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Well...

AnonymousUserAAnonymousUser Posts: 49,622
edited 06/11/2012 - 7:19 AM in Back Surgery and Neck Surgery
I had my 2nd opinion yesterday regarding my scheduled 360 spinal fusion on two levels (L4-L5 & L5-S1) for August 11th.

This doctor is another fellowship trained orthopedic spine specialist who has the same number of years under his belt as my surgeon. Although, I wasn't too comfortable with this guy he said that if I were his sister he would only do a discectomy, not fusion at this time.

So, I just don't know and no I can not get another opinion as insurance will not allow, so any thoughts please.

I have spinal stenosis, DDD, arthritis, pinched nerves, herniated discs and sciatica. Most of pain is in my back, but leg pain has been worsening.
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Comments

  • I would appeal the insurance company and get a third opinion. That is too conflicting. The insurance would rather pay for the cheaper surgery but cheaper may not be better for you. If you have anything saved possibly you could get a third opinion on your own since you already have all your test results. Just a thought. Remember as I write this I am soooo broke and understand money is an issue.
  • It's a telling tale when a surgeon references what he would recommend a family member do. A 2 level fusion is extreme and should only be done as a last resort. You should seriously consider doing the discectomy as the recovery time is faster. Have you had any other back surgeries yet? If this is your first, then i think your original surgeon is doing you a disservice by immediately going for a fusion.

    Seriously consider what you are doing. Fusion is no joke, and can cause additional problems.

    Just my two cents.

    Dave
  • I had 2 micro disectomies. Both failed. I never had much pain in my legs, but my back was horrrible. No surgeon or doctor took me seriously because the pain was in my back and not down my legs. I am now a month out from a 1 lvl. fusion and I am doing WONDERFUL! NO MORE BACK PAIN! The NS got rid of that disc that had been bugging me for 15 years and now my back doesn't hurt! No leg pain. I have never felt so good. My age was the only thing my NS was worried about. I am 31 and he predicts that I will have problems in the levels above and below the fusion site, but I will live every pain-free moment as if it's my last because I lost 15 years of my life to pain. And if/when I have issues with my back in the future I will know what to do. In the end, listen to your heart/gut. You will know what to do.

    Best of luck!
    -Jess
  • The guy who did my injections(also does micro d's) told me if I was his wife he would have me get the disc replacements.....Telling- not at all because he didn't have all of the information.

    Then I saw the NS who did some other tests and I found I wasn't a candidate for disc replacement.

    Thinking not all surgeons are cut from the same cloth- I wonder how many discectomys this guy does before truely fixing the problem $$$$$$ How big are your herniations? Are they bigger than 4 mm? Some surgeons won't do discectomy on the disc if it is not bigger than 5 mm.

    Also what is he going to do for the stenosis and arthritis?

    Like Cosmic- my pain has been primarily in my back and frequent numbing attacks in my legs/hips/feet.

    Good luck Gina- I hope you figure this out.

    Julie
  • regarding surgery in general this will be my first back surgery although I have had a tubal ligation.

    The 2nd opinion guy said he does 2 discectomies for every 1 fusion, and to treat the stenosis and arthritis he would do facet blocks, and physical therapy.

    Not sure on the size of the herniation, though I think it is about 3mm, but I could be wrong.

    Thank you all so much, please keep up the great advice, I really need it as I am very confused as to what to do.
  • Gina,

    I'm not trying to offend here, but a 3mm herniation is not all that big. That's not to say its not gonna cause pain if its compressing a nerve just right. I would do some further research before you allow someone to remove discs from your back. Ask if you have any loss of disc height. Have you had a discgram yet? If not, why would the surgeon recommend removing 2 discs without first verifying they are bad. The surgeon recommending the discectomy sounds more conservative. You can not undo a fusion. Your possibly setting yourself up for further damage to other levels down the road. Talk to these surgeons and get an understanding as to why there approaches are different . Maybe even get them on the phone together and have them explain to you in layman's terms which approach is the best.

    Dave
  • Hi Gina,

    If I were in your shoes, then I could have the discectomy first, then worry about fusion if and when that doesn't work. As Dave said, a fusion is a huge surgery with a very long recovery time and lots more possible complications. Prior to my last surgery I didn't have a herniated disc, it was just a bulge and it was very small relatively speaking. However, that did not stop my pain from being extremely debilitating. I had 18 months of hell before I got fixed. Lots of people argue that it's pointless doing discectomies as people often end up having fusions anyway, but there are lots of people out there who have successful ones. You need to do the most conservative thing possible to begin with where your spine is concerned. If it was me, I'd be tempted to hold off on the fusion and give the discectomy a try first. Just my opinion to add to the mix! Good luck, I know this is difficult because I'm facing some tough decisions myself pretty soon. Let us know what you decide. Take care, Spicey
  • My DH had a discectomy 7 years ago. He was in massive pain prior to surgery. Now he re-enlisted in the military (at age 44) AND he runs competitively.

    I don't think I hurt as bad as he did. But I had 2 herniated discs and have just had a PLIF 2 level fusion. It makes sense that I should have hurt more than him. I didn't though.

    So, while my injury was 'technically' worse, his more minor bulging disc hurt him more.

    The point is that the discectomy helped him - he still aches but he can do everything and even more than what he could do before surgery.

  • I spoke to the insurance company and was told that my plan will allow another opinion so I have a call in to a doctor that I found this website. Hopefully they will be able to fit me in if not I think I would like to try the discectomy just because their are too many unknowns as to my case in particular.

    Please if you have any further advice, post it, I truly appreciate all I can get.
  • Gina,

    I truly think you are making the best decision for yourself right now. Hopefully the third opinion will concur and you can move forward knowing you are making the best possible decision you can. If you do go through with a discectomy, make sure you take the time to build your core muscles after the surgery and not push yourself to hard.

    Good luck.

    Dave
  • it is good that you are able to have a third opinion and i hope you find a resolution soon.

    based on the above posts, im going to be devils advocate here,

    there are specific indications for the various types of lumbar surgeries.

    in the case of microdiscectomy the primary indication is change in bowel and bladder habits, progressive muscle weakness, leg pain, sensory loss due to lumbar disc prolapse compressing the nerve root as evidenced on mri and backed up by clinical findings (muscle weakness; loss of reflexes; change in sensation). the surgeon trims the disc thereby decompressing the nerve root. microdiscectomies are not indicated for primary low back pain and are commonly known to increase back pain

    in the case of fusion, they are indicated for discogenic pain and/or instability of the spinal segment (among other things) causing radiculopathy (not relieved by micro-d) and/or lower back pain.

    as much as one would love to have just a micro-d, if it will not address the primary complaint then it is not indicated. so if you are seeking help from a spinal surgeon for your leg problems due to nerve root compression then a micro-d is indiciated but if you are seeking help for your low back pain of discogenic origin then micro-d is not indicated. it sucks, but only fusion surgery will address lower back pain or discogenic origin that is sufficiently severe to severely limit functional tasks and quality of life depite greater than 6 months of aggressive conservative therapy.

    i hope you find a consensus and a positive outcome. please dont be afraid to ask the hard questions,

    rachel
  • I am very pleased to hear that you can get a 3rd opinion.

    It sounds as if you havn't yet had PT and facet joint blocks which I really would concider before having a fusion.

    Really a fusion is the last resort after you have tried everything else. It is not a quick fix as there is nothing quick about the recovery.

    Blessings Sara
  • Gina,

    I'm sure you are a little over whelmed by the responses and the decisions you have before you. I thought I'd forward a link to the Burton Report which is very informative about some of the procedures and concerns that I have been trying to raise with you.

    http://www.burtonreport.com/
    http://www.burtonreport.com/InfSpine/SurgStabilFusionForBackPain.htm
    http://www.burtonreport.com/InfSpine/AnatLatSpinalSten.htm

    I highly recommend giving this a read. Definitely follow the third link about Spinal Stenosis.

    Again, I wish you all the best.

    Dave
  • Rachel,

    I disagree with your assessment that only a fusion will relieve lower back. There are other procedures less invasive that can provide relief and still leave stability in your back. There is the Discectomy, Laminectomy, Foramintomy to name a few. There is also a regimen of PT combined with steroid injections. I'm sure you mean well, but your post seems to indicate that there are only 2 options for someone suffering from back pain which can't be further from the truth.

    People need to identify a Doctor who is willing to try numerous types of treatments and lay out a treatment plan before they just go and open you up.

    Dave
  • you are right there are alot of conservative measures to try and alleviate lower back pain and in most circumstances lower back pain is either self limiting or it gets better with conservative care (only a very small percentage of lower back pain sufferers ever go on to need surgery). but in the case of lower back pain that severely affects quality of life despite greater than 6 months of aggressive conservative care that can be attributed to a specific anatomical source through a combination of clinical picture and diagnostic imaging, then surgery may become a very valid option. the key here is identifying the source of the symptoms (this is not easy when it comes to lowr back pain)and undergoing aggressive conservative care. if a source can be identified and aggressive conservative care has not alleviated the problem then the proposed surgery has to address the source of the problem.

    gina, if you have not already, when you attend your next appointment with the surgeon ask them to explain to you what they believe is the source of the symptoms and how the proposed surgery will address that source (get them to explain to you what leads them to that conclusion so that you clearly understand why they are making the suggestion they are). then you may want to ask them if there are any other less invasive options that may produce a positive result (PT, injections..., im not sure if youve been there done that?)

    as an aside, if surgery could only relieve either the back pain or the leg problem which would it be? make it clear to the surgeon that this is the primary reason you are here, but that the other exists.

    good luck with your next appointment
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