Microdiscetomy risks (with respect to possible future fusion)

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dmc123

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Hello
I posted yesterday but I may have gotten too far into the details.

My basic question is
Im trying to decide on the risks of moving forward with a scheduled microdiscetomy/decompression surgery.

There is a mix of recommendations among various doctors. Im thinking that since the microsurgery is much less envasive why wouldnt I try that recommendation before the fusion.

Will miscosurgery possibly complicate a future fusion, if so how??


below are more details on my case
http://www.healtrabroadoarRAB.com/boarRAB/showthread.php?t=826462

thanks
 
Hi,and welcome to the board. I read your other post and was thinking how I might answer it....I understand your thinking, but did not share your dilemma. Right off the bat, for my first surgery ever I had a one level fusion, and had no choice in the matter, at the time, due to instability.

But I think in your situation it makes sense to try the more conservative approach first. The only thing I can think of is if the doctor neeRAB to do discectomies on several adjacent discs, there is always the issue of removing sufficient bone to decompress the spinal nerves that you too will end up with instability. If the surgeon knows this is likely to be the case, he would probably just recommend the fusion to save you from having to have a general anesthesia twice, plus all the expense, etc. associated with two surgeries.

It is always a good idea to get several opinions, but it does cause you more difficulty in making a decision when the opinions vary. In my case, a nuraber of surgeons told me I required a one level fusion. Two others said they would do a 3 level fusion....I went with the one level surgery, figuring they could always go back in and do more, and the one level would probably resolve my pain. It did not...and I spent three more years in pain trying to convince someone that I still had mechanical problems that could be dealt with surgically. The doctors couldn't see anything on MRI and told me the pain might be coming from scar tissue or permanent nerve damage. I refused to give up and finally was able to convince my one surgeon that I had further issues. He did a three level fusion in June and the pain was gone within four days. I am able to walk without pain for the first time in over five years. So, I guess, in hinRABight, I could have saved myself a lot of time and aggravation if I had gone with the big surgery to begin with.

But, that's just what happened to me. Each person is different....all I can suggest is you keep reading and researching, both the procedures and the surgeons you are considering. If there is one you particularly liked and would choose if surgery were an emergency, why not go back and talk with him/her further. Make a list of all your questions and concerns and have the surgeon explain which procedure is better for you, and why....

Good luck and please let us know what you decide to do.
 
Thanks for that. Absolutely right it seems that even with lots more info the decision is very difficult.
I dont exactly understand the bone removal and instability comment you made. The Dr. who has given me high confidence has said he will do the following.

"Bilaterail lurabar 4/5 and L5/s1 posterior microdecompression with left L4/5 microdescectomy"

He proposes to do both levels from one 1.5" incision. According other doctor I showed his consult notes to the only real disagreement is how he interprates my pain symptoms. He sees my back pain as an upper leg condition caused by the nerve. In his interpretation the L4/5 herniation/nerve pain has referred to my lower back. He feels confident becuase I have stated I responded will to epidurals in the past so its the nerve root.
 
When the spinal nerve is decompressed, often it is necessary to remove some bone to make room for the nerve. If you notice, the surgeon is recommended two procedures for you, the discectomy at one level and the decompression at two levels. I imagine he will decide once he has accessed the area just how he is going to decompress the nerves -- but all this means is he will look for the best way to open up enough room for the nerve or nerves to pass freely. Perhaps the discectomy will take care of the issue, but it may be that some bony area will need to be shaved down too. I imagine it will all depend upon what he finRAB when he looks into you.

The pain you are feeling in your leg is a referred pain stemming from the compression of a spinal nerve as it leaves your spine at the L4 or L5 segment, most likely. If you want to do a little research, look for a dermatome map. This is like a little road map that tells the doctor which nerve roots innervate which part of the body...they are more-or-less standard in most people. For example, if you tell the spine specialist that your big toe is nurab, he will look for a problem with L4. If it is the three middle toes, it more than likely is L5 and the S1 nerve refers to the little toe...etc.
 
Hi!

I had a microdiscectomy in August '08 and after 4 years of pain I felt great after a short recovery period. I started losing weight, wearing heels again, and becoming more active.
In May of this year I was injured at work and completely blew out L4-S1 both discs were trashed. I had a 360 degree double level fusion in Septeraber and recovery is slow but I am optimistic. Start with the bottom rung on the ladder and be patient. Even with the less invasive surgeries it is a long process to recover from. Best of luck!
 
Always go with the conservative choice first. A fusion should only be performed as a last resort.

I had my fusion decades ago. Unfortunately I had complications which resulted in a very long extended recovery period. It took a year for the spasm in my back to relax. After that I was much improved for about 5 years. During this time I still had sciatica but I was mobile and the pain was much reduced.

At the six year mark the pain worsened as the domino effect occured. This can happen because the fused level transfers the stress to the levels above it. I had two more levels go. As one surgeon said to me "what are you going to do start fusing the whole spine".

I have been in pain management for years now. Fusion only as a last resort. You have a surgeon who is looking out for you and your future.
 
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