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Lumbar fusions S1 to L3. Neurosurgeon or Orthopedic surgeon to do the job

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Posted 1/13/2008 5:21 PM (GMT 0)
eyes  The same Ortho surgeon that did my laminectomy L5-S1 in 98' wants to do fusion now.  Don't have any problem with the Dr he is good. But when did the laminectomy had bad nerve compression then which he could not fix,damage allready done he said.  If I go to a neuro-surgeon for the fusions will he be able to do a better job,especially with all the nerve issues I am having now
Posted 1/16/2008 7:18 AM (GMT 0)
Rubydoo I would definetly have a neurosurgeon due the fusion. Those guys deal with the nerve issues all day long and they are just better qualified when it comes to the nerves in this surgery. I know an ortho very well, he has a neurosurgeon do the fusions with him. He does the ortho part of the surgery and then the neuro steps in and does his. They work beautily together, I always call them the tag team. Their results are outstanding. Susie
Posted 1/17/2008 6:19 PM (GMT 0)
mad  Hey Susie,

From what I researched on the internet a Ortho is trained at School to do backs and a Neuro is not,has to go to more schooling post grad. also when a nerve is damaged it can't be fixed,is this true? Would like to ga to a Back institute but there is not one here locally,would have to travel at least 6hrs. to get to one. I believe a back institute would give treatment as you described. Any advise?

Posted 1/18/2008 1:22 AM (GMT 0)
Rubydoo1, unfortunately, no one can tell you if the nerve damage is reversable or not. The less damage to the nerve the greater it may heal itself, but alot of times if the nerve has extensive damage or if the person waited too long then the chances are smaller than the nerve can heal. A decent dr will always tell a patient this. I cannot say if a back Institute does the surgeries the way the drs do I know. Have you pulled up any places close to you? It will tell you what kinds of drs they have on staff. Riding is a killer after surgery. If you knew someone with a van so that you could lay down, thats a terrific way to travel home. Those drs I told you about required pts to be lying down going home, you went home in a van or ambulance. If you travel away from home for the surgery,, be sure to have pain meds on hand and take them before the pain gets bad and out of control. Do you have a neuro in your town you could consult with? Let me know. Susie
Posted 1/18/2008 3:03 PM (GMT 0)
I had my first fusion with an Orthopedic Spine surgeon and my revision with a Neuro-spinal surgeon. With the nerve issues you are facing, I think that I would go with a Neuro spinal surgeon instead of the Orthosurgeon.

That's just me and my experiences. I was left in bad shape with a post op CES case after my first surgery and while the surgery went well, he was more concerned with the technical aspect of the surgery, rather than the new , sudden onset of spreading nerve damage I was experiencing, which is why he missed the CES.

My neuro tried to go back and redo my fusion which never took, and repair some of the damage but  unfortunately for me, it was too late.

Or you can consult with both and see if they are at least in agreement about what should be done. See which one you feel more confident in. Anyone considering spine surgery, should have at least two consults with another surgeon to see if they agree with the game plan.......

Sandi

Posted 1/18/2008 5:47 PM (GMT 0)

eyes   Thanks to all for the reply. I already planned on going to a neurosurgeon for a second consult. From what I can gather reading on the net it will be best to go to a spine center and the closest one I can find is the Virginia Spine Institute. But I am sure there are others. I have been looking into the Stabilimax NZ devise. There is a trial going on for it right now and a doctor in Bristol,VA. is taking part in it. His practice is called Neuro-spine solutions P.C. For some reason this place really appeals to me I guess because it is close to home and they seem to be up on technology. Web addy is http://www.neurospinesolutions.net/ check it out and give me some feedback. I called the Stabilimax people and after answering a bunch of questions they said I qualified for the trial and they would contact neuro-spine solutions and see if can put on list. I had allready made an appointment with neuro-spine solutions and they said to cancel it. Should hear from Neuro-spine solutions with in 10 days if not said to call back. I believe this is the place for me to go. So please if you folks that have been thru this could take a look at this web site for me and post back with your opinion it would be a great help to me and my family. 

Thanks and hope you all well.   P.S.-  I am running Windows Vista on my laptop and it is driving me crazy.  confused  

I just love these Emoticons tongue

Posted 1/18/2008 6:00 PM (GMT 0)
What is CES? Maybe I know but don't recognize the abbreviation. I certainly related to the surgeon being enthralled with his (or her?) handiwork. When I went for my 2 month post op with my neurosurgeon, even he was focused on how well the fusion was proceeding, the cage, screws, etc., being all lined up. And I kept say yes, but the reason I had the surgery in the first place - the nerve pain - has not improved one bit. I still get all kinds of mixed messages from his office, and this is at a major teaching hospital/medical center. His physician assistant told me that if I hadn't had any improvement at my two month visit, I'd never get any. Then the neurosurgeon says wait another 6-8 months (making a total of 10 months post op) and then we'd deal with other options (although they are precribing optiates and musicle relaxants and such w/o question). Just Tuesday I talked with the nurse to request the percocet refill, which they have to send me by mail, and she again tells me to be patient. This patience stuff is for the birds. I've lost my job, am being hounded by credit card companies because I couldn't pay my bills in December, and may lose my home in a few months. Oh, did I mention also lost my helath insurance so am paying for COBRA coverage. My view is that I now have to deal with what I have, see if I can get back to work (get HIRED by a new employer at the age of 58), and if the nerve pain gets better in a few months then great. No one will be happier then me! But from all I read the fact I've not yet had any improvement in nerve pain 4 months post op is not a good sign. This is all so challenging, not only to deal with but to make decisions about surgery. Sorry to have rambled, but it seems most of us area dealing with so many of the same things, just as different points in the process. Thank goodness I found this board!
Posted 1/18/2008 6:15 PM (GMT 0)
PA, I am so sorry to hear about what you are going thru. You will not like what I am about to say, but they say and I know from my own dr friends that do back surgeries. It can take anywhere from 6to12 months for the nerves to heal, if they are going to heal. The repair depends on how damaged the nerves were at the time of surgery. This is the one aspect of surgery that cannot be given an answer to, other than what I wrote. Have you been placed on a medication for the nerve pain, other than pain pills. If not-please contact your dr ASAP. There is medication out there for nerve pain. Hugs, Susie
Posted 1/18/2008 6:32 PM (GMT 0)

Thanks Susie,

My doctor at the Pain Clinic has me on morphine sulfer 30mg for pain and Lyrica 50mg for nerve pain. I waited way to long to seek treatment I was told by my Pain Doctor. I have this problem of waiting till I hit the floor to get help,you know tough it out and it will go away or get better. I did the same with my hips,waited till the femoral head (ball) caved in and couldn't walk before I got them replaced. One would think I would have learned my lesson from that but I didn't. I have been in pain for so long I guess I learned to live with it like it was part of life. Heck the lyrica has given me some feeling in my foot and lower leg and alot of the oain is gone also. First time in 10yrs. can wiggle my toes and tell when I step on something. My 11yrs old son thinks its great having a dad for a change. Not the person sitting on the couch,kind of like a new person according to my family and other people that know me. Please check out the web site and tell me what you think.

Thanks and have a painless day.  

Posted 1/18/2008 6:51 PM (GMT 0)

PAlady,

Sad to hear about what you are going thru. When I had the laminectomy in 1998 I never gained a bit of relief in nerve pain I am sad to say. If you call the credid card companies and tell them what you have been thru they will be understanding. It is when you don't call them is when it is bad. My wife had a discectomy 3 weeks ago and called everybody we owe (bills) and told them what was going on they all were great. Some required a written statement from her and others a statement from the doctor but most companies defered payments,put payments on hold,only had to pay interest and things like that. So give it a try,it can't hurt at this point. That COBRA stuff is rediculous what they charge,call them and see if you can drop some of your coverage such as dental,vision and only keep the basics,what you need. It WILL get better. When I had both my hips replaced I was close to loosing everything but I didn't. Just tackle one thing at a time and get a plan on how to deal with it. Worrying will not get the job done,actions will. This sounds harsh I know but it is true. Took me awhile to snap out of the pitty me and make a stand. It worked when I started communicating with my creditors and let them help me.  

Posted 1/18/2008 7:06 PM (GMT 0)
Thanks for the posts everyone. I do realize the nerve regeneration can take time, but in the meantime one has to deal with life, not just live in some limbo. I am alone; have no spouse or second income and that makes a huge difference. I cannot even afford to pay ANYTHING on my debt right now and not for the foreseeable future. That also makes a difference, plus because I have equity in my house an attorney I consulted just told me the credit card companies can not only put a lien on a house, but force a sale. i knew they could put the lien, but not force a sale. I am working to get information from legal services, free consults from attorneys, etc., and will talk with the credit card companies soon - once I know what to say that doesn't hurt me more than help. (what I would have done before I talked to an attorney would have hurt me big time!) No way I want to drop any parts of the COBRA right now - and the dental and vision are less than $10/month - well worth keeping for as long as i can. A cousin has offered to help me for a couple of months. All hinges on my ability to get back to work, which I want to do, but what concerns me most is the lack of stamina due to meds. and pain. I do take neurontin for nerve pain; lyrica didn't seem to help although I don't think I've had a fair trial and I am tired of begging doctors for help. Where I live there are serious problems with pain management. The District Attorney has prosecuted several local pain doctos, and only one remain who prescribes opiates and he is a bit of a quack. What pisses me off is my neurologist, who refuses to prescribe opiates and even my neurontin, even though all of my pain is nerve related AND I've been going to his office for over 25 years for another condition. The D.A. has them all scared and it's pathetic what we have to go through to get adequate help. I really believe with better pain management I might be functioning at a higher level, but I'm afraid right now to challenge my neurosurgeon's office any more than I already have, as if they stop prescribing I'll really be up a creek...until I've found other options. My PCP's office kept me practically begging for a small amount of vicodin to help me sleep for two years before the surgery. '
Ok, I'll stop now! I have to go call attorneys!

Thanks for everyone's support and ideas.

P.S. I still don't know what CES means.
Posted 1/18/2008 7:35 PM (GMT 0)
  Neurosurgeon without a doubt
Posted 1/19/2008 1:44 AM (GMT 0)
RubyDoo, I have not had a chance to look at the site you posted. I will either later tonite or tomorrow. Good to see you checking things out.

PA, how awful for you to be at the mercy of those idiots for any kind of pain control, thats just inexcusable. You are absolutely right, you would probably function much better with proper pain medication. Whats the chance of finding another pain clinic perhaps not too far from where you live, and maybe even get into one that see's the big picture. In my opinion if the other pain clinics there have dotted their i's & crossed their t's they should not have anything to worry about. The quack must be smarter than all of them,lol. I would get on the internet and start seaching for pain clinics in your state and narrow it down by locality and see if I couldn't make some calls. Hugs, Susie
Posted 1/19/2008 4:35 AM (GMT 0)
Susie,
I would really appreciate you and others checking the site out real good and give me some feedback on it. Jast click on link and it will take you straight to it. Listen to the radio broadcast on it also.
Thanks
Posted 1/19/2008 4:37 AM (GMT 0)
razzle51,
Why do you say neurosurgeon without a doubt,just curious. More info better off I am. Please check out the link I posted also and give me some input. Live in isolated area and have to travel for quality health care. This place would be close if it pans out. 

Post Edited (rubydoo1) : 1/18/2008 9:40:31 PM (GMT-7)

Posted 1/19/2008 4:58 AM (GMT 0)
PA,
CES is Cauda Equina Syndrome. It is a compression of the lumbar nerves in the cental canal. It is usually caused by massive herniations, but also by back surgery, trauma, and a few other causes. Mine was caused by a combination of central canal stenosis, multiple herniations that were not fixed during the first surgery, post op swelling, all put together put me in a bad way......then to complicate matters further, they sent me home 30 hours post op after a 6 1/2 hour PLIF/TLIF fusion, with a whole slew of other things added in for good measure.
http://www.csmc.edu/5702.html

This site tells you what it is and explains it rather well.
Sandi
Posted 1/19/2008 5:05 AM (GMT 0)
Ruby,
Since this is a new system, you might want to do considerable research into it. There were /are lots of problems with the Dynesys stabilization system and from what I am reading this is similar. While we want doctors who are up on the latest technology, I wouldn't want to be the guinea pig per se of a new procedure, especially one still in trials......look at all of the bad things happening with the artificial discs.......
You only get one back, and you only get a chance to have back surgery done right the first time, after that, it becomes a salvage job....
Sandi
Posted 1/19/2008 5:50 AM (GMT 0)
Sandi,
I've been thinking the same things. My insurance will not pay for anything but a straight old fashion fusion. I called and they said will only pay for somethiung when it becomes the standard treatment.
When I had my hips replaced I picked out the ones I wanted and they had just been approved by the FDA ant it took awhile to find a doctor that had been trained to put them in,had to go to Knoxville,TN was the closest place. Thanks for taking the time to look at it for me.
Any way the doctors can't rule out AVN/ON of the spine and if that is the case the bone would be too soft for this type or any like it antway
Thanks again,you have been a great help.
Posted 1/19/2008 5:50 AM (GMT 0)
Thanks, Sandi, for explaining CES. And thanks everyone for your comments and support. What would we do without this site?
Posted 1/19/2008 4:59 PM (GMT 0)
Good for you Ruby. Do as much research into this as you can. One of the problems with a new "stabilization " system is that while it sounds good in theory, back surgery is still back surgery and if something goes wrong, you are the one who has to live with it.
And since it's still in trials, there isn't a whole lot of information about what to do if things don't turn out good.
As they did with ADR in our country, they are finding now that there are tons of problems with the implants, from wear, to debris from the discs, to facet joint problems being created after a few months of having them put in, and causing a need for revision surgery, which then becomes life threatening.
They can't do like they have done with ADR and decide to try to find a way to fix things after the fact. That should be part of the trials, what and how they can fix it if it doesn't work.......These stabilization systems are having the same problems.
Just do your homework before you agree to being part of any trial.
Sandi
Posted 1/19/2008 8:07 PM (GMT 0)
Ruby - I would also caution you to research nerve pain issues before proceeding with ANY surgery. Your initial post says you've been having nerve compression problems since your surgery in 1998. I would really suggest talking with maybe a GOOD neurologist in addition to a neurosurgeon about the likelihood of even fusion helping your nerve pain. It may be that - and trust me I KNOW firsthand this is hard to hear - it may be too late for any surgery to help your nerve damage. Your surgeon back in 98 seemed to have even indicated that to you. So if you'd be having any surgery to help the nerve pain, really get some honest answers from doctors. And my experience is that a lot of surgeons want to give you the best case scenario. After all, surgery is what they do for a living. A neurologist, on the other hand, may be more forthright with you. I know it's hard for all of us, but it seems so many of us have had failed back surgeries....yet it's so compelling to try ANYTHING that might get you out of pain. I do agree with earlier posts about be VERY cautious about new approaches and trials. I'd only consider that if I had tried all other options and they had failed, and the specific approach was the ONLY choice I had left.
Posted 1/19/2008 10:17 PM (GMT 0)
eyes   yeah yeah Hello PAlady,
Thanks for the reply. Have been getting on the Fda and other government wab sites and looking at the trial results(what will tell you anyway) Seems that the manufacturers of these products push real hard to get them approved and lobby real hard with the gov. to get them approved. With the manufacturers having incredibly deep pockets they can pay on capital hill for this. Look at the arthritis drugs and others.Most of the companies that make these products are phamacutical companies and we all know how that is carried on in washington. After doing alot of thinking and research I feel that with the bone disease,arthritis,and on some of the xrays there are even bone fragments floating around in the spine. my neighbor is a doctor in the local ER and was there one time when I had to go and showed them to me. I was walking my dog earlier and he asked how I was doing,make a long story short took all Films and reports over to his house and his opinion was to get a cemented fusion as he calls it cause with the bone issues screw and pins will not hold in the long run,bone is too soft to take a chance on it. He also said will hook me up with a good neurologist. Said he has been watching me for all these years and has seen me go steadily down hill. Said did not think much could be done for the nerves as far as fixing them but a neurologist can definatly do something for the nerve pain,also said the pain clinic I am going to works real close with the doctor he is going to get me into.Said as far as he is concerned the neurologist I will be seeing and the pain clinic I go to are by far the best in the area as my PCP says the same. The Neurologist I know somewhat cause he evaluated my son years ago and found a dermoid sinust syst that was communicating with his brain and said that it was way beyond his area of expertice and sent us to Atlanta(Emory University,Eagleston Hospitals)to get him fixed. All is ok with my son now as far as that goes but it is not often a doctor will tell you such things as I can't do that when it is their area of practice. Honest man so I will trust his opinion. After all he did save my sons life.
Thanks AGAIN and you all keep the advice coming. It sure helps learning from you all and your opinions are from experience which makes them invaluable,priceless. yeah tongue hanks,
Robert

Post Edited (rubydoo1) : 1/19/2008 3:21:31 PM (GMT-7)

Posted 1/19/2008 11:29 PM (GMT 0)
Ruby -
That's great you have such a wonderful and knowledgeable neightbor! Sounds like you are being pointed in the right directions. I will say although I had the surgery mainly for the nerve pain, I also had severe DDD and the neurosurgeon said I probably had already lost mobility from that and he was right. I can honestly say the fusion probably helped me regain a little mobility, and I certainly haven't lost any. I had what's called a Minimally Invasive Interbody Fusion - 2 levels. Maybe it's wishful thinking, but I do think the fusion has helped strengthen my spine for the future, as I was only getting worse and worse re: DDD. If you can have a minimally invasive procedure, I'd highly recommend it. I went to a major medical center (Pittsburgh) and I was pleased with the fusion and healing except for the rather major fact that it didn't help nerve pain at all. If you go into your surgery realizing that, and planning for the likelihood that you'll need to manage the nerve pain in other ways, you probaby will have a much more realistic expectation regarding outcome. I had screws and cages put, but also the latest substance - some kind of protein - that is used in place of bone graphs. Anyway, you're on the right track with some good people.
Chris
Posted 1/20/2008 2:14 AM (GMT 0)

Hi RubyDoo,

Well, I went back to the site listened & watched then read. Ok, I am totally in agreement with the others on this being new and still in the trials. Instances like this, I like to sit back and watch all the bugs get worked out, because there always seems to be a slew of them on new techniques and procedures. I know sometimes we can get so frustrated with pain that we are willing to do just about anything if we can to get some relief.

Its kind of like the new car thing. When a new one comes out on the market, I will not buy it for a couple of years until they have worked out the bugs. 

I am needing both knees replaced and last year UTSW Medical School over in Dallas did knee replacement on an active 83 yr old woman with replacements made to fit a woman in size. They interviewed this lady and she was just estastic over the surgery, she could not say enough good things about it. Basically,  replacements were made for a man in size and had to be cut down for a woman. Now women have their own replacements.

I think its great that your neighbor is helping you with some of this. He see's his share of the good, the bad and the ugly in drs. I think he is right about seeing a neurologist. When you have that view it can really be helpful to someone else. When I was working I had the same info available to me. I knew who I would go to for a specialist and who I would not go to.

I have a neighbor too, he is a rn and works er at our county hospital, so he really see's it too. He has done alot of work in pulmonary and has helped  me alot since I am an oxygen patient. He comes over & gives me my B12 shots once a month. He also recom I talk to my pm dr about using Dilaudid in my pain pump. He was the one that told me it, it is a very old pain drug that works great on pain, has few side effects. I was having a terrible time w/morphine in my pump. Needless, to say my pm dr changed me to Dilaudid and I have 3 other drugs mixed with it. It really made a difference.

Please keep posting and we will all says prayers that you get ent in the right direction and get the help you so badly need. Susie  

Posted 1/20/2008 3:53 AM (GMT 0)
Thanks Susie and Chris,
I guess it is a trip to the neurosurgeon now. I just hope I can find one that does the minimally invasive procedure. I have allready accepted the fact that the nerves are not going to get better but if I can prevent from getting much worse that will be ok. Was just reading an article on http://www.spineuniverse.com/displayarticle.php/article2520.html about the new approachas to spinal fusion. The one that is done thru the side looks interesting,don't need to fool with the nerves as much.
I just need to be patient right now and stick to me game plan. Go to the Pain Clinic on Jan. 29th for my epidural to try and get me by till gat things in order for surgery. I know one thing those epidurals do work for a short time in most cases at least they did for me ONCE. But then again the epidurals and the other steroid injections to keep me up and going to work gave me AVN/ON so i'll cross my fingers this time
Thanks again,
Robert
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