Would like educated opinions on this - back surgery

[Plutto]

I had a microdecompression at L5 S1 just over two years ago.
My left leg was going numb when standing for about 10 minutes. No brainer for me to have surgery. The site below helped me alot with what to expect, detailed animations, what questions to ask. etc ...

http://www.spine-health.com/topics/surg/overview/s01.html

 

[KillahBee]

I'll preface my remarks by telling you two things: First, I am a surgeon. Second, I've performed over 1000 anterior spine approaches for various spine surgeons in my area over the last 10 years. I am not a spine surgeon myself, I am a vascular surgeon that is asked to provide exposure of the spine from the front.

The symptoms you describe sound clearly to be related to an anatomical abnormality (i.e. a bulging disc or a degenerative neural foramen). This is the type of pain that can (and really should) be completely relieved with surgery. I say these things for a reason. There are many individuals (I'd say roughly 50% of the patients) that have back pain without clear anatomic reasons and some get surgery and they usually don't do as well as people in your situation. There are a large number of folks out there that use chronic back pain as an excuse for not living their lives and that is clearly not you... which is good.

Now for the bad news. I say you can get better (and not that you will) because back surgeons vary widely in their approach and skill. I've worked with a few that weren't competent. If it sounds scary, then I've succeeded.

Check out your doctor. Get a second opinion (or a third). And for god's sake DON'T LIFT (doesn't sound like you can right now). Also, ask around for how other patients have done with the doctor you're going with. And remember, that this surgery will permanently affect your mobility at this spinal level and will affect the vertebrae next to it as well.

Good luck to you,

Jerol

Thank you for the insight, very very helpful. I agree on all points and if it's one thing I am figuring out, it's that I really need to do my research on this surgeon. I am actually going to get a second opinion next week.

 

[KillahBee]

I had a microdecompression at L5 S1 just over two years ago.
My left leg was going numb when standing for about 10 minutes. No brainer for me to have surgery. The site below helped me alot with what to expect, detailed animations, what questions to ask. etc ...

http://www.spine-health.com/topics/surg/overview/s01.html

How was the surgery and post-surgery recovery?

 

[Plutto]

I'm new here, I'm still looking around so I didn't want to say too much. I could write a book on the subject but I'm gonna try and keep it short.

First of all I'm not really in the same situation as you. My back was injured in a work accident in 1988 so it's a real old injury. It was a disc bulge. I didn't need surgery until it herniated 16 years later.

The surgery went well. They took about 40% of the disc out. I was walking the same day and the numbness was gone. There was alot of pain at the surgery site but that was expected (it's surgery - they cut you!) Pain went away in few weeks.

The following info/exercises really, really helped PT and I still do the McGill exercises as part of my warmup.
Physical Therapy Corner: Low Back Pain and Lumbar Stabilization Exercises
http://www.nismat.org/ptcor/lbp/

Dr. Stuart McGill exercises (click "Next Article" to see exercises)
http://imprint.uwaterloo.ca/issues/110300/5Sports/sports18.shtml

I'm in my 40's so I don't heal as fast as I used to. I started squating again at about 18 months post-op. No-where near the weight that I used to do, though I'm not really pushing it.

Feel free to ask any questions I'll do my best to answer them.
Hope that helps...

 

[win19]

Arch Phys Med Rehabil 1999 Jan;80(1):20-5.
Can spinal surgery be prevented by aggressive strengthening exercises? A prospective study of cervical and lumbar patients.
Nelson BW, Carpenter DM, Dreisinger TE, Mitchell M, Kelly CE, Wegner JA.

OBJECTIVE: To determine if patients recommended for spinal surgery can avoid the surgery through an aggressive strengthening program. SETTING: A privately owned clinic, staffed by physicians and physical therapists, that provides treatment for patients with neck and/or back pain. METHODS: Over a period of 2 1/2 years, consecutive patients referred to the clinic for evaluation and treatment were enrolled in the study if they (1) had a physician's recommendation for lumbar or cervical surgery, (2) had no medical condition preventing exercise, and (3) were willing to participate in the approximately 10-week outpatient program. Treatment consisted mainly of intensive, progressive resistance exercise of the isolated lumbar or cervical spine. Exercise was continued to failure, and patients were encouraged to work through their pain. Third-party payors in Minneapolis were surveyed for average costs. Average follow-up occurred 16 months after discharge. RESULTS: Forty-six of the 60 participants completed the program; 38 were available for follow-up and three required surgery after completing the program. DISCUSSION/CONCLUSIONS: Despite methodologic limitations, the results are intriguing. A large number of patients who had been told they needed surgery were able to avoid surgery in the short term by aggressive strengthening exercise. This study suggests the need to define precisely what constitutes "adequate conservative care."

The program basically consisted of isometric strengthening of: including the lumbar extensors, cervical extensors and rotators, and thoracic rotators. Full study at: http://www.backbuilder.com/archphys.htm


I'm not a spine expert (although based on the casese suggested for surgery it seems somewhat similar to yours), so I don't know how this would apply to your situation. I'd highly suggest that to form an inquiry and try emailing two of the researchers about your situation here: http://www.ncbi.nlm.nih.gov/entrez/...t_uids=8726348&query_hl=6&itool=pubmed_docsum But be professional and hope they check their email, and if you do decide to email them let us know what they said.

 

[KillahBee]

Interesting, thanks for the info. FYI - I was in the gym and PT running a pretty intense strengthening program for probably 4-5 months. Made some good progress with strength gains, but flexibility progress was very minimal. And the SAME stretch/movement was the issue - hammy stretching with my left leg. When I am sitting on the doc's table and I try to hold my left leg out straight the pain gets bad. No improvement there.

Maybe I will try emailing these cats, once I do some research.

And as far as being professional - yeah, I manage multi-million dollar sponsorships for blue-chip international clients daily. So I definitely understand that

 

[win19]

Interesting, thanks for the info. FYI - I was in the gym and PT running a pretty intense strengthening program for probably 4-5 months. Made some good progress with strength gains, but flexibility progress was very minimal. And the SAME stretch/movement was the issue - hammy stretching with my left leg. When I am sitting on the doc's table and I try to hold my left leg out straight the pain gets bad. No improvement there.

Maybe I will try emailing these cats, once I do some research.

And as far as being professional - yeah, I manage multi-million dollar sponsorships for blue-chip international clients daily. So I definitely understand that

Alright, good deal man. A quick synopsis of the study: In the study, 46 patients basically completed it (though 77% completed the exercise program and 82.6% who completed it were available for follow-up), 38 were thus follow-ups. They mention that 90% of the patients already tried but failed some type of exercise program. They also mention: "... Early attrition is unfortunate because patients undergoing aggressive strengthening exercises often do not begin to feel better until 3 to 4 weeks into the program. Also, some patients are unwilling to devote the time and energy required for aggressive strengthening exercises and elect passive care and/or surgery instead." And out of the 38, they were originally recommended to surgery and of those, lumbar fusion (technique for degenerated disc, 15), lumbar decompression (technique for relieving impinged nerves, 13), cervical fusion (3), cervical decompression (7).After the exercise program completion, 17(44%) had "excellent" results, "good" in 14 (36.8%) and "fair" in 4 (10.5%). And in the end 3 of the 38 needed surgery.

If you have done an intense strength training progam for 4-5 months, I'm not sure how the nature of that program would compare with those of that seen here in this study and how that would affect the results (ie, 90% mentioned they already tried some type of program).But then it seems surgery is certainly an open option.

 

[KillahBee]

FYI - got a second opinion today and, as expected, I got the same feedback. Although, I liked this surgeon much better in terms of personality and information sharing.

Same deal - either you live with it or you get the surgery. He has done hundreds of these and was realistic in explaining everything.

My father is talking to a surgeon in RI (where my parents live) that did his back a few years ago (a Brown University surgeon) to see if he can talk to me and potentially to the surgery. Since I will be out of work for 2 weeks, it makes sense to have the operation at home and stay at my parents' place.

Looks like I'm going for it.