future if you need it.
    I guess as every surgeon has own preference.
    Hope that helps you a little
  • cabinmanccabinman Posts: 3
    edited 08/10/2015 - 9:51 AM
    Thank you anddan for the reply and for the information.

    I just got out of a follow up with the neuro-surgeon. I am going to go with his recommendation and have him preform the procedure. He gave good reasons as to why he thinks the coflex device isn't good for me.

    1) My age, 35 is very young for this implantation. He said that this is typically for an older patient that may not be able to withstand a full fusion surgery.
    2) In his experience he's noticed that the can move or shift around and not stay where they were originally implanted. He feels the teeth that get clamped down don't create a strong bond.
    3) Potential problems with weakening the lamina while prepping the area for implantation.
    4) The extra and added stress to the 2 interspinous process that the device adheres to. He has seen and has concerns around the added stress over time and what it could mean if the bone fractures.
    5) He said the device really wedges in there and is close to the thecal sac, increasing risk if it ever has to come out or especially if the supporting bone fractures.

    So given those facts plus his credentials and how highly regarded he is I decided to go with the neuro surgeon. I should be having the surgery within a month or so. It will be a bilateral microdiscectomy. There is a possibility that I can go home same day, but I may require an overnight stay. That all depends on the time of day when the procedure is done. He said my back looks healthy otherwise and my stenosis is caused by the sheer size of the herniation, and my back pain correlates to the size of the herniation (as its gotten bigger, my localized back pain has increased). He said that's a good indicator that clearing out the herniation would also help with relief from the localized back pain.

    I did find some good 3rd party medical reviews of the coflex device and most seem to have a positive conclusion about it and its future. It sounds like for now I am just not a good candidate. If anyone would like to see those links, please PM me.
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