Decision time.

[Hooch]

5 different surgeons, 5 different opinions.

2 level ddd, rupture at l4\l5, l5\s1 minor bulge. Both dessicated. Axial mechanical back pain only.

Doc 1 (1 and a half years ago) - 2 level anterior fusion, artificial discs are rubbish.
Answer - Makes no sense to dismiss artificial discs when alternative is fusion.

Doc 2 - No endplate reaction therefore no surgery, here's a referral to pain management go eat tramadol and get a sedentary job.
Answer - He freely admitted that you won't find anything in the literature about end plate reaction affecting outcomes. There's a reason for that, it's called anecdotal evidence. Plus, you know, he's a ****ing ****head.

Doc 3 - Hybrid procedure, maverick prosthesis at l4/l5 plus anterior fusion at lowest level (worn facets)
Answer - Reasonable option.

Doc 4 (overseas option) - 2 level replacement with M6.
Answer - Reasonable option. Facets concern me yet surgeons seem to think there is still enough cartliage left and has put discs in worse with good results. Who knows. Very good surgeon. M6-L discs show potential but have no meaningful clinical history as yet. Medical tourism.

Doc 5 - L4/L5 prodisc disc replacement. Leave L5/s1 alone, wait for possibility of stem cell therapy in 5 years if needed. Part of 'spine centre' with good follow up care and post-op physio.
Answer - WTF. This guy is a very good surgeon and a leader in his field so wtf is this stem cell rubbish. Been working on it for 16 years blah blah blah. When pressed on whether it is not best to do both levels once I'm opened up anyway, insists he feels it is better to do as little as needed. There is definitely more pathology at the upper level, but honestly that's the last thing I was expecting from him.

He also claims regarding scar tissue that accessing another level that hasn't been touched anteriorly isn't a problem as the incision they use is so small.


Ok internet doctors. Whaddya reckon? cos I'm in coin flipping mode pretty much, there are pros and cons to each.

[trkdoc714]

Hooch,

I'm not a doctor, but it appears you're at the same crossroads I was at two years ago. From your comments, you have the greatest confidence in surgeons 3 and 4. If in your shoes, I'd drop the others out of the running. Your confidence in your surgeon is a huge component in a successful recovery.

From personal experience, I had decided on a single ADR at L5/S1. The MRI taken just before leaving for Stenum showed L4/5 had degenerated severely since the CT Myleogram 8 months earlier. I chose to have the second Maverick instead of fusion at that level. In hindsight, I wonder if I would have experienced the same success if I'd decided on the hybrid, fusion at L5/S1 and ADR at L4/5. There have been a lot of success stories from hybrid surgeries at those two levels.

I had the good fortune to meet my surgeon when he visited my city and got a physical exam, shared my symptoms, MRIs, XRays and CT Scan with him. I was impressed with his thorough explanations and diagnosis. He answered all of my questions with care and patience. When his laptop couldn't open the CT disc, he borrowed another computer to open and study it. I was confident and comfortable choosing him as my surgeon. My research had me comfortable in the Maverick as the level of success was high (Terry, Rhatzy, Todd, Morse and others). The M6 had not gotten CE approval yet, so I didn't do a lot of research on it. I don't know whether I'd have chosen it over the Maverick though. The simplicity of the Maverick was a deciding factor (as well as the success rate).

I'm sure you'll find the same level of confidence before making your decision. You're done a great deal of quality research and decision making to date. You'll know when your options meet your needs and go forward with your decision. I'm sure you'll make the right choice for yourself.

Good luck to you!

Bob

[KBear]

Dr. Kathy recommends option 3. LOL I feel like I should have an honorary degree after all the medical crap I've been through. The facet issue would worry me, so I would be very concerned about putting an ADR at that level. I'm also a big believer in doing a hybrid at the lowest levels, since L5/S1 doesn't have a lot of movement anyway. Just my opinion, lots to consider....

[ajj1001]

sound like 3 and 4 are only options.

as someone who had good facets pre 2 level adr and then suffered deterioration a few years later my opinion will very biased so no advice being given!!!

hope you get there soon.

[Cindylou]

Kathy, I hear ya with "after all the medical crap I've been through" gig.....so Dr. Cindylou says options 3 and 4 seem like the only viable ones Hooch, and I'd be pushing for option 3 myself, if I really was a Dr. lol I sometimes wonder if 2 lumbar adr's along with 2 fusions beneath, would have served me better than my 3 lumbar adr's, and my ALIF at L6-S1, but that's hindsight. Who knows? Have to deal with the here and now. I agree with Bob, Hooch. You have done some remarkable research along this journey of yours, and it will all come together for you soon. Good luck, Cindylou

[Hooch]

Thanks to my esteemed colleagues! :P

I slept on it, I'm going the overseas option. Basically because he's the surgeon I hold the most confidence in. He's open to doing a hybrid if I choose as well, reckons there isn't much in it. I really have no desire to go overseas, but on balance.. well ****, I dunno, but I'll just do it and get it done. He has a lot more experience than option 3, and stem cell guy well and truly lost me.

[KBear]

Hooch- I'm glad you made your decision, having confidence in your surgeon is a big deal and that will help you be more at ease with your decision. Any idea when you might be having surgery?

[Justin]

Thanks to my esteemed colleagues! :P

I slept on it, I'm going the overseas option. Basically because he's the surgeon I hold the most confidence in. He's open to doing a hybrid if I choose as well, reckons there isn't much in it. I really have no desire to go overseas, but on balance.. well ****, I dunno, but I'll just do it and get it done. He has a lot more experience than option 3, and stem cell guy well and truly lost me.

Hey Hooch, sorry for chiming in late. If I were in your shoes, I would pursue Doc 3's option.

Doc 3 - Hybrid procedure, maverick prosthesis at l4/l5 plus anterior fusion at lowest level (worn facets)
Answer - Reasonable option.

Doc 5 - L4/L5 prodisc disc replacement. Leave L5/s1 alone, wait for possibility of stem cell therapy in 5 years if needed. Part of 'spine centre' with good follow up care and post-op physio.
Answer - WTF. This guy is a very good surgeon and a leader in his field so wtf is this stem cell rubbish. Been working on it for 16 years blah blah blah. When pressed on whether it is not best to do both levels once I'm opened up anyway, insists he feels it is better to do as little as needed. There is definitely more pathology at the upper level, but honestly that's the last thing I was expecting from him.

He also claims regarding scar tissue that accessing another level that hasn't been touched anteriorly isn't a problem as the incision they use is so small.

Ok internet doctors. Whaddya reckon? cos I'm in coin flipping mode pretty much, there are pros and cons to each.

Can you refresh my memory about what L5/S1 "looks like" on MRI? Did you have diagnostic facet injections?

Good luck moving forward, mate. (Note: my comments above are not considered medical advice.)

[Cindylou]

Hooch, is that Nick Borelee (sp) in UK? (If yes, seems like we've only been hearing stellar things about him as well.) I'll bet you feel a weight off, just making your decision. CL

[ajj1001]

Glad you can move forward, its amazing how a sleep can make things clearer. Being confident in your surgeon is a crucial thing. Hope your plans come together quickly.