Ready for Surgery

[jessedo]

Hi everyone....I have been avoiding a surgical option for my lower back problems but this past year has been very difficult. When I was younger I could recover from "an event" with rest/ice/pills, etc... but I can't any longer. I have had too many missed vacations, work days and other family events because I couldn't stand or walk. I feel fragile and at any moment something could go wrong and I will be laid up again.

I saw two surgeons over the last week and both told me that a Micro-disectomy would not alleviate all my pain and that fusion was not a good solution for me due to the multi-level degeneration I have.

One surgeon did not have another solution because he does not believe that an Anterior approach to ADR is a good solution and said his practice is waiting on advancements in smaller appliances that can be inserted from different approaches.

The second surgeon is an advocate of ADR and even suggested trying to get insurance to cover a two-level replacement. He is an experienced Neurosurgeon who has performed many ADR procedures in Texas and Atlanta.

I am leaning towards a single-level ADR for L4-S1 and a Micro-Disectomy for L4-5 during the same time. The surgeon said he would perform both by completing the ADR and "flipping me" to perform the Disectomy. I am not considering doing anything for the L3-4 at this time.

Has anyone had both of these procedures during the same surgery?
Any thoughts on this approach?

Thanks for listening.

[laid up doc]

Can't say my problems are similar, but I do know that imaging and symptoms can be hard to correlate. have you had any testing to see which of these levels is causing your pain?

sometimes this involves doing injections at various levels - but this is not too reliable since the steroids and local can spread to other levels (usually up strangely enough!)

more typically though, a discogram is done to see what level(s) are painful.

another question - do you have all back pain, or leg pain as well?

[jessedo]

For many years I mostly had back pain and stiffness. I remember so many occasions where I couldn't stand up straight because of back stiffness and had only minor leg pain. Over the last two years or so the leg pain has gotten worse and now it's about a 60/40 split with more radiating pain through hips and upper legs.

I had spoken with the Surgeon about testing the discs for pain and he said because my L5-S1 disc is pretty much gone and the L4-5 disc still has some height he would always recommend replacing the L5-S1 disc. He said he doesn't like to send many patients for those disc tests unless they are similarly degenerated on the MRI.

[laid up doc]

I ask b/c it would be a shame to have a procedure on L5/S1 and it's not your pain generator... a lot of times those badly degenerated levels don't hurt anymore. You could have pain from 4/5 or even 3/4 as well.

Some surgeons don't believe in discograms... the one I saw who didn't had no answer for me but to continue PT. Every other surgeon (total of 4) believed in them and recommended surgery based on that alone.

As my signature says, I'm not a spine surgeon... but from my experience and in looking at the experiences of others, it seems that accurate identification of the pain generator or generators is pretty key in a good recovery.

As I said before - MRI's don't tell the whole story. Before you make a decision, I'd have a good conversations w/ your surgeons again about pain generators.... or even get another opinion say from a spine PM doc.

[Dingie]

Hi,

I too have had a history of back pain that advanced in severity particulaly over the last 3+ years. I saw 3 US surgeons who all suggested ADR at one level as that is what is currently available in the US. I have 3 lumbars with DDD, 2 were + on discogram

I am havimg a 3 level don 3/14 in Barcelona withDr. clavel. It is such a tough decision figuring out what is best for your body and what quality of life u can achieve and accept.

There are several people here with experience in both types. Not sure if done at same time although i know there are several hybrids as well.

Good luck, keep reading researching. You will eventually find the answer for you. Good luck!!

Dingie

[jessedo]

Yipes - Why did you decide to go overseas for your procedure? Was it because insurance wouldn't pay, your doctor would not do a multi-level procedure or were you looking for the latest in disc technology?

I am not considering going out of the US but I would appreciate your perspective.
Thanks

[Dingie]

Hi,

First to my knowledge I am unaware that multi-level lumbar ADR are available in the US with the exception of a clinical trial. My US MD is involved in an upcoming 2 level prodisc trial for the lumbar spine, but it is cirrently in approval process with the FDA. Irregardless, I am allergic to nickel which would disqualify me for any of the current trials as the prodisc has metals closely related to nickel.

I have seen posts before about people getting multilevel in the US. i don't know how that is happening as the FDA has only approved one level. Unless of course they are enrolled in a clinical trial.

I have had debilitating pain for about 3 1/2 years. I had every tx offered on the US for DDD. I saw 3 US siurgeons who all concurred that due to my multi-level DDD they would not fuse, and recommended an ADR. Since I am allergic and the only model availble in the US has nickle/chrobium, I looked at Europe.

My discogram was positive for 2 of the 3 discs. This solidified the need to go out of US. I looked at three MD's Dr. boeree in England, Dr. Bagnoli in Germany and Dr. Clavel in Spain. I selected Dr. Clavel because I wanted a neurosurgeon, I wanted to be in a level one hospital and I knew I wanted the M6 disc. After my consultation and alot of pondering, I decided to do the third level as well, as it was already endstage DDD, though neg on discogram.

There are a number of excellent MD's capable and experienced in this surgery. You just need to choose whom you feel most at ease with. As far as going to Europe, I would have paid a higher price if the same options were available to me in the US, to stay in the US, Moot point.

Let me know what you find out regarding multi level in the US. It wont change my decision now as I have paid my travel arrangements and surgical costs for my OR on 3/14, but I am curious.

Good luck, hope this helps, feel free to PM if you need anything.

Laurie

[Dingie]

Oops forgot to answer that part, my insurance appeals have been exhasted and I am now in a third party arbitration. I dont expect to win, will be a nice surprise though. If u do have to pay out of pocket in the US dont be afraid to negotiate, I did this for a while working for an HMO as a case manager. We negotiated rates for out of network providers. Just ask for the hospital CFO and tell them u r paying cash and need to negotiate a lower rate.

Dingie

[SpineSearch]

The research is endless. I had no idea how many surgeries are performed in foreign countries on US citizens. However it does make sense with all of the lawsuits here.
Dingie, you have to be so relieved just to have made a decision and have an OR date. I am waiting on Dr Clavel to review my MRI. After reading that Dr B does not respond as well post-op, I have concerns with him doing the surgery. Further, I was not aware that the prodisc was nickel. I too have had an allergic reaction to a nickel crown which ultimately had to be removed. That was fun.
Has anyone had any treatments with the Laser Spine Institute?

[Dingie]

Hi,
I will just pass along the info I received regarding Laser Spine Institue. My US surgeon said he has a laser in his office that his practice purchased--they have over 30 orthopedic surgeons in the group. He said it is gathering dust because the outcomes were so poor they dont use it. He said the laser spine institue uses a "bait and switch". And dont actually do much laser because it doesnt work.

That is all I know and bear in mind that is one MD. I dont have any further opinion or info, so for what it is worth

Laurie