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Going for surgery - which one to do?

Started by scottzbj on 06/01/2010 1:35am

Hi - I'm new to the boards and was hoping for some advice.

I have disc herniation L3-4-5 and have been suffering for about 6 months. I found the anti-inflammatories and pain killers ineffective but had some acupuncture (I line in Beijing) which worked better. However, after a lengthy trip abroad things deteriorated and I have severe leg pain that I assume is sciatica.

Last night I met the specialist with my MRI results and he says that the two discs are not only herniated but are degenerated and pretty much done for. He gave me three options for surgery:

1. Replacing the discs and screwing them in which he said would be the best thing if i was older, but at my age (35) he was concerned about the pressure this would put on my other discs over time and the limitations it would impose on my physical activity.
2. Taking out the degenerated material to prevent the pressure on my nerve which is causing the pain. My understanding is that this is not then replaced with anything which means that the condition could reappear at any time. My understanding might not be entirely accurate though :-)
3. Replacing the discs with what he decribed as a more springy artificial disc that doesn't need to be screwed in. This is less invasive than the first method and should give me more flexibility in my movement andnot put as much pressure on the otehr discs. If for any reason it is ineffective then we go back to option 1. He said that this was a relatively new procedure (only being don for the past 7-8 years) and that some of the long term effects are not yet clear.

At this stage I am thinking that option 3 is the one to go for and I was hoping people on the forum might be able to give me some advice about what kind of questions i should be asking prior to the surgery and any advice about the procedure. I'm in a lot of pain at the moment and have tried many conservative methods of treatment so for better or worse it's going to have to be surgery of some kind. I am lucky that I have medical insurance and a lovely wife to take care of me pre and post op.

Thanks
Scottzbj

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Scottzbj,

Have you looked around this site for all the different surgeries there are out there? How about "asking the experts" section? You probably have done your homework and have looked deep into this site, but I was just wondering. It's the mom in me that tells people to read and do research, especially on this site where there is sooo much information at your finger tips. How about a second opinion? I worry about the long term outcome. There is gonna be major pain involved after surgery, many people here can tell you that, but what is the surgeon telling you as far as a time line? Is he telling you that this will permanently fix you or will there be required surgeries down the line? Alot of people don't get the fix on the first time, it has taken most of them more than the one surgery over a span of years to get better. And why jumping right into surgery? Personally it sound like your doctor just wants to jump in and cut. Some people have had better luck with going to a chiropractor with disc herniation. I understand the degeneration part, but why not get those discs back to healthy first and then fix the degeneration later down the line when it needs to be done?

Sorry, but in my personal opinion your doctor is sure quick to cut you open. I haven't gotten to the surgery part in my back and I had herniations and prolapses where the discs are concerned. I went to a chiropractor that got my discs healthy by using a big machine that was pretty much glorified traction. My discs aren't the problem with me anymore, it's the facet joints and degeneration and slippage where my problems lie. I just don't want you having to have multiple surgeries in years to come because your doctor jumped the gun.
Please dig deep into this site and see what exactly people are doing for herniations and degenerations.

Keep us informed please!

Wendi

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Hi Scottzbj,

First of all, get more than 1 opinion! Wendi is also correct. You need to exhaust every therapy out there before you consider surgery. The first option is called spinal fusion, second is microdiscectomy and third is disc replacement. Are you incapacitated in any way? Are you incontinent? Drop foot? Then surgery may be medically emergent, otherwise you have time to do your homework and gather other opinions. SpineUniverse has a wealth of Information. Good Luck and try to be patient.

alleycat

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Thanks very much Wendi & Alleycat. I really am going to reconsider the options. In fairness to the spine specialist he did say that none of the three options were good options, but if the pain is so bad then the surgery could fix it. He certainly didn't underplay the seriousness of undergoing surgery. I'm asking my doctor to refer me to a chiropractor as i think that my insurance will cover up to 10 sessions. One of the reasons that I was worried about waiting any longer before surgery is a concern about nerve damage. Because the sciatica is so severe and the treatments i have been trying have not seemed to work, i worry that leaving it too long would also be harmful. Hopefully i can get the referral to the chiropractor and some understanding from my employer (it is easier to get time off for surgery than it is for rest!) and have one last go at a non-surgical solution.
Thanks again.

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scottzbj,

I too was worried about nerve damage, thought the only way was surgery, but then that was I believe 5 years ago and here I am, no prolapse, no herniation, discs are fine. Something is hitting something, but it's not a disc. Sometimes discs will go back to their origional own spaces, of course with a little coaxing with spinal manipulation from your chiropractor. I know that I'm repeating myself a little with this reply, but just want the best for you! Keep us informed

Wendi

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I've heard replacing a disc without fusing the level can cause instability, but I'm not sure. Just check into everything. I wish u the best!!!!

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Make sure your insurance company will pay for option three. This is still experimental and has not been approved by most insurance companies. I am facing the same thing and find out tomorrow what my surgeon is going to do.

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You must at least try different options before undergoing surgery. Chiropractic being the first one. It may very well take more than 10 visits, but I am certain you can work some type of payment plan with your doctor. Spinal decompression is also a very good option and even more effective if used in conjunction with Chiro care. Spinal injections(epidural or other) is a last resort before surgery since those injections really do not fix anything, but will sometimes make you feel somewhat better. Medrol dose pack/steroid (oral) are also commonly used to help with swelling and pain. As far as nerve damage, as long as you do not have neurological defecit such as foot drop or inability to push off with your toes, numbness in big toe or middle three toes or little toe and side of the calf (L4, L5 and S1 nerves in that order), you can buy time, but even if youy have those, you still have time to try different options. As far as surgery, your best option is probably a microdiscectomy, but not all disc condition can be effectively treated with that technique. The pedicule screw fusion is a big operation and you want to stay away from it if at all possible. The disc replacement is highly dependent on the surgeon's skill and I have never seen one one walking thru my doors in 20 years of practice. This is especially difficult to correct if it fails since they may have to cut into the bone to remove it. Replacing the disc at 3 levels I think will not work well for you.
Good luck

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Dear scottzbj,

I honestly and friendly advise you to consider and explore possibilities of minimally-invasive spine surgery. Especially because you are pretty close to famous Wooridul Spine Hospital. Fusion and total disc replacement should be your last resort.

Let me know if I can help you further.

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Scottzbj,

I wouldn't worry about nerve damage quite yet. I've had a severe herniation at the age of 12 and I'm currently 35. Never had surgery, although I might have to go for one now, but all surgeons I've seen said that my strength is very good. Physical therapy is very important. Keep this up diligently and you should have plenty of time to think through your surgery options,

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