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Posted in: Spondylolisthesis, and Surgery.

ortho or neuro (Isthmic Spondylolisthesis)

Started by jimmyfonz on 06/05/2010 11:12am

So, 1st and 2nd opinions concur that a TLIF of L5-S1 is required to remedy Isthmic Spondylolisthesis with a PARS defect.
All things being equal, ie. doctors' track records, reputations, recommendations, procedure, everything... am I better off having the surgery performed by an orthopedic surgeon or a neurosurgeon?

Unfortunately, I am one of those people that, no matter which Dr. I choose, I'll surely wish I had chose the other. Need someone to possibly provide some clarity to the situation.

Thanks.

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What are ur symptoms that ur presenting with? Your pain levels? Any leg weakness or pain? It really boils down to those issues with spondylolisthesis and if it has become symptommatic. What grade is yours and what conservative methods have u tried first before attempting surgery?

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I have a grade II spondylolisthesis at L4/L5/S1 and after a year of spine injections, as my ortho refused to do surgery before we tried to see how long injections would work for, they would not last for longer than a month and a half at a time. I think it depends on the skill set of the doctors in your area, the degrading of the spine, and your comfort level. I have one of the best doctors in my area and he walked me through my MRI and explained my injury spinal bone by spinal bone starting at L1, which is where my calcification occurs on the nerves. That and the fact that the first questions I had were on surgery and he refused, raised my estimations of him. Nerves are neuro, Bones are ortho - so where is your primary damage, bone or nerves? Most ortho practices have neuros on hand to do the spine injections anyways so I am sure you could ask the doctor about it. He would have an opinion and the net is for research. Walk in with a handful of questions.

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Just read your post. I was diagnosed in 09 w/ IS - L5-S1. At that time I had an MRI and was referred by my md (who was treating me for sciata before ordering the MRI - for 2 mo). The doc
he referred me to was a nice guy, older surgeon who had retired and came out of retirement to
do consults. (I was rather uncomfortable with the fact he kept straining to look at the MRI on the
computer screen). He was (neuro,) and said his opinion was I did not need surgery. After a variety
of nsaids that did not work, and PT which was excruciating) I went for a second opinion. That
was a (ortho) who ordered a new mri. **FYI - if you ever need an MRI or Cat Scan - you want to get it
somewhere that has "NEW" or updated equipment. The new MRI, along with my description of what was going on led the ortho to say I needed surgery. A fusion with instrumentation would be
necessary. He was honest enough to say they never can tell with exact certainty what they will
have to do until the surgery itself. I also went to another "neuro" at a larger hospital who interesting
called me back for a 2nd consult. He said periodically he and one of the "ortho's" pick a surgery
to perform together but when I asked what the benefit would be he joked and said "well it keeps
me from walking from one side of the table to the other". (that's not the answer "I" was looking for).
Having both I thought may be the way to go, but there's also the saying "too many spoons in the
pot?". So now it is a year later, I still havdn't had surgery, and further facet injections, epi's etc
are not going to be an option much longer (problems with internal side effects). So I am sitting
here myself wondering what to do. I do know the 2nd doctor, an ortho, is board certified from
Emory (a leading Spine Institute)...though he told me he still takes bone from your hip for the
fusion instead of cadaver bone.. I know for me Logistics will certainly play a role..the "ortho" is 25 min, the big hospital 1 1/2hrs. Plus I have heard some horror stories how you go out of your area for surgery, go home, have problems, and can't get another doctor to even look at you. The only way that works is if you talk to a surgeon who is willing to do your follow up (in fantasy land!! ha!)
..So that's what I have learned so far...FInd out how that particular doc does the surgery (fusion materials if needed etc), the hospital you'll be at - rehab facility you'll go to for PT. And keep going to different armed with your questions. I'm in a rural area but do have two cities near by with different health care systems. I checked them both. Good Luck...I felt great at the beginning of the summer, last two weeks not good. Good luck - hope i haven't clouded any progress you've made making a decision.....

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