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Now I'm totally confused!

tiresmokettiresmoke Posts: 10
edited 06/11/2012 - 8:46 AM in Back Surgery and Neck Surgery
I just saw my "third opinion" doc today. Now I'm totally confused about my potential neck surgery. Here is the run down:

(1) First doc is an Orthopaedic Surgeon. She said that I should get a fusion and/or artificial disc replacement. She said that I don't have to get in there right away but that my situation will get worse.

(2) Second doc is a Neurosurgeon from a highly regarded hospital. He said no way to artificial disc because he says they aren't good long term. This point is pretty much moot since my insurance won't cover them anyway. He said multi-level (2 levels) fusion ASAP. He said that the longer I wait, the greater the risk of permanent nerve damage.

(3) Third doc is an Orthopaedic Surgeon and president of orthopaedics from a different highly regarded hospital. He said he could do a fusion (3 levels) or artificial disc with a fusion, but that there is no difference long term as far as he thinks. He also said that he would not recommend surgery unless my symptoms get unbearable enough that I need it. He also said that he absolutely does NOT believe that I will be doing unreversable damage to my nerves if I wait... that he hears that all the time but it's not true. I believe he literally used the phrase "one in a zillion chance of doing damage to the nerves".

I've run the course of conservative treatment (epidurals, PT, massage, chiro, oral steroids, Lyrica, NSAIDs, etc.). My symptoms are NOT unbearable... I can deal with them fine as of right now. I'd like to believe doc number 3, but I don't know. I don't want to get surgery now if I can put it off without doing more damage since I can tolerate the symptoms. I also don't want to put it off if I'm making it worse long term.

WHAT NOW??? :-(


  • Lets break it down to look at it, okay?

    All 3 say one version or another - fusion is warranted or recommended.

    2 say ADR or ADR and fusion

    All agree 2 levels, last added another level (did he say why?)

    2 say damage highly probable, last says '1 in a zillion' (my kind of luck, not interested in being the zillenth!)

    Your body knows more than you do, at least that is what I have found. What is your body telling you? Are you getting to the point that you can't stand the symptoms day after day? How is it affecting your lifestyle? Are the symptoms progressing? See, there are a lot of things to look at. Try and write a 'pro/con' list on paper to see if that helps you sort it out. Surgery (or not to have) is a very personal decision, and only you can decide on that in the end. Please keep us posted. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • My symptoms are progressing slowly. But I can tolerate them without much trouble... primarily because they are numbness and tingling more than pain. If it was pain, it would be harder to take. I would most likely not have surgery if the current level of symptoms never got any worse. The CONS outweigh the PROS at this point if we're talking strictly about the symptoms.

    You are right... all the docs say I have damage. I have three levels of problems. The second doc said he would not want to fuse three levels at this point. All three said I *could* have surgery. First two said that I *need* surgery either now or down the road... the third said I might but only if the symptoms get to the point where I can't take it any more. Then, according to him, I could have surgery that should stand just as much chance at that point of relieving my symptoms as if I got it done sooner no matter how long I wait.

    What scares me is what the neurosurgeon said... that I need to get it done soon to avoid doing permanent damage that I would not recover from even after surgery. I'm completely baffled as to why doc #2 and doc #3 TOTALLY disagree on this topic of nerve damage. It seems like something basic that two people of their apparent expertise would agree upon.

    Some else that bothers me is that the neurosurgeon said that the "conservative" treatments I've been trying are bunk... that's PT was likely to make my condition worse because the movements are just aggrevating the pinched nerves. He said PT after surgery is what I would need to do -- not before. Doc #3 said exercise and generally getting "fit" would help -- no surprise that he's an athlete himself.
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  • Here is one reason that to *me* your getting the more damage vs not likely to have damage... 2 are bone surgeon specialties (granted trained in the spine), and the other, deals specifically with the makeup and physical aspects of the nerves themselves...mechanical vs neuro. Hope that helps a bit there.

    I've only had 1 Ortho who said "stay away from PT" prior to surgery, the others pushed it! Basically as was described to me (and too by my NS) is once a nerve is "pinched" "entrapped" etc., it isn't going to get better with PT, as the actions induced to that location with the PT causes more aggravation, hence possible damage. Your 3rd surgeon, I think what he was getting at was the "physical" (in shape) aspect. The better cardio/overall physical shape you are in prior to surgery, the better the odds that you will recover sooner and with better results. I can fully understand that. Vs, PT for the region you're having problems with. Two different animals there.

    My NS told me the "big" thing to worry about is weakness. My NS told me that the order of worry is: Weakness, numbness, tingles, pain...yeah pain is the last on the list, but the most detracting from our daily lives! (G) Weakness is 'much' of the nerve isn't getting a signal to the muscle, numb 'some' of the nerve is being affected, tingle 'intermittent' nerve affects, pain 'nerve' reacting excessively to what is going on with it. Again, these info nibbles I've gotten mainly from the Neuro side of the house, but some from the Ortho side of the house. Hope it helps.. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I have to go along with brenda.
    I've had 2 cervical fusions 92 and 95, my family doctor and my neuro. both agreed i needed surgery, and nerves and muscle rejuvinate, unless you wait to long, then your kinda "sol".
    My neuro told me if i did'nt get it done i would not be able to pick-up my children again.
    Guess what i did.
    I gotta go along with doctor #2
    But ultimiatey only you can decide.

    Best of luck to you.
  • Why not consider a mix of these opinions. You can handle to pain at the current level. So use the next few months to get in the best physical shape possible. Lose a few pounds, maybe do some swimming or other activity that won't make you worse. Get your financial and home life in order. In other words get ready.

    Deciding when is the hardest decision. I've been there - twice in the last year alone. You need to consider insurance issues, pain levels, work, family and scariest of all the operative issues. By that I mean how old are you since we know that some people have more issues after a fusion. Obviously there are different opinions among doctors about permanent nerve damage. As Brenda says you don't want to be that one but you have to weigh all the different aspects. And you alone need to consider when you feel the pain outweighs the other risks that come with any surgery.

    I was very pro-active with my two surgeries. My doctors were very matter-of-fact about the sugery and success. Today I am a lot more cautious. You are lucky that 2 of the 3 say you have some time to think. Take some time and think it through.
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  • I understand some of your confusion. A lot depends on whether the nerve is trapped or the space where the nerve exits is just tight (stenosis). If you have stenosis and your nerves can still move, then gentle stretching may help the nerves move. If your cord is being impinged, then I have no idea what to tell you. The main thing you should do is ask one or all of your doctors why or why not PT will help you. Maybe that will help the confusion.

    On another note, Brenda disseminated some info that is not correct but her point is valid.
    Aviatrix36440 said:

    Weakness is 'much' of the nerve isn't getting a signal to the muscle, numb 'some' of the nerve is being affected, tingle 'intermittent' nerve affects, pain 'nerve' reacting excessively to what is going on with it.
    There are two types of nerves exiting to your extremities, motor (efferent) and sensory (afferent) nerves. Weakness indicates that the motor control nerves are being impinged and tingle, numb, or pain is the sensory nerves. You really should get an understanding as to where your nerves are impinged, so you can better devise a plan on how to proceed.

    Good luck, I hope you can make some sense of it all.

  • SpineAZSpineAZ WiscPosts: 1,084
    The concern may be that if the pain is consistent then there is potentially a benefit from surgery. I had a C5-C7 ACDF and it worked well. But my C4 was "iffy" and I should have asked to have C4 added in. So now I may have it re-done to add in C4. So for me, when I had my back surgery in February, I told the doctor to do the most complete surgery needed. That meant if he got in there and found L2 needed to be added to the fusion that was fine in order to avoid further surgery. So my approach has always been "do as much as you need to so we get this done in one operation if possible"

    Nerve pain that lasts a while can get to a level where it either takes a long time to recover or you may not end up as pain free as possible. For example, my left index finger is slightly numb as I waited too long to get my ACDF. The first symptoms I had was numbness in that finger, then it progressed to arm and neck pain, and then I decided to do the surgery.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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