Here we go! Just found out MRI showed Herniated Disc at L4/L5 with nerve impingement

[yvette]

I originally hurt mine at 19 and kept being told I was to young for surgery. I've had many years of problems and now at 36 I've been back to square one for a few years, and kept hearing I was to young (for fusion) Which made no sense to me. You think it would be easier on ya when your young, and when its killing off your quality of life waiting whats the point.

[Blairsara]

Im 25 and had ADR when I was 22. I only had the surgery when it came to the point where I couldnt walk, sit, stand, basically do anything. Physical therapy didnt work - microcurrent, phototherapy, hands on etc.... Pain killers stopped working. Basically I totally see your opinino on wanting to fix it right now, I wanted to do the same thing before too but I decided to only do it if it was absolutely necessary.
Now, I still have problems. If you want to read my post to see what's going on go to Charite ADR 2.5 yr update.
But this is a major decision, and you dont want to end up worse off than you are now. I would definitely do epidural blocks, other injections etc... before surgery. You never know, it can releave you of your pain for a long time.

[Michelle]

Originally Posted by yvette

I originally hurt mine at 19 and kept being told I was to young for surgery...Which made no sense to me. You think it would be easier on ya when your young, and when its killing off your quality of life waiting whats the point.

I was told this as well. I was told it was because of the transferred pressure to surrounding discs that fusion creates. The younger you are, the longer your discs have to survive that extra pressure. And, the more active you usually are. At, least that's what I was told.
Anyway, sorry Rutman, but I'd agree you're heading down the road for surgery. It's not 100% yet until you fail a few conservative treatments, but once that happens, don't put it off. The longer you live with the damage, the harder the recovery is, and possible permanent harm. I hope an epidural or something will help but... Good luck!

[rutman]

Thanks for all the comments, but after review with MRI and this Dr. Jeff Beane out of Greensboro, NC my severely ruptured disc looks like the route of a lamitonomy NOT ectonomy. Basically will remove some of the lamina covering to relieve herniated disc off of the nerve for which even I could read on the MRI. Has anyone out there has that procedure--seems basic--but I saw that one had several surgeries after ADR including lastly putting in a ProDisc between the L4 and L5. Question is with me being an avid golfer which probably caused this problem to begin with over a 30 yr period could I end up with the same problem and should have the disc replaced or for now go with relieving the pressure off the nerve. Just food for thought, but looks like the lamitonomy will be the route within the next 2 weeks. Any thoughts here? Thanks again! John

[yvette]

I don't know why they work for some people, and some they don't. The ones that i have had didn't change anything.

[dshobbies]

I just wanted to add my two cents into this pot. After rupturing my disc back in 1994, I was in so much pain and disability, I would have done anything to fix it immediately... and did. And this surgery, a disco and lami, worked for 8 years, until the pressure on the adjacent L4/5 became too much and I had a second surgery. Less than 1 year later, I was in trouble with L3/4.

Looking at the statitistics, there seems to be an 80% success rate with first surgeries, which drops to 50% for a second and then all the way down to 5%. I know a woman who has had 11 surgeries and is now in the fusion stages.

In '94, an adr wasn't really an option for me. It was in 2002 but I had never heard about it and was never told about it.

Now the point, these surgeries caused further DDD on adjacent discs. The scar tissue made the chances for my ADR surgery less successful. If an ADR was available (to me) in 1994, that might be the end of my story. Would I have gone for such a drastic procedure when something far less invasive was available to me? I don't know. But as long as you're lucid, you should have all this available information to help you make an that 'informed' decision.

Could you be entirely successful with a lami... sure. Will you? Who knows. Will an ADR solve your pain more permanantly? Again, an unknown. You should just know that the decisions you make today can impact the decisions you might have to make tomorrow.

I do wish you every luck and a pain free 2007.

Dale

[rutman]

Thanks for the comments Dale. Interesting! Dr. Beane told me if it had just been the slight bulging of L3 disc he would not recommend surgery, but here's the question to you guys and give opinions or what you know from experience please. You could definitely tell there was a problem at the L4/L5 disc with it ruptured and the annulus slamming into the nerve--I could see the problem without the doctor telling me when I saw the MRI with the doc. Okay he goes and does this laminotomy in that area should he not go ahead and do something with that L3 that appears to be bulging a little. Dale, you mentioned it lasting 8 years or so and then mentioned about another area - maybe L3, that became a problem a year later. I hope when he's in there he can fix that area too or can anything be done on just a bulging disc? Lastly, if he just does the laminotomy on the L4/L5 disc area and does absolutely nothing to the L3 disc bulged out am I looking at going through the same problem of that one rupturing if one has become fized and then I'm relying on another disc that may be questionable? I plan to tell him fix it all, but easier said than done and of course I'm not the doctor--I can't wait till this crap is over, but reading comments it may be going on for awhile. Please advise when you all get a chance and emjoy reading the responses for sure! THX! JB

[mmglobal]

I think that everyone will be surprised by this post. Here is a most important statement that Rutman made:

Originally Posted by Rutman

I can't wait till this crap is over, but reading comments it may be going on for awhile.

That's the most important issue in the discovery process that we go through. Too many people I see never get to that realization and they make the mistake of making surgical decisions based on wishful thinking. It may be electing to do too little surgery in spite of the fact that additional areas are demonstrated to be pain generators. It may be electing to do a huge surgery, hoping to 'fix everything at once', or because 'I only want to have to do one surgery.'

There are many reasons that go into these decisions and many of them are valid or even critical decision points, but each case unique too many times I see these decisions as clearly flawed. Often they are are correct, but often they are not even close to logical or appropriate. Leaving painful levels in place because your surgeon can 'only do one level now, but I'll be able to do more later if needed' is absolutely incorrect if the level that will remain is clearly incompetent and proven to be a major pain generator. Making that same decision is absolutely correct if the questionable level is still in pretty good shape and is proven NOT to be a dominant pain generator.

These same issues can be true for people who elect to do more rather than less surgery. Electing to do a 3 or 4-level fusion because the imaging looks bad can be problematic. While I know several people with successful 3, 4 and 5-level lumbar fusions, I also know the disasters. If your spine is a train-wreck at many levels, but there is high confidence that one level is THE MAJOR problem, electing to do surgery at one level instead of 4 may offer the best chance of success. However, without the confidence about one level being the major pain generator, perhaps more surgery would be the most appropriate decision.

These decisions must be made with the full understanding that that if you and your surgeon decide to do less and it works, he's a saviour. If you do less and it fails, he's a goat. If you do more and it works, he's a saviour.... There is no template... there is no other case that will tell you what to do in your case. Your surgeon's experience is an important part of the process, but more important than what a similar case was like will be getting the proper diagnosis. Watching this process take shape in so many different arenas is quite interesting and there is a huge difference between going into a surgery with a thorough diagnosis and clear understanding what what is happening; versus discovering after the surgery that a group of symptoms turns out to be unrelated to the operated area. The outcome may be the same in some cases, but in other cases, the surgical plan changes. Making decisions with more and accurate information is better, better, better. MRI's being denied because of cost may be important for the big picture related to the cost of health care, but it is frustrating when it comes at the cost of a proper diagnosis for an individual patient.

My discussion (above) is of the extreme cases and I realize that the original thread has to do with the prospect of less invasive surgery for patients who are not too far down the degenerative cascade. However, the same issues are involved. Many people look at my history and ask if I regret my 2 discectomy/laminotomy surgeries. "We make the best decisions we can with the information we have at the time." I'd do the same thing again in the same place. I do wish that I understood more about discogenic pain and discectomy results with leg pain vs. back pain. However, at my time in the process, skipping the discectomies probably would have resulted in a multi-level fusion (which may well have been a smashing success.)

Read about Anastasia's review of her case with Dr. Zeegers: here.
He reviewed every aspect of her case in excruciating detail. Like mine, her history includes 2 attempts a minimally invasive surgery that failed. Zeegers said that he did not see a flaw in the decision making process and that attempting to salvage the disc with less invasive surgery, avoiding more invasive surgery is appropriate when one is a good candidate. These decisions are not based on wishful thinking... one has to be a reasonable candidate.

I do not agree with Dale's statement that her prior surgeries placed additional stress on the adjacent segments. I suppose it's possible that if the structure and kinematics were inappropriate, adjacent segments will break down faster... but what was the alternative? We will never know the answer to many of these questions, but we do not know the time-line of what might have happened. Our discs are going to break down. ADR will not keep adjacent segments from breaking down, but it may extend the life of the adjacent discs compared to what fusion might do. Her statement about scar tissue may be correct, but again, what are the options. Looking back I don't think that more surgery earlier in the process would have been appropriate or even an option. For many of us, looking back with 20-20 hindsight it may seem that jumping straight to the maximum surgery would have been an easier path to get to the ultimate solution, but that does not mean that the decision process was flawed or that someone in the same situation should jump straight to more surgery instead of less. We do not see the people who have the successful 'lesser' surgeries because they go back to their lives and don't come here.

I'm glad that Rutman realizes that he may be in this for a while. That knowledge will help him to take his time, learn what he can, and make informed decisions based on a proper diagnosis and an understanding of the risks / rewards of all his options... not a decision based on frustration or wishful thinking.

Sorry for the long post... I hope this helps.

Mark

[sahuaro]

Mark:
Can you clarify what you were referring to when you wrote that ADR does not protect the adjacent disks (sorry, I haven't figured out how to do the quote thing)? Did you mean that if you have DDD, the ADR won't stop that--or did you mean that as with fusion, the pressures on adjacent disks will be such that they will eventually be damaged?