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Why Would Someone Not be a Candidate for Surgery if There is Pain and CT Shows Problems

winkerwwinker Posts: 18
edited 06/11/2012 - 8:48 AM in Back Surgery and Neck Surgery
My husband has clear stenosis and narrowing between disk area in C5. He had two lumbar surgeries (same area six months apart) after which doctor determined it was failed back syndrome. He has since had a spinal cord stimulator implanted and the back pain is under control. He has rheumatoid arthritis which he takes embrel injections for that is by far under control as well.

Now the doctor today said that he is concerned about how well he would recover and get anything out of the surgery given he has so many other chronic pain issues. What does that have to do with the neck?

If there is clear cut very horrible pain (debilitating) and he is not getting relief from pain meds or injections, what are we to do?

Do the doctors sometimes think that someone has so many problems that they are beyond help or what? I just don't understand. If that is the case, then who do they operate on? Is it only patients with clear-cut injuries that they can help?

Please enlighten us. We are so stressed and confused.

My husband cannot have an MRI due to the stimulator implant but has had a CT scan and is now scheduled by this doctor to have a myelogram next week to see if there is anything different going on. I am wondering what he thinks else there might be. He also indicated that many people have what my husband has with no pain or little pain and manage with it with pain meds and what not.
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1

Comments

  • HI,

    It sounds as though the doctor wants to do a myelogram to check the space around the cord and have a better look at the nerve's themselves. The question becomes if he didn't fair well with the lumbar surgery and there is no cord involvement then would surgery benefit. Surgery doesn't always eliminate the pain and can as you aware make someone worse.

    Myself after having 6 cervical surgeries and now a herniated disc in my lumbar we are opting for conservative treatment for as long as I can stand the pain. When we opened my neck was like opening pandora's box, so to take that risk with my lumbar is kind of a crap shoot. But in your husbands case the myelogram will give them a good look as to what they are looking at. So while the surgeon said No to surgery for right now that doesn't mean once he see's the myelogram that he/she won't change their minds.

    What kind of pain is your husband having? What makes it worse and what makes it better? What type of treatments has he tried so far? What medications is he on at the current time. Has he done a emg study? What levels specifically are they looking at?

    Try to wait till you get the results of the test to see what they have to offer. Often times plain CT's won't give all the information they need to make a decision one way or the other. keep us post as to the out come of the myelo.
  • I would listen to your doctor and go very slowly. Cervical surgery has alot more risks associated with it and if he has already had two spine surgeries that didn't turn out as expected surgery might not be the best choice. Why didn't the back surgeries work?

    Before doing surgery you also want to make sure that the surgery is going to help. There are lots of ways that the doctor can determine if this is the cause of his pain. No point in doing a fusion if that's not the problem.

    And if after the doctor does everything he can you are not satisfied then get another opinion.
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  • Tamtam: you indicate that if my husband did not do well with lumbar surgery then he might not do well with cervical surgery. I am not sure why they would be related. Can you tell me. The lumbar surgery (hemilaminectomy and laminectomy) caused scar tissue which is called failed back syndrome. That is why that surgery did not work supposedly. Not sure why one gets failed back syndrome.

    He has tried physical therapy on four separate occasions in the past ten years with pain meds and muscle relaxors at different times. He just recently had a selective nerve injection which did not work.

    He is having pain (C5 - C6 joints involved) at base of neck and across shoulder, down bicep, forearm and index and thumb with numbness.

    Immobility even rarely help with pain. Pain meds barely helps.

    No EMG study done.

    KRIS-NY - What did you mean by being careful having cervical surgery when he has already had two surgeries that did not work? I seem to have heard this sort of thing before and am not sure how they relate to each other. They are separate surgeries for separate reasons. Is there something maybe I don't understand about this?

    The doctor did not say definitely he would not do surgery but that he was not sure it would help given that my husband has rheumatoid arthritis and failed back surgery becaue he has too many chronic pain issues going on. The RA is under control with injections (no pain or progression going on - the doctor said you would hardly know he has RA) and the back pain is good because he had a spinal stimulator put in and that takes care of the pain. He was without pain meds prior to this neck thing going on lately.

    Sort of seems like doctors don't really want to do surgery unless you have a clear-cut injury that they can say "here's the injury and exactly the problem that was not there before." Is this true? Do you have to beg so that they don't have you coming back and telling them that it did not work and that it was their fault. This way they can say well I told you it might not work.

    We are so confused and upset right now.

    Will someone please enlighten us.

  • is your husband seeing the same surgeon for his neck that did his back surgeries?
    I to had a cervical fusion which did not help my problems at all. Actually they have increased. During my cervical fusion my rt. vocal cord was paralysed and the pain has intensified along with still having all the same symptoms + that I had before the surgery.
    The same neurosurgeon looked at my lumbar MRI's which show problems at L4, L5 & S1. Also EMG shows issues in the same area. Actually the pain is so bad I can barely walk and have lost feeling in rt. leg and rt foot is numb.
    The surgeon also stated I was no a candidate at this point for lumbar surgery. (believe me I do not want anymore surgeries) Since then we moved out of state and I am working with a neurologist. I have several other problems so have not yet seen a surgeon for another opinion.
    In my particular case I really don't think the neurosurgeon who did my cervical surgery wanted to take on another surgery with me. He actually released me before even finding out if I had fused properly.
    In your husbands case perhaps getting another opinion after all of his tests have been completed might be a good idea. 2nd and 3rd opinions are always a good idea but the surgeons need all the information from the tests to make an educated decision as to whether your husband would need surgery. I realize he is in a great deal of pain but you certainly want to try all conservative methods before surgery.
    Jan
  • First please remember that we want the best for your husband. But many of us can speak from experience and say that not all surgeries do what we expect. Your husband's back surgeries are proof of that.

    I would not do any surgery until the surgeon is absolutely certain that he knows what is causing all of the symptoms and that he can resolve all of them. What you describe could come from a few different areas.

    My guess is that the surgeon is afraid of the scar tissue forming again. That could be as bad if not worse that what he is feeling now. There is alot less room in your neck. And cervical surgery is notorious for causing muscle spasms which can reek havoc combined with scar tissue. Been there and done that one.

    All that aside I don't understand why they can't control his pain to a manageable level. Has he worked with an orthopedist or neurologist or did he jump right to a surgeon? I ask because in my area surgeons only cut so if you go to them that's what you will get. My neurologist has worked with me and had successfully controlled my pain prior to surgery. Now we are working to get the returned pain under control.

    Now my personal experience. My pain was being managed by meds. The surgeon assured me he could fix the problem making me pain and med free. So being 44 I jumped at the fix. I wanted it to all go away. And it did for about 3 months. Then it came back and in addition I had complications from the surgery that will be with me my whole life. If I knew then what I know now I would never have had surgery.

    So take your time. Get a good ortho or neuro who can get the pain controlled. Do the tests that the doctor is recommending. And get a few opinions.
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  • The doctor that did my husband's back surgery was a different neurosurgeon completely.

    After the back surgery failed he went to a pain clinic with neurologists that work with pain. He was given injections to no avail and that's why he was given the spinal stimulator implant finally. That has worked for him. For the back only. Things were going well and then this neck problem started.

    My husband worked with a primary doctor for his neck pain about ten years ago and did PT and then again three more times each time getting worse with less time in between flareups. This last time he started in June with PT and then chiropractic and then acupuncture and then just recently pain meds after an unsuccessful selective nerve root injection from a psyciatrist. The psyciatrist then sent him to a surgeon who only works with necks.

    It's just hard to imagine going back to pain meds again forever this time because they can't fix this.

    I had no idea that someone who had scar tissue problems from a surgery was more likely to have scar tissue again.
  • Not all spine problems are fixable. It's as simple as that.

    Not that a second or third opinion isn't worthwhile, but the state of the art in spine surgery isn't at the point that it can just go in and repair any pain-causing issue. Specific people are surgical candidates. Others are stuck with pain management.

    People who push for surgery despite not being good candidates find themselves in worse shape afterward than they were to start.
  • Excellent post Happy :)

  • I think you need to find a new neurologist. Start from the beginning on the neck. THere are many drugs available that could probably manage his pain effectively.

    Someone told me once that you should only do surgery if you will be worse off without surgery than the worst complication. So if not having surgery would leave you paralyzed or cause more damage to your spine then you have surgery. Otherwise look for other solutions. I wish I had heard this before i had surgery.
  • I forgot about the scar tissue. Years ago I had a c-section. Then about 6 years later I had a tubal ligation. Same incision site. The doc told me later that he removed a tremendous about of scar tissue but that it would just come back. His explanation was that if your body tends to grow excessive scar tissue it always will. That's why I don't understand them doing surgery to remove it.

    My theory is that if you heal quickly you will also tend to get excessive scar tissue.
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