Best time for surgery ?

[KenG]

I wonder when is the best timing to decide for ADR surgery.

If my spine condition become really bad, I kind of give up and decide, go for the
surgery.

I sometimes think 'Am I too good to have surgery ?' 'Is it too early ?'

after all, I know I'm just scared.

[KBear]

I think the sooner the better. Treefrog asked the same question before her ADR and is now doing great. I think if you get it taken care of before it gets way bad, you have a much better shot at 100% recovery. Also, it's not going to get better on it's own, if there were any chance of it regenerating, I would have waited; but no such luck.

[Katie]

The problem is the doctors often don't think you are bad enough for surgery when you first start out on this journey. They want at least six months to a year of 'conservative therapy', including exercise, physical therapy, injections, etc.

By the time you go through all that, you have usually hit the end of your rope with pain, etc. Then you have to begin the search for a doctor who wants to treat you the way you think it should be done, and not have multi-levels of fusion instead of ADR or hybrids.

So it is a difficult question Ken. It is rarely done when you want it, but more when the right doctor comes along and agrees with you.

In most cases, it is hard to find a doctor who will treat you fast enough, often by the time you go through insurance fights, etc., you are more than ready to have it done.

If you wait too long on your own choice, then you risk having more damage, like arthritis in the facets, etc. which may ruin any chances you have for ADR. Why go through all that pain and the problems with narcotics or other pain medication if you can avoid it by having surgery sooner. I knew three years ago that I needed surgery, but I am still fighting the insurance and doctors to get it. The medications have made me very ill and I have wasted three years of my life.

Better sooner than later is my thought.

[ajj1001]

In my opinion definitely sooner rather than later, as long as you have tried all conservative treatment options then I would say go for it. If you keep thinking about surgery because nothing else is working then surgery is most likely to be your best option.

I had my first bad episode in 2000, did all the conservative stuff for ages and was listed for surgery in 2002 but then had emergency surgery due to cauda equina syndrome. I never recovered some sensation in my right leg due to nerve compression and as muscle tone had gone recover took 18 months.

[New-disc]

KenG,

Good ? ...... I believe it's a personal choice, surgery is risky.

You will know when the time is right ....

Todd

[Justin]

Surgeons operate for a living. However, they recognize that >80% herniations resolve spontaneously and do not need surgical intervention. The most common problem with a patient presenting with acute low back pain is a lumbar strain. This is why conservative care is pursued initially and further diagnostics may be recommended 4 to 6 weeks later.

Unfortunately, what patients *think* they need in terms of intervention for their spines does not often match the data that tells surgeons what is most clinically appropriate for patients presenting with specific histories.

In terms of having already undergone diagnostics and knowing "where you stand with spine issues," adds a unique perspective in that surgery could have been recommended previously by a surgeon. The decision in terms of when to ultimately move forward after a surgical recommendation is the hardest part.

In my personal opinion, there is no optimal time to have an elective surgery--any surgical intervention inherently carries significant risks. However, there are also risks of putting off surgery too long. There is a careful balancing act between one's quality of life still being too "good" (they feel that it's too early to have surgery), and then there is the point of waiting too long where options the patient once had are no longer available based on worsening pathology.

Like Todd said, you will know when the time is right to move forward. I knew I was ready for surgery after extensively researching my own condition and truly understanding the severity of my situation. I felt comfortable after 1) establishing realistic postoperative expectations, 2) exhausting all conservative care, and 3) understanding that my quality of life would not improve without necessary intervention.

Ken, good luck in your decision and be confident after you decide to move forward--I know just how hard it can be.

I wish you the very best.

[KBear]

Definitely exhaust all conservative care; because like Justin said, most people don't need surgery. I was told that 90% of people get better with conservative treatment. That those of us who need surgery are the unlucky 10%. That's why when I said that if there were ANY chance of my back getting better (regenerating) without surgery, I would have tried it and put off surgery. Unfortunately, 3 surgeons and 1 physiatrist all explained my MRI's and told me that my problem would never get better, explained why and told me that my option was a) pain management for the rest of my life b) fusion or c) ADR; they all reccommended the ADR.

I don't think anyone goes into surgery and isn't scared. No one wants surgery; but it ultimately comes down to that or pain. Then, we must make the decision if we would rather live in pain or have surgery, that is risky; but at the same time has great success rates.

It really boils down to each individual, how severe their spine is, how much time they have before they are to far gone, the surgeon, and the pros and cons of either decision.

[Justin]

I don't think anyone goes into surgery and isn't scared. No one wants surgery; but it ultimately comes down to that or pain. Then, we must make the decision if we would rather live in pain or have surgery, that is risky; but at the same time has great success rates.

It really boils down to each individual, how severe their spine is, how much time they have before they are to far gone, the surgeon, and the pros and cons of either decision.

Well said.

[Cindylou]

Justin, thank-you for your informative responses. Always a good refresher, for all of us.

[rhatzy]

I think the time to go is before your collapsing disc space starts to destroy your facets and your vertabrae becomes arthritic and the adjacent discs start to go. They don't cal itDegenerative Disc Desease for nothing.

Mark