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Met with the NS today...3 level fusion vs. repeat Micro-D

FarmgrrlFFarmgrrl Posts: 146
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I finally had my appointment with the NS today. He reviewed my films, listened to my history and did a pretty thorough exam. He is offering me two options: we can do another discectomy or just skip that to a 3 level fusion from L3-S1. He feels that I have some significant changes on my MRI compared to the last one (it was actually in Dec '07 3 weeks post-op). Along with that I am continuing to have back pain as well as my obvious reherniation...he feels that I have enough instability to warrant the fusion.

He is however leaving the choice to me. He encouraged me to do my research (I've been doing nothing but that for two months LOL) and even to seek a 2nd opinion if I want to.

I felt pretty dumb when I got home because I really was just expecting him to want to do a repeat discectomy. I wasn't prepared to ask him any questions regarding fusion! I did ask him about recovery times & my concerns regarding my job.

I'm thinking I need to gather my thoughts & my questions and make another appointment just to get my info straight before I can make a decision.

I talked to my parents and my boyfriend (he was at the appt with me) and all three think I should throw in the towel and go for the fusion. I honestly have been dealing with back pain issues since I was 16 years old (my disc issues started at 24); I am getting ready to turn 33 in March.

I think I'm in shock right now, I never thought I would be faced with this decision even though he told me this would be coming down the pike two years ago when I had my Micro-D. I know something needs to happen, my pain relief was short-lived from the combo of the 2nd ESI & Medrol dosepak...its been creeping back up since Thanksgiving.

How did you decide? Would you go for a second opinion?

I feel completely dumb-founded. I can't even cry.

Thanks for reading,
Christine

P.S. Any thoughts on stem-cell therapy? My dad was asking me about this too...
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13

Comments

  • Yes I would definitely get at least one more opinion...and if it were me, I would go to a fellowship-trained orthopedic Spinal specialist for one of those opinions. I found that there was quite a discrepency between the specialties.

    You want to be absolutely certain that you need three levels fused before you move ahead. The more levels involved, the less the rate for success...so you want to be certain there are no other options than a three level fusion before going ahead with it. This is kind of the end of the road as far as spinal surgery goes. It's not like a discectomy where it can fairly easily be repeated.

    Some surgeons are doing combination surgeries where they replace a disc and fuse the others, or there is a more flexible fusion that is being done, if instability is not one of your problems.

    Stem cell procedures sound very promising but are not far enough along quite yet. I did read about some doctors doing a procedure though where the center of the disc is injected and "puffed up" rather than being removed. I'll see if I can find the article....

    Just remember that unless one has done quite a bit of research or participated in a board such as this, people do not realize that fusion is a BIG surgery and should not be entered into lightly. It is very important to realize that it will not restore the patient to the way he/she was prior to injury or onset of pain. It is done for stabilization and pain relief, but it won't turn back the clock! Most people who understand this concept end up satisfied with their results. People who expect to feel like "they used to" are often disappointed.

    Take your time in reaching a decision. Turn over every stone so you know you have examined all your options.

    Gwennie

  • Christine
    I know how you are feeling. I am on the fence about a much smaller surgery. All day each day I change my mind many times.

    Gwennie is right. You need to understand the honest outcomes of each procedure. THe biggest complaint that I see here is people who expected more from their surgery than they should have.

    You may also want to speak with a psychologist who specializes in surgery candidates. Your hospital should be able to recommend someone. This might help you to accept what the future may hold for you.

    My motto is hope for the best and prepare for the worst. Please keep sharing. Maybe something someone says will strike a note for you.
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  • I knew something wasn't right about my microdiscectomy and when I went in and heard revision surgery, I thought ok.

    I never expected on my 'real' 2nd opinion to hear the word fusion. My husband thinks I should go for it but it's not him and I don't think he fully understands the potential risks. But what he did agree to and keeps encouraging me is to get enough opinions until I find a doctor I'm confortable with.

    So since I struggled finding a neuro surgeon until 12/15, I made some other appts while I waited. I have met with a total of 4 doctors (including my original surgeon) and 2 said revision and 2 said fusion. Of 1 of the fusion doctors, he said at a minimum, he'd recommend a hemi-laminectomy and explained why.

    I found that while the appts cost me co-pay of $30, it's a drop in the bucket to get me the information and finish my research.

    I'm seeing 2 neuro surgeons before making final decision. One that is a little older and I lucked out and got in on a cancellation this week instead of having to wait and the other in 2 weeks. I now have a list of questions beyond to fuse or not to fuse. I have other options to ask about and then I have more questions about the fusion approach, pain management philosophy, pt approach, hardware questions, and long term success since I'm only 40.

    I think you have to set up a 2nd and possibly 3rd opinion.

    FOlks here can help you figure out what to ask.
    If you aren't sure at a doctors office, I sometimes ask "well, doc, if you were me what would you ask? If I was your wife or child what would you recommend?"

    Good luck and stick around. You have a big decision but you aren't alone.
  • SpineAZSpineAZ WiscPosts: 1,084
    I agree with maybe a second opinion with a Orthopedic Spine Surgeon.

    Also know that you can do well with a fusion early in life. Mine was in my 20's and it improved my life a ton!
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Thanks guys! I knew I'd find help I needed from my fellow spineys...when I first posted I was 24+ hours of no sleep, had to work all night Sunday then stayed up for my appointment. I managed a nap so my head is a bit more clear. :)

    I have found an ortho group, all of their spine surgeons are fellowship trained. I'm going to call them in the morning to set up an appointment for a second opinion. Once I set up that appointment, I'm going to make a 2nd appointment with my NS. There is also another NS group I'm considering for a 3rd opinion if needed.

    I'm getting ready to sit down and start writing down my questions. As Gwennie suggested, I need to find out if fusion is necessary at all 3 levels. I know L4 & L5 are my most troublesome levels but I'd like to preserve as much motion at L3 as possible. I have a real concern about that especially considering the nature of my occupation.

    I'm also thinking that I may need to reconsider the nature of my job if fusion is the choice I go with...I love, love, LOVE bedside nursing with the kids but maybe I need to just take care of the babies (i.e. newborn nursery, NICU). That's something I need to discuss as well with the surgeons.

    I know that I'll never be the same, even with the 'broken' back I've had half my life. Something has to change though. I had a 6.5 cm tumor removed from my liver this past June (had 1/3 of my liver removed) and no one knows why I had it. Typically, its seen in women taking hormones (i.e. birth control), which I don't take (only for 2 months a long time ago). Otherwise, I had a 1 in 1.2 million chance of developing it. The only thing that sticks out in my mind is that repeated doses of steroids I've taken since '01 for my back issues. This may have contributed to it, who knows? Never mind the damage of the Tylenol & Aleve. Sorry if I'm rambling but can I keep taking meds like this???

    Thanks for the help & suggestions, keep 'em coming. They're keeping me half-sane at this point!

    Christine
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  • Well I made a follow-up appointment with my NS for Dec 3rd, this upcoming Thursday. As I mentioned above, I wasn't prepared for what he said, so I'm going back to see him armed with my questions this time!

    I also made an appointment for my 2nd opinion with an ortho for next Friday, Dec 11th. When I see the NS I have to sign a release so they can fax my records to the ortho. I'll be seeing him with my MRI in hand. Do you suggest I bring both my current MRI and the CD of my MRI from Oct '07 for comparison purposes? I forgot to ask them.

    I also have an appointment to see my PM doc tomorrow to give her an update on the outcome of the NS appointment. I want to see if she's willing to try me on another nerve med besides Elavil b/c my numb areas are now starting to burn and it hurts! Everyone has to wear shoes & socks and its driving me crazy, especially at work now.

    My 4th appointment (yes #4!) is in the process of getting set up because this month is my 6 month follow up to my liver surgery. The part that scares me is that I've been having similar pain in my abdomen as pre-op, hoping to chalk it up to IBS symptoms due to nerves. Oh yes, I get to have another MRI!!! I should buy stock in Phillips or GE at this rate. ;)

    Whew...$180 in co-pays coming up plus $150 for another MRI. It looks like a lean Christmas this year for sure. I'll be maxing out my out-of-pocket with the insurance company (I don't know if that should scare me or comfort me? LOL)

    Now, I have to really sit down and start writing down my questions...this is the tough part!

    Thanks for reading!
    Christine
  • Just think of it all as a Christmas present for your future! You don't want to make the wrong choice, or at least, an uninformed choice.

    The surgeon that did my second surgery has a standard procedure. When he meets with a patient the first time, if he recommends surgery, rather than going into it then, he has the person make an appointment for the following week and come back with spouse, friend, another person. At that point, he explains more about the surgery he is recommending and goes into all the details. He realized early on that when people heard the word "surgery" their minds just kind of shut down and they do not absorb anything beyond that point. So he has then come back for the full explanation, with another person who can remember what the patient forgets. I thought that was a good idea.

    Even when I go in with a long list of questions, the conversation inevitably takes a change in direction...we cover other things and on the way home, I always think of two more things I need to know! C'est la vie.

    Good luck with your homework. It is a big decision.
    Gwennie
  • Making progress...

    Saw my PM doc this morning. I'm starting Neurontin tonight for the nerve pain. Chantix for the smoking and she also placed some accupuncture stickers on my earlobe to help me with quitting. (I have no choice at this point, I'm headed for surgery either way).

    I asked her for her input about the fusion idea and if it really was necessary to do the 3 levels. She agrees with my NS on this because the load that L3-L4 would have to bear would be too great having both L4-L5 and L5-S1 fused. She said the stress will be less, or more evenly distributed, at the upper levels. Its hard to explain it but it makes sense to me.

    I asked her for suggestions on who to see for a 2nd/3rd opinion...she gave me a few names. She told me she would lean more towards having a NS do the surgery. I'm still interested to see what an ortho has to say. The ortho name she gave me (doc A) is different from the one I made the appointment with (Doc B), she didn't have many positive things to say about Doc B. Apparently, Doc A is pretty good, is conservative in his treatments and created one of the cages used in fusion. I'm gonna have to call and change my ortho appt. She also gave me the name of another NS so I'll be calling to see how soon I can see him too.

    Gwennie, it is an unexpected gift I guess! Hopefully one that continues to give in a GOOD way LOL We bought our Christmas tree and all the trimmings last night and it felt good to distract myself for a little while listening to Christmas music and decorating with friends. :)

    Gotta run...off to have baseline labs drawn to check liver and kidney function before starting more meds! Then to my mom's to run more errands and have dinner. Another welcome distraction :)

    Thanks for reading!
    Christine
  • Christine -

    just checking, but have you also had a discogram done? It was crucial in my surgery - would have had the wrong disc worked on, the NS was going to wait a year for the 'not-so-bad' disc, but the discogram showed that it was the main pain generator.

    Of course, if you are having all 3 done, well then that kind of takes care of that.

    Regarding the L3 - if it's not done now then it WILL take on all the load from the lower 2 fused discs. My NS says that it's not a matter of IF but WHEN it'll go. I still ended up with only 2 levels fused though.

    Best of luck!
  • Hi,

    No discogram done yet, its one of the items on my list though. It might be a moot point but I'm planning on asking the same questions from both surgeons.

    Unfortunately, my appointment with my primary NS was cancelled today due to him getting stuck in surgery. They at least rescheduled me for tomorrow.

    I have an appointment next Thursday with a 2nd NS. I'm thinking I may just seek the 2nd opinion of the NS and trash the idea seeing the ortho. I guess I just have my own personal bias but I guess I just prefer neursurgeons LOL

    I also had a problem picking up my meds yesterday (e-scripts) but it got straightened out. I now have my Neurontin in hand! Unfortunately, my new pharmacy plan doesn't cover Chantix! I simply didn't have the $$$ to pay $147 out of pocket, but I'll get it figured out.
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