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3 previous surgeries...what next?

Started by james302 on 07/06/2010 8:32am

Hi- newbie here but not new to back issues/surgeries. Have had 3 lami's (L3/4/5) over past 4 years- the most recent just 8 months ago. A few weeks ago the previous familiar pain in my leg started back up . Is weight- bearing so doesn't keep me awake but most days reaches the 7-8 pain region by mid-day. Managing by self medicating with drugs from previous bouts (Tramadol,Lortab) but am taking only enough to knock pain down a notch so that I can function/work. Heading back to neurosurgeon next week after MRI . He previously mentioned spinal stimulator if pain re-appeared but said I can't have any more surgery except fusion (which I want to avoid).
I guess this is FBSS per se - any other options for me from this description? BTW- age 55- good shape, cyclist , etc. Any thoughts and experiences would be appreciated. Thanks! James

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If pain dr dumps you after giving you a spinal cord stimulator then no other pain spec will see you because of liability issues. Have learned from experience! And don't forget it will mean no more MRIs!

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Other pains docs will not stop seeing you because of liability. There are no liability issues to prevent them from seeing you, just lack of viable treatment options.

You certainly do have FBSS, but the question is "why?". If you have abnormal motion or compression of the neural foramen and disc space with weight bearing, a fusion is a good thing (it will fixate the painful motion levels). Fusions have gotten somewhat of a bad rap for their overusage by surgeons. However, if motion at a particular pathologic level causes pain, then fusion at the level is a very good option. It still allows motion of your spine at other levels. However, the more levels that are fused, the worse the outcomes typically are. I have many patients who have had fusions who are actively involved in sports - not right away, but certainly after 6mo to one year.

If there is scar tissue/arachnoiditis more surgery likely won't help and stimulation may very well be a good option. Spinal cord stimulation is very effective at treating leg pain (much better than treating back pain).

There is a study sponsored by Boston Scientific looking at this very issue (repeat back surgery vs. stimulation). http://www.prnewswire.com/news-releases/boston-scientific-begins-groundbreaking-clinical-trial-comparing-spinal-cord-stimulation-to-spine-reoperation-in-patients-with-failed-back-surgery-syndrome-92660719.html

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Actually 3 separate pain specialists told me the liability issues of taking my case because if the scs was the issue. Since I had it removed...not fun...I have no problems getting treatment or din ding a pain specialist. Yes it is a liability issue for some reason and people need to be aware that when you get one finding another doc is a pain in the ass. Maybe it was the state that I lived in but that isnthe facts as are documented in my records.

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I actually could get my stimulator to shoot the numbness down my leg. Not saying won't work. Just issues involved.

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Many thanks for the replies particularly Dr. Hightower . I have located the study that apparently is still in the recruiting stage. I may qualify for inclusion and have made initial contact with one of the study sites to see if I am a fit. In the meantime new MRI next week and visit with doc. Some days only moderate pain but some days almost unbearable. I know there is no magic but I hope I can find a good solution.

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