Who should I trust?

[xiaoyu80305]

Hi,

I live in Boulder, CO. I was diagnosed with DDD (L4, L5 and S1) in 2005. Right now, I can't stand and walk for long period time without the pain on my right leg. My daily treatment are similar to DRX9000 (decompression machine) and yoga. I am planning to have surgery in 2012, but no decision has been made for the detailed procedure yet. I am open for all options.

CT report on 06/25/2010:


L3-L4: There is mild disc bulging. There is severe left facet degenerative change. There is moderate left and mild right foraminal narrowing.


L4-L5: There is severe bilateral facet degenerative change with anterolisthesis as above. There is moderate bilateral foraminal narrowing.


L5-S1: There is posterior disc bulging with endplate osteophyte formation. There is severe bilateral facet degenrative change. There is severe bilateral foraminal narrowing, right greater than left.


MRI report on 02/23/2010


L3-L4: Disc desiccation, moderate facet hypertrophy, and ligamentum flavum thickening resulting in minimal bilateral neural foraminal narrowing, worse left than right, are unchangeed. The central canal is widely patent.


L4-L5: A diffuse broad-based disk bulge combined with facet osteophytes and ligamentum flavum thickening continues to result in mild central canal narrowing, moderate bilateral ventrolateral recess narrowing, and moderate bilateral neural foraminal narrowing. The L5 nerve roots are moderately compressed in the ventrolateral recess as they course inferiorly toward the right and left L5-S1 neural foramina.


L5-S1: Disk desiccation and broad-based minimal posterior disk bulge combined with uncovertebral and facet osteophytes result in moderate severe right and moderate left neural foraminal narrowing. The degree of narrowing is largely unchanged since 2007. The central canal is widely patent.


I have visited three surgeons in Colorado and they all recommended me to have fusion at L4-L5 and L5-S1. One surgeon who is specialized for ADR told me that I am not a candidate for ADR.


The surgeons in Germany responded me with different opinion. Here is their response:


…...... Dr. Bertagnoli could already view your medical data. I am here to pass on his surgical recommendation.

Your l4-s1 degneration is marked

· L45 should receive an ADR – to preserve maximum mobility, and to prevent overload to higher-up segments.
· At l5s1 the extent of secondary changes makes it favorable to address this segment by a fusion.
Prof. Dr. Bertagnoli would perform both of these steps with one incision from ventral , using special non-profile fusion cages in l5s1. This will spare your back muscles from intervention by a standard screw fusion – and you need your dynamical structurs espl when preserving a mobile spine.

Who should I trust based on my CT & MRI results? I value your input. Thanks,

Xiaoyu,

[Buckeyeback]

Hi,

I live in Boulder, CO. I was diagnosed with DDD (L4, L5 and S1) in 2005. Right now, I can't stand and walk for long period time without the pain on my right leg. My daily treatment are similar to DRX9000 (decompression machine) and yoga. I am planning to have surgery in 2012, but no decision has been made for the detailed procedure yet. I am open for all options.





The surgeons in Germany responded me with different opinion. Here is their response:


…...... Dr. Bertagnoli could already view your medical data. I am here to pass on his surgical recommendation.

Your l4-s1 degneration is marked

· L45 should receive an ADR – to preserve maximum mobility, and to prevent overload to higher-up segments.
· At l5s1 the extent of secondary changes makes it favorable to address this segment by a fusion.
Prof. Dr. Bertagnoli would perform both of these steps with one incision from ventral , using special non-profile fusion cages in l5s1. This will spare your back muscles from intervention by a standard screw fusion – and you need your dynamical structurs espl when preserving a mobile spine.

Who should I trust based on my CT & MRI results? I value your input. Thanks,

Xiaoyu,

I am not a doctor, so you know the drill... Anyway, the CT scan and MRI should be viewed together to see the big picture. They both are very good scans. The CT seems to be more in depth when it comes to the bone structure infringing upon the nerves/cord. I think I would want another set of eyes on both scans and another surgical plan given. Those facets don't sound very good and with ADR you want as little damage to them as possible. I would seek the opinions of Dr. R-Lang in Germany and/or Dr. B in England. The more opinions, the better imo. GL!

[akillas]

The more opinions, the better imo. GL!

try to get more opinions. compare procedures and prices.
and then u decide....

keep us posted...

[KanRunMo]

I agree with the two posts above. Besides Dr. Bertagnoli check with Ritter-Lang Germany, Dr. Boree, in U.K., Dr. Pimenta in Brazil and a local doctor. Are you waiting until 2012 because of money? Otherwise do it as soon as possible.

[xiaoyu80305]

I agree with the two posts above. Besides Dr. Bertagnoli check with Ritter-Lang Germany, Dr. Boree, in U.K., Dr. Pimenta in Brazil and a local doctor. Are you waiting until 2012 because of money? Otherwise do it as soon as possible.

There were very little changes in my MRI between 2005, 2007 and 2010. I don't believe there will be big change in 2012. Two reasons that I am planning to have my surgery in the fall of 2012: 1. I can have more time to research, consalt and find the best solution for me. 2. There is an important reason for me to retire in the end of 2012, not before. I want to have surgery shortly before retiring, in case I need longer time to recover.

Xiaoyu,

[KBear]

I agree with everyone else, get more opinions. With the 'I'm not a doctor' disclaimer, I will say that I personally would go for the fusion because of the bad facets. I'm not a big risk taker, so I tend to lean toward the less risky. Playing devils advocate though, you get an ADR and be just fine.... there is no way to know with any surgery what your outcome will be. All you can do is research, get multiple opinions, research some more and then make the best decision you can with the information you have.

[ajj1001]

hi. have you been told that whatever op you go for that it will improve your pain and sitting/walking? how long have you had problems with these?

[xiaoyu80305]

hi. have you been told that whatever op you go for that it will improve your pain and sitting/walking? how long have you had problems with these?

For fusion, yes. The surgeon told me that the surgery will help me. The ADR docter from Germany didn't mention anything about outcome. My problem started in 2005.

[xiaoyu80305]

I agree with everyone else, get more opinions. With the 'I'm not a doctor' disclaimer, I will say that I personally would go for the fusion because of the bad facets. I'm not a big risk taker, so I tend to lean toward the less risky. Playing devils advocate though, you get an ADR and be just fine.... there is no way to know with any surgery what your outcome will be. All you can do is research, get multiple opinions, research some more and then make the best decision you can with the information you have.

Like you, I am not risk taker. I am very lucky, my insurance pays all FDA approved surgeries, even abroad. I read some threads here. It seams to me the ADR are most for younger people and the problem caused by the accident, so the rest of spine are in very good condition. Even though, some of them had only 4 to 5 years in trouble free, then needed more surgeries. I am 67 years old, I only need 10 to 15 years comfortable life. Can fusion give it to me?

[KBear]

Like you, I am not risk taker. I am very lucky, my insurance pays all FDA approved surgeries, even abroad. I read some threads here. It seams to me the ADR are most for younger people and the problem caused by the accident, so the rest of spine are in very good condition. Even though, some of them had only 4 to 5 years in trouble free, then needed more surgeries. I am 67 years old, I only need 10 to 15 years comfortable life. Can fusion give it to me?

I would say the fusion is the better bet. Fusion gets a bad rap and the whole 'it causes more degeneration' thing, but read around and you will see that there are many ADR patients who are in way worse condition because they had ADR when the should have had fusion. There are also ADR patients that ended up with more degeneration a few years after the ADR, so it didn't slow it down for them. One of the reasons my insurance denied me was "because of my young age, it was unknown the longevity of the ADR. That's true, no one knows beyond 20 something years, that's how long the first ADR patient has had theirs. I was 29 at surgery time, is it going to last me 50 or 60 years? No telling. I think there is a very good chance that I will need more intervention before I die; but it was a better chance than being in pain forever (and if fusion would have been my only option, I would have taken it.) My uncle just turned 60 and has multiple fusions in his cervical and lumbar spine and feels great. I think almost his entire L spine is fused and he can bend over and touch his toes (I can't do that.) Fusion isn't as bad as everyone makes it out to be. You could still go abroad or wherever for the fusion, it's just as important to have a good surgeon for it as ADR.