My Dad's Surgical Evaluation at the Texas Back Institute

[Justin]

Justin, I'm so sorry.

Maybe this is a way to help educate us. Why can your dad not have two or three levels of fusion and the top one or two with ADR? I really don't know the why's and why not's of this.

I know you are all in a tail spin right now, so don't try to answer any of this till much later, if at all. I wish things were better.

I am so sorry Justin. Really not good news. Yes, I don't understand either why some type of hybrid cannot be considered. But don't worry about explanations now. All in due time. Your Dad and all of you are in my thoughts and prayers.

Justin, I am sorry to hear this and am praying for your dad and family. I am also very curious as to why 5 levels couldn't be done?

OK, so I totally spaced replying to this thread. Someone should have smacked me.

Anyway, I'll do my best to explain why a four or five-level operation is not the best way forward in my Dad's situation.

The films below are from his discogram in November 2009.

• Lumbar level L2-L3 "looks" the worst, but only produced a 1/10 in terms of pain.
• Lumbar level L3-L4 produced a 6/10 in terms of pain.
• Lumbar level L4-L5 produced a 7/10 in terms of pain.
• Lumbar level L5/S1 produced a 10/10 in terms of pain.

Based on the discography, my Dad's lumbar spine issues jumped from L2/L3 & L5/S1 to four "bad" lumbar levels. Now here is the kicker, his facet joints throughout his entire lumbar spine show marked / severe degeneration. The physician that did the discogram said that my Dad's spine looked similar to that of a "rodeo cowboy."

Now, it was initially established that based on pain and annular tears at L3-L4, L4-L5 and L5-S1 should be addressed surgically. However, this leaves L2-L3. Even though L2-L3 is not a significant pain generator, it will continue to degenerate--now we are talking a four-level procedure.

In summary:

• A four-level fusion is not recommended.
• My Dad's insurance (United Healthcare) does not cover artificial disc replacement and he does not meet the inclusion criteria for the Freedom Lumbar Disc Replacement trial at the Texas Back Institute.
• Severe facet degeneration is contraindicated in artificial disc replacement.

Recommendations:

• A spinal cord stimulator (will not address facet issues).
• Lumbar facet joint injections.
• Medications.

Unfortunately, there was no "cut and dry" solution to my Dad's situation. Essentially, his spine is too far gone for surgery--a four-level fusion would be more disabling than his current situation and multiple level artificial disc replacement is not warranted due to advanced facet degeneration. Thus, he has opted to utilize medications and injections in the future, if needed.

I hope this helps. On behalf of my Dad, thank you for all of the feedback and support.

[KBear]

Justin, Thank you for posting this, as it is very valuable for others to see that surgery is NOT always the answer and can make things worse. I think this is also a classic example of why many people do and should have surgery before the symptoms and pain gets too bad. I'm sorry that your dad is this example and in this category; but thank you soo much for sharing with us.
How is he doing with the injections and treatment?

[Cindylou]

Correct me if I am making the wrong conclusion Justin, but is it fair to say your Dad waited too long for viable options? So very unfortunate. I hope the injections will help. Has he had any yet? And is he now going to have to take opiates for the rest of his life? Ugh. Hope not. From your descriptions tho, he sounds like a real trooper. My very best to him as he weighs his remaining options.

[Justin]

Justin, Thank you for posting this, as it is very valuable for others to see that surgery is NOT always the answer and can make things worse. I think this is also a classic example of why many people do and should have surgery before the symptoms and pain gets too bad. I'm sorry that your dad is this example and in this category; but thank you soo much for sharing with us.
How is he doing with the injections and treatment?

Hi Kathy. It is very true: not all Spine Patients need / can have spine surgery. This is a very good thing, as many of them would be operated on and still have significant pain.

He is currently prescribed non-narcotic medications and is doing well (injections might be pursued down the road).

Correct me if I am making the wrong conclusion Justin, but is it fair to say your Dad waited too long for viable options? So very unfortunate. I hope the injections will help. Has he had any yet? And is he now going to have to take opiates for the rest of his life? Ugh. Hope not. From your descriptions tho, he sounds like a real trooper. My very best to him as he weighs his remaining options.

My Dad is a very "tough, Italian guy." I think he just became accustomed to being in pain over the years. However, his pain didn't start bothering him until earlier this year. His baseline and tolerance of pain must have been increased over the years (what would keep most people in bed, he just felt it was the normal aches and pain of life). In his case, he didn't have significant, disabling pain after a traumatic injury or accident.

He has not had any injections yet and is doing well with non-narcotic medications. Long-term narcotic therapy is not desirable and he doesn't even like taking ibuprofen--example: he didn't have anything for pain after his discography because he feels the side effects of the drugs are not worth it. He had a full day of appointments after his discogram and waited 4+ hours in the airport before he flew home. I'm telling you, the guy is tough.

So, this is more of a case of severe degeneration over time without the clear, disabling pain that would send someone to a surgeon for evaluation.

Thanks for your support.

[Cindylou]

One tough Italian? I like him already! Being married to an Italian and all. Thank-you for the clarification Justin. And that is just wonderful that non-narcotics are aiding him with no plan for anything stronger. Good for him. It makes you go, if he can do it, so can I! :thumpup: