2nd opinion, even more confused

[SPC70]

On my first visit to a Neurosurgeon he suggested a two level fusion. I just had a second opinion that took me in a totally different direction. This Dr. suggested physical therapy and take some muscle relaxers to help with the pain and stiffness in my low back. I took a muscle relaxer last night and it actually loosened me up a lot. I am just set back on two different treatment plans. Since I don't have any major leg pains and I can control my pain by Advil the doctor feels to take the conservative approach. I wanted to see if anyone else had the same experiences in getting two opposite opinions? My impression from my latest MRI is L4-5 left intraforaminal disc herniation whtich impinges upon the left L5 nerve root, resulting in mild left neural foraminal stenosis. A associated annular tear is demonstrated. This is to give you some background of my spinal history. I am just afraid I may cause permanent damage and don't know when I should get serious about surgery.
Scott

[Gilbert P]

SPC70
The conservative treatment is best.Surgery is final no going back.

I have had 12 surgical consults and none were close to being the same, you have to go with what you feels is best for your condition.

Study! Do your homework and take your time for the best treatment for your spine.

No two spines are alike no two surgeons are alike

All The Best

Gil

[ajj1001]

conservative is always best, try it for a year and then consider surgery if you aren't coping. get a good physical activity programme supported by effective pain medication and stick with it.

[SPC70]

Thanks Gil & ajj1001

I am going to go ahead with PT and see if that helps. I have never had therapy so I we see how it goes. I am just concerned about having nerve damage or waiting too long that it is so damaged that fusion will be my only option. Since I still have strength in my legs and my sciatic pain is manageble this is probably the best way to go for now.
Thanks,
Scott

[rhatzy]

You know, they don't call it DEGENERATIVE Disc Disease for nothing. This is just my opinion, but I think you are just delaying the inevitable while things get worse like nerve and facet joint damage. I'd keep an eye on those facets as if they get bad might preclude ADR and then the only remedy is fusion unless by then they have the artificial facet joint perfected.

Mark

[SPC70]

Mark,

I would be lying if that didn't cross my mind. The two neurosurgeons I have seen, when I bring up ADR seem like they don't want to talk about it. I am only 40 and I feel I have a lot of life to live so fusion definitly scares me. A part of me feels the surgeons here in the states have hands that are tied and fusions are the only procedures they have to go with. They would suggest to prolong it as long as possible and the damage that would be caused for waiting would make ADR impossible. I have sent my scans off to the Texas Back Institute to see what they have to say. I am debating on sending it to Europe because even if they could fix it I don't know how financially I would be able to do it. I just worry about quality of life decreasing as it already has and facing a surgery when I am older and more fragile. I don't expect to be 100% ever again but I would like to be more active than I am now. I am proceeding with the PT and still researching my ADR options. I guess I really need to have a conversation with a surgeon about my facets to see what shape they are in. I have not had that conversation and that is my own fault. I am learning a lot from this site and soaking it all in. Thanks for your help.
Scott

[rhatzy]

You can send your films to Stenum in Germany as they will look at them for free and get back with you pretty fast to let you know what they can do for you. I believe Boeree in England and Clavel in Spain do the same. But keep an eye on those joints. Also, I took the money out of the house as I had a lot more to lose if I did nothing.

All the surgeons here in the states just know fusion as that is what they are taught and that is what insurance will gladly pay for. When it comes to ADR, they know nothing much about ADR.

mark

[runagain]

SPC70

There are surgeons who do both ADR and fusion, these are probably the best ones to go to. You are in Florida and if you look up KBears thread, she went to a top surgeon in Miami. If you are getting by with Advil, I don't know if I would do surgery.
However, you might have more of a problem than is presenting right now.
In my case, ADR was the best choice, however my surgeon does both ADR and fusion and micro surgeries. You need to go to a surgeon you can trust.
If the facets are too degenerated, doctors in the US will for the most part not do ADR. Little different in other countries but there is a point where they are too degenerated. Mine were mild hypertrophy.
Read up on this forum, almost every kind of surgery is covered here that relates to your problem. Each person is individual, however, so remember that.

[Katie]

I agree with Mark (rhatzy). So many have been told that the vertebrae are too far gone and can't be fixed with ADR. Plus neurological damage may be progressing and can be irreversible.

My pain in my lumbar levels was so bad that I was ignorant of what was going on in my neck. I sent my images off to Dr. Fabien Bitan in NYC after being rejected by all surgeons here in Canada..."we don't operate just for pain". I got an urgent phone call from him as soon as he got my CDs, saying that he needed to see me immediately...that I was at risk of quadriplegia if I had a fender bender or fell. When I started talking about my lumbar, he said it was my cervical levels that were critical...and they weren't causing me much pain at all. I thought the lumbar compression was causing the neurological issues as well as the pain.

Because of other complications and cost, I ended up going to Brazil a year ago to one of the top surgeons in the world, Dr. Luiz Pimenta. He said that I never would have been left in my condition if I lived down there...that many North American surgeons leave things go until they are critical and permanent damage is often done. Like Mark said, most things in the spine are progressive, and you could be putting off the inevitable. Plus it could be affecting the adjoining discs when things are out of alignment.

That again affects treatment down the road...

I am all for conservative therapy, don't get me wrong. But I've seen the effects of waiting too long as well. Do the therapy while putting your images out there; it can take quite awhile to put a plan in motion. One of the most common and valuable pieces of advice I received here is to send the images out to as many international/top-notch surgeons as possible. Having only a couple of consults confuses things. Getting a half a dozen or more helps clarify your options, as a common thread starts to emerge.

Good luck with this...you are on the right track by looking at your options earlier instead of later.

[SPC70]

Katie,
Thanks for your response. I do agree with both you and Mark. I guess the biggest issue with spinal patients is when do you have surgery? I am very worried about creating nerve damage or going so far that fusion is my only option. I had one neurosurgeon tell me he did not care if it was bone on bone as long as it wasn't creating a lot of pain or problems. That just didn't seem right to me. I am fortunate enough that my pain is not unmanageble but I have altered my life so much because I am afraid of hurting myself in any way. I am not sure if I can get any of that back but I sure hope so. I am going this Friday to see another doctor who is an orthopaedic who seems to be a very upfront and honest doctor. I have asked doctors point blank with their experience where they see me in a couple of years and none of them want to touch that subject. I guess that is what we are left with when lawyers run the country. (Sorry, if anyone is a lawyer)
Thanks again,
Scott