Dilema and need guidance

[martyusa]

I had made a post a while back about my situation.

Brief history. L5-S1 bulge with mild DDD. He now believes the disc is a bit worse and a possible herniation. Pain was only down right leg and is now starting down the left glute nd left ham as well. As long as I do nothing, and I mean nothing I am fine and it is tolerable. As soon as I have some moderate activity ( driving, bending over too long or sitting too long ), I am done for a couple of days and can't even sit on the toilet without pain.

After pain management and PT they have finally decided we cannot get it under control and it will not heal. It has been almost 7 months since the initial injury that opened this chapter up.

The Doctor has decided that he wants to do a micro-laminectomy. He feels this non-invasive procedure will work great for me. My biggest concern is another herniation in the future and being laid up even longer. I'm not sure if I like the idea of bone being removed or not and feel this will limit other options in the future if we do have any other problems with my active lifestyle.

Thoughts would be great. This is scheduled for Feb 1.

[JeffreyD]

I know time is short, but if at all possible, please consider getting at least one more opinion.
Not sure if you live in an area where a doctor with a well rounded background (including ADR experience) exists, but in my opinion it's worth the effort.
You just want to make sure you don't burn any bridges should the day come that you need ADR and something done now might (I'm yelling MIGHT) prevent your candidacy for ADR.
Could be that the procedure you are scheduled to have is just the thing you need.......I'm just suggesting having one more pair of eyes look at your case.
This is only my opinion; I'm not a doctor, just a veteran of the spinal wars.

God Bless,
Jeff

[ans]

I agree with Jim to get more opinions and see the best - even if you have to travel a bit.

I was scheduled yrs. ago to have a disectomy but held off. Good thing that I did because a later discogram revealed that the disc's integrity was shot. I'm not saying this is your case but I wonder if this would be a good idea - if you have fairly nonstop back pain outside of your sciatica.

I hope that you're working out with lighter wts. and more reps. Also, be cautious about overhead lifting/spinal loading. Not that I'm a workout expert but this was an important part of my previous life.

Good luck, ans

[Maria]

A few more opinions advised. Don't know if you are structurally ready for anything more than this degree of surgery or would be advised of anything more and also it can be best option re optimally qualified surgeon performing surgery as well.

[martyusa]

Thanks for the input, everyone....

I know I will have to alter my lifestyle, somewhat. I am very active in sports. Martial arts for over 20 years, Bodybuilding for the last 7 years, flag football, softball and what every competitive sport I can find. Including but not limited to rough housing with my children.

I am trying to keep a positive attitude through all of this and just want to get back to normal. Now if Mark can play a round of Tennis, I should be able to get most of my activities back.

I live in Delaware and currently am being treated via Premier Ortho in PA. I would love some other options to consider.

[dshobbies]

Marty,

I can so empathize with your pain and plight. You're absolutely right to be concerned about future DDD and/or the decreased effectiveness of future, more invasive procedures. On the other hand, going for broke at this time might be too premature. What to do? Others have faced this same dilemna. The best thing to do is arm youself with as much knowledge as possible. This not only includes a second opinion and possibly a third, but also a consult with an ADR surgeon to ask what might be your chances for successful implantation in the future should it become necessary. Doctors unfamiliar with ADRs or those not performing the surgery are less likely to endorse it's effectiveness, thus downplaying your concerns.

Mark's wife, Diane, just recently had this same situation where considering an ADR was premature yet intervention was still needed. You might want to call him to find out how she's doing and what their doctor's advised.

Whatever you decision, I wish you luck and pain free days. Happy holidays, Dale

[martyusa]

After a long discussion with Dr. Foti, we have come to the conclusion that maybe a micro-laminectomy may not be the best long term option. We talked quite a bit my expectations, risks and goals.

In the beginning we had radicular pain down both legs. The left leg had subsided for a while. Now it is prevalent in both legs on an intermittent level with no or limited activity. However, there is a constant pain in the right leg.

We have a disco gram scheduled to make sure that the disc in question is the problem and that I am a possible candidate for other options.

I hear this is going to hurt like hell. But better a few hours of pain and a few days of discomfort to make sure we get this right.

[mmglobal]

How much disc height left?

[dshobbies]

Marty,

Just want to let you know that I was so fearful of my discogram in Germany, it pretty much overshadowed all my other concerns. I previously had one in L.A. but with anesthesia and really don't remember the pain. However, like you, I heard those without anesthesia hurt beyond belief.

First, while a 10 pain is true, it last for less than a second and by the time your feeling the pain, it's already over. So if your discogram is going to be performed without anesthesia, your pain will last for a moment, not hours. Fear not!

[e-gal]

Marty, Here is my 2 cents.
A discgram is not fun, but most times in the US they will give you drugs and it is over very quickly. I had it done three times. The results will help you make a decsion. If the disc is shot then ADR is the right answer. If a micro/lami is an option then find yourself a good neurosurgeon. I know many people that have had successful microdiscetomies but they all used neurosurgeons. The reason -- it is primarily soft tissue and neurosurgeons seem to be more gentle with the nerves. (sorry if anyone is offended but thats my observation) One downside to any surgury is the formation of scar tissue. There are some new procdures that are supposed to be less evasive, also worth looking into --orthoscopic type procdures. I had an micro/lami on one level (which helped) and later on IDET on two levels. The IDET cooked my discs and pushed me over the edge but I found out later that I really shouldn't have had it because of my advanced condition. You need more info to make a decision. Consult with two or three doctors, at least one who has been trained in ADR. Preferably one that has particiapted in the early trials as they have the most experience (all orthopedic surgeons). I use Dr. James Yue at Yale in Conn. He is an associate of Dr. B and very easy to talk to. There is also Dr. Goldstein at NYU in NYC and Dr. Cammisa at Hosptial for Special Surgery in NYC. All three have extensive experience with ProDisc ADR.
One other option I didn't see discussed is epidural shots. Even if it doesn't solve your problem long term, it may give you relief short term, while you gather info.
good luck
--------------------------------
3 level ProDisc, L3-S1, 10/06 Dr Bertagnoli Germany
3 rounds of facet injections--Eastern Long Island Hospital
Continuous PT and Graston treatments (keeps me moving)
Out on long term disability 5/04
IDET 8/03 L5/S1 and L4/L5 Hospital for Special Surgery
Micro discectomy/laminiectomy L5/S1 1/00 St Lukes Hospital
3 rounds of epidural shots HSS
Years of PT
Injured while gardening 1991 and lifting weights 1994

[Maria]

I've had 3 to date and didn't have the ADR and fusion proposed yet or any further surgery so most likely I'll have at least one more discogram in the future which is OK w/me because:

1rst discogram~ was painful afterwards like my back had gone out. The pain asted nearly 3 days and then felt much much better. L2,L3,and L4 were tested. Dr.Said L5S1 was shot and we knew it so he would save me the pain of testing that disc.

the 2nd discogram was better than the first.
This time L3, L4, and L5 were done. I was scared to have L5 done considering I had been told previously it would be too painful but this doctor said he had to test it and it was the most painful disc.

At the end of the 2nd one Marcaine was injected behind the procedure for pain relief and to make it easier for me to fly home post procedure. My back only hurt for one day and it was like when it would go out. No worse really. Had to rest in bed one full day.

3rd discogram, L3, L4, and L5 were done. I had an ESI after it ( Epidural Steroid Injection). That provided great relief and I was down only for a short period of time after that procedure like the remainder of the afternoon/evening.

It can depend on who is doing it and how they do the procedure as to the quality of the procedure and it's diagnostic value. Also you will want a well written report if this is for insurance purposes as well as for diagnostics.

Personally for me this procedure has not yielded horrible painful results esp. with an advance discussion with the person performing it as to some kind of pain relief afterwards. Of diagnostics I've had done for my spine, while relatively scary in terms of thought of what's going to be done, all turned out OK in good hands.

I thank Mark for his input when I was concerned about having the 2nd discogram back in 2003 when seen at UCSF for 2 level Prodisc trial.