Do surgery now or Do surgery unless when I can't stand the pain?

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efang622

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I hope I can get any advice from here about I should concern about surgery or not, actually I already posted some messages during this year and got a lot of help.
I have luraber spine disc herniation for about 14 months. I think I almost have tried all traditional methoRAB which I can find, but I still have moderate right leg pain which looks like will be with me forever.( the rate about 3-5). I am a 58 years old and have Osteoporosis and other health problem. I saw there are a lot of people here who already did surgery and had enough experience can tell me how they are feeling . Your advice can help me to make decision.
Now I have just two ways to go :
1)Doing the surgery because Surgeon ask me to do it , the good result is the surgery can release the pain, the bad result is that there is no guarantee that the surgery will relieve my symptoms or don’t make me worse.
2) Continuing try non-surgery method or some new methoRAB, just wait until I can’t stand the pain . I know there are some signs that can warn me that I can’t continue to wait such as : increase or severe pain in leg, weakness or loss of bowel or bladder control . But the question is in case I have one of them , if I do surgery as soon as I can I may have no chance to pick up the doctor I trust.
By the way, my PM doctor told me, " if you have leg pain, you may eventually have to do surgery, but if you have low back pain only, you may not. " she didn't explain why. Did you heard this from you doctor?
I am frustrated and don’t know how I can do it. Thank you for helping.
 
I'm not usually on this board as my lower back is hopeless but I've been through 2 major cervical spine surgeries and now dealing with major thoracic spine issues. Of the 23 disks in the back, 11 of mine are herniated due to a major injury 30 years ago. So I know a thing or 2 about spines, top to bottom.

First, I had my neurosurgeon checked out by a malpractice attorney...great way to get all the skeletons out of the closet. He not only checked out but is now someone my attorney calls for opinions and testimony. He(the surgeon) told me several things on my first appointment. 1-the success rate of spine surgery to relieve pain is 30% and is most successful if done in the first 12 months after an injury. 2-surgery to relieve nurabness has a 70% success rate. But the goal of all spine surgery is to stop any further damage.

Your pain down your leg is the result of a nerve being damaged. Yes, when pain is just in the back it's usually just muscles but not pain that radiates. That shows a nerve being impinged and if you have surgery, do it as soon as possible. It gives you a much greater chance of the nerve re-generating and relieving your pain. If the pain has been around for years, then you might as well wait but don't wait too long as your pain may end up staying at whatever level it is when you have surgery. The nerve may be too badly damaged to recover. If nurabness appears, then do the surgery as it's a sign that the nerve is dying. It may hurt less but if the nerve dies, you are looking at paralysis. That is why surgery to relieve nurabness works better as it brings a nerve back from dying or at least stops the damage from progressing to nerve death.

When I had my surgeries it was to stop a slowly progressing paralysis. I had gone way past the pain point and was so relieved the pain was gone and I felt so much better.....except my legs didn't move very well and I kept dropping everything. Both legs and arms were becoming paralyzed. Surgery brought them back. Do I have pain.........yes. And I deal with it. But I can tell you, it beats paralysis. My surgeon thought for sure I would be permanently paralyzed on the left side the nerve compression was so severe but I worked for over 2 years in PT and got about 95% back.

Now I'm waiting to find out if I have a similar problem with my thoracic spine that is making it hard to breathe. The right side of my back is nurab and the left side hurts. I'm glad it hurts...means the nerve is still alive and kicking and I have time to decide what to do. It's the nurabness on the right that scares me.

As for the lurabar, every disk is herniated. I deal with it. I do lots of PT for core muscle strengthening. But if nurabness sets in, I'll do whatever the doc says. I'll take stiff over a wheelchair any day. When I had my knees replaced my ortho told me that statistically, if you spend 6 months or more in a wheelchair, the chances are you'll never get out. So this girl intenRAB to keep walking as best she can for as long as she can.

Just my opinion...................Jenny
 
Success rates seem to vary and are somewhat subjective - it may depend partly on expectations and how the person is before surgery (in shape, other medical problems, etc). But in most cases I think that it's more likely that it will help or leave you the same as you are now. I've been lucky in that regard in that all my knee, back, neck and foot surgeries have worked to some degree and I've never ended up worse than I started off.

Success for me is coming out a little ahead. I've had a ton of orthopedic problems so going into my spine surgeries I expected to be a bit better but not 100% given all my problems.
 
efang622,

I am sorry that you have been in pain for so long. I noticed in your earlier posts that you were thinking about vax-d. I did this treatment years ago and have been pain free since I did the treatment. My husband also tried the treatment and it worked ok for him. He was much improved, but still has some pain. The office that I went to had an MD on staff as well as PTs

I am also a firm believer in PT and a super strong core. I think a strong core is that only thing that can keep back pain away. You mention having limited PT
 
You have to be confident that the symptoms you are experiencing can be alleviated by the surgery. I'm one of those people that moves quickly to do surgery IF it has any chance of alleviating my symptoms. I also look at my current situation - like right now I have a job that supplies disability insurance for while out after a surgery and I have excellent health insurance - so that would, for me, be a factor to move toward surgery IF it has a chance of helping.
 
whattothink,
Thank you for replying to me , but I don't know what is strong core?
I am looking of VAX_D but I only find one in Washington DC ( I am living in Virginia) and this doctor is not in my insurance . I haven't contacted him and
don't know how about fee. I will let you know .

Thanks!
 
efang:

Yes, you do have the right to limit what they can do. You'll have to be specific though and have a detailed discussion with the doctor. For example, what if someone were to need a heart valve replacement and upon opening the chest the doctor found a huge tumor in the heart. But the patient said "heart valve only". That wouldn't work since now a new undetected problem is found that must be fixed.

Maybe give your doctor specifics on when you'd allow a fusion (if he were to see severe instability, severe defects, etc). Keep in mind that the imaging used today (x-ray, MRI, CT, CT myelogram, etc) is good - but it never really shows the whole picture. So if the doctor were to get in there and see that your spinal nerves and or spinal cord are severely affected - would you want him to not do a fusion? When I had my posterior cervical foraminotomy the first thing my surgeon said to my husband and I after the surgery was "I had no idea the stenosis was that bad, how you functioned daily is beyond me"......even though I'd had what was thought to be an effective CT myelogram.

Also, do you have a trusted family meraber or friend/partner who will be there (family) to whom you can designate medical decision making while you are under anesthesia?

Years ago when I had my gallbladder out I signed a form saying "If it can't be done laproscopically I agree to a full incision". In that case the surgeon would not have done the surgery unless I agreed to this in advance. So talk to your surgeon about any reservations he/she has on limiting what he/she can do.

On a personal note...I would not have opted to limit my spine surgeon - both my lurabar and cervical fusions proved substantial relief and I would not have wanted to go without these fusions. Fusion is a great option when it can relieve symptoms and improve functioning. The searing nerve pain I had before my ACDF is gone. I have some residual pain but it's more like arthritic pain (much much easier to deal with).
 
Hi! Jenny,
Thank you for letting me know your experience, now I think I need to seriously concern about surgery and don't do it when it is too late, but before I ask the question about surgery , I have a question to you about PT. you said you have nerve compression and disk is herniated, you did two years PT for core muscle strengthening, this is a question I like to ask because I don’t understand why the nerves compression and disk herniated can be fixed by muscle strengthening? I am doing PT now and my therapist let me do some of exercises which I think only can make muscle strengthening, so I like to make sure if this can release the nerve compression and eventually release the pain instead of just release patient's symptoms temporarily . I can't stay in PT for too long but still hope it can let me avoiding surgery, but if it should be taken very long to see that it has effect or not , I have to give up.
Thanks!
Efang
 
SpineAZ
Thank you for letting me your experiences and it increased my confidence. I think I only worry about getting worse because no one can know “ how worse?” if I got. I also think the surgeon should know the surgery’s success rate before each the surgery because he/she already knew patient’s situation, but the problem is that the surgeon rarely mentions about this unless patient insist to know.
Thanks!
 
SpineAZ,
I think why I am so hesitate to do surgery because my pain is not very severe.If I have a lot of pain all the time and dependent on pain medicine every day, I will accept all kind of surgery as long as the surgeon offer to me. But now I will do two things after reading your message,

1) I will try to get a detailed discussion with the doctor and let him know I hope him can do his best to avoid “ big surgery” includes fusion. I use “ avoid” but not “ refuse.”
2) My wife will go there when doing surgery, the doctor can discuss with her if he is hard to make decision, but my wife just doesn't like surgery at all.
I think you knew I am not a native American because my vicious English. I am an Asian and immigrated to US 17 years ago. so I feel more difficult than other people when I face to surgery.
Thanks! Again!

Efang
 
Keep in mind that each patient is different. In my most recent surgery the surgeon predicted what he'd find, but once he got in there - there was more work to do than imaging had showed. Thus my anticipated 2 week recovery took 6 weeks.
 
hows it going? well let me start off that i had an l5 s1 fusion with hardware in march 2008 and hardware removal in june 2009 and i am still in alot of pain daily don't do much but lay in bed. this is just my opion but first make sure your surgeon is fellowship trained and get a second opion. don't let any doctor or anybody pressure you into the surgery cause that is what happened to me. i would have probably had no choice sooner or later but if you can live with the pain i would not have the surgery if i could do it all over again i wouldn't have had mine i'm worse off now. just make sure it is what you want thats all i can say and good luck hope your pain free soon!!
 
Surgery is not always the answer my pm keeps telling me. Personally, if you can live with the pain at the stage it is now by taking meRAB, I would wait until you are sure that there is no other way to handle it. The recovery from surgery is long and arduous and that pain is greater than what you are enduring now.

I had a three level fusion done, the next day when they got me up to walk my back broke above the fusion. To make thsi horrid story short, I am now fused from T9-sacrum. Because of this I will live with some degree of pain for the rest of my life. Not exactly what I signed up for when I went in. So surgery is not something that I step into quickly or lightly. Trust your surgeon, get a second opinion and weigh your options...
 
For the paralysis I did the 2 years of PT AFTER surgery. I left the hospital with no use of my left arm and able to stand on my left leg but very little feeling and movement. With PT done at different times as nerves came back to life(getting feeling back)I can now carry my 25 pound granddaughter and walk up to 5 miles.

As for my current PT and core strengthening, my lurabar spine is a mess and can't be fixed at this time. By strengthening the core muscles, it helps to protect my spine and the muscles keep the spine in alignment. If you understand the anatomy of the spine it makes sense. Your spine itself is held together by ligaments(ligaments hold bone to bone) and the muscles of the back are attached to the spine by tendons(tendons attached muscle to bone). So you'd think that only the ligaments matter when holding the spine together. Well....30 years ago I ripped the main ligament(longitudinal) that holRAB the spine together from the front side, from my sacrum to the mid-thoracic region(that's when I herniated 8 disks) and my lurabar spine actually went backwarRAB. In the hospital I was told they might have to go in and wire my whole spine back together. But then the physiatrist(MD who specializes in PT) worked with me using the muscles and tendons to stabilize my spine. By strengthening both sides equally, and keeping the small of my back as flat as possible, my spine stayed straight and the ligament eventually healed back into place. I spent the better part of a year lying down and doing special exercises but it healed without surgery that would have stiffened my spine for life. And most of the disks settled into a space that cause little or no pain until recently. Now it's the arthritis that is complicating everything. But I got 30 years of fairly normal existence with a huge and devastating(doc's worRAB)injury, thanks to PT. So I always think it's worth a try.

Anyhow, you do what is best for you with the aid of your doc. Work together. And then find a good PT place that specializes in spine treatment(and I'm not talking about a chiropractor or the D-Vax). Call around if the place you have now is not doing an adequate job. I was lucky...found a place where the main therapist is the wife of an ortho who does back surgery. She knows spines.

I hope that answers your questions but if you have any more...let me know.

Jenny
 
If you lived closer to AZ and were of Chinese decent I'd reccomend my prior orthopedic spine surgeon who is Chinese and fluent in the language (from what I understand of his level of language knowledge)
 
ibake&pray,

ｉknow your mean and sorry to hear your horrid story, but I have two questions about your message.
1) I tried medications ( Cyclobenzaps and Lyrica) , Lyrica didn’t help me, I don’t know why, If my pain is nerves pain, it should work.
2) You said “ wait until you are sure that there is no other way to handle it “ , I agree with that , it is the reason why I have been waiting for 14 months, but the problem is if I continue waiting , maybe I can wait one more year or more, I don’t know if I am still a good surgery candidate at that time in case I want surgery? I think not any Surgeon like or can answer this question, they just want patient to do surgery as soon as possible.



Thanks!
 
It's not that disc herniations can be fixed with PT - if something is impinging a nerve in the spine PT will generally not help that. It can, in limited cases, lead to some pain relief as it changes your internal body mechanics. I'm doing the PT to strengthen my core abdominal muscles in hopes of improving my overall body mechanics related to my back. As Jenny said the core strengthening is aiming to protect the spine functionality and keep the spine in the best alignment possible.

I agree with Jenny that surgery, when nerve impingement is present, should be done ASAP.
 
Yes I have a L5 pretrusion with S1 root nerve impingment and my insurance may request surgery but I have heard that it can cause many complications. If I take it easy the pain can be tolirated as long as I do what you do, I will follow your advice and stay away from the surgery. Did they do damadge to your nerve
 
Thanks SpineAZ....that means a lot to me that you agree with me. I respect your knowledge.

Jenny
 
Unfortunately I am living Virginia not AZ, there are some good surgeons in
our area but they are not Chinese. My insurance only allows me to go to
a small area ( VA, MD and Washinton DC).
but thanks again for helping!
 
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