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Old 06-18-2019, 02:23 PM
 
5,910 posts, read 6,707,131 times
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Get to the very best neuro surgeon you can find. Do NOT go to the local guy who has two partners and advertises as a spine specialist.


Get to a major hospital like the Mayo Clinic, Vanderbilt, Duke sort of thing....check where Tiger had his surgery in Texas and might be closer to you, and that is where you want to go. Yu want people in a research setting who did residencies with the best, have worked on spine research, and speak and write regularly...as well as having received national recognition. Less that 4.7/4.8 on rating is a NO GO.




Trust me, I know about these things, and it is a world of difference between truly world class people that you want operating on you and the local guy who does a few of these, a few of those, and is a master of none. In a big center you will have three or four top spine specialists in the operating room, not to mention the proper pre- and post- operative care.
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Old 06-18-2019, 03:57 PM
 
Location: Nantahala National Forest, NC
27,093 posts, read 5,877,402 times
Reputation: 30347
Quote:
Originally Posted by nancyf View Post
Well, he needs it done soon. This has been getting worse for years and now he has developed foot drop and uses a walker. The pain management doc just wanted us to go ahead for a surgeon consult instead of doing injections and PT. I was just kinda mad at myself for not addressing this sooner. Well, he had been to an orthopedic group and they addressed his hip and knee which we thought was the problem..I wish they would have checked his back.

Get a second opinion!!
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Old 06-18-2019, 04:04 PM
 
13 posts, read 5,478 times
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I've had three back surgeries. Two of them fusions.
I believe the most important criteria for selecting a surgeon is his experience, the number of surgeries performed along with positive outcome percentages. I is not easy to determine who to select to perform your surgery. I had an MRI a week ago and just scheduled an appointment with a neurosurgeon, that appointment is July 31. I was very surprised when the OP said they got an appointment the next day. I have always had to wait weeks......proceed carefully.
With all due respect....The fact is that since your husband can walk his condition is not emergent. Though I believe he does need surgery.
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Old 06-18-2019, 06:22 PM
 
3,534 posts, read 1,344,614 times
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my story:

played golf with a retired ExxonMobile exec.
he was really good....but his back surgery limited his long game.
he told me: "if you cannot stand the pain One More Minute", have surgery.
if you can "get through the day" without it, go without until tomorrow.
back/spinal surgery is the coin toss of common surgeries.
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Old 06-18-2019, 07:09 PM
 
217 posts, read 70,118 times
Reputation: 543
Quote:
Originally Posted by turkeydance View Post
my story:

played golf with a retired ExxonMobile exec.
he was really good....but his back surgery limited his long game.
he told me: "if you cannot stand the pain One More Minute", have surgery.
if you can "get through the day" without it, go without until tomorrow.
back/spinal surgery is the coin toss of common surgeries.
This. Steve Kerr, Golden State Warriors coach has recurring problems from back surgery. He says if he had it to do over, hed try more PT, put up with the pain, anything but surgery as long as he possibly could.
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Old 06-18-2019, 07:29 PM
 
319 posts, read 150,271 times
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Quote:
Originally Posted by joepierson View Post
I had doctor say the same thing, had fusion, made it worse YMMV because it does work for some people.

Doctors won't admit it, but the spine is still a big mystery to them.

There are people with horrible MRI's but zero symptoms, and people with perfect MRI's who are disabled.
The spine is not a mystery to spine doctors. They have a thorough understanding of both its anatomy and physiology. Imagining studies of the spine are very refined -- esp. CT scans, MRIs, and myelograms.
Contrast can be added to provide more precision in the reading. On MRIs in particular, see the following: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080848/

And plain film x-rays still have a role to play in diagnosis.

Your statement <There are people with horrible MRI's but zero symptoms, and people with perfect MRI's who are disabled> is spot on.

So what's going on here?

MRIs detect anatomical abnormalities -- degenerative disc disease (discs are darkened [= dessication], collapsed/flattened), foraminal and central canal stenosis (= narrowing), misalignment (spondylolisthesis), fractures (spondylolysis -- crack or fracture in one of the vetebrae), arthritis (e.g., formation of bone spurs), spinal cord compression, etc.

But there is not necessarily a correspondence between anatomical abnormalities and low back pain.

Spine doctors recognize this. They recognize that a compressed spinal nerve (what the public calls a "pinched" nerve) can hurt like hell, and radiate down the leg (sciatica). It is horrible pain. On the other hand, dessicated and flattened discs in the spine may produce no pain.

A good spine doctor (neurosurgeon or orthopedic spine surgeon) tries to correlate the patient's symptoms which 1) physical exam findings; and 2) any imaging studies that were ordered. He tries to triangulate these three sources -- he tries to get them to "line up", but not force them to line up. For example, if (s)he sees foraminal stenosis at the L4-5 level on the left side, and the patient comes in with right leg pain, then (s)he concludes that the foraminal stenosis on the left is an incidental finding, because the doctor's goal to to find the source of the right leg pain.

If this seems complicated, then that is why they train for so long, and literally read hundreds of x-rays, CTs, and MRIs during their residencies, refine their exam techniques to improve the yield from physical examination, and listen careful to hundreds of patient complaints. It is a puzzle that they practice over and over putting together. They have no interest in forcing the pieces in the wrong places.

They know that low back pain may not due to an anatomical abnormality that shows up in an imaging study.

One final illustration to make the point: from patient reports, migraine headache pain can be severe, so severe that the patient becomes nauseous, leading to emesis. Guess what? Assuming this is a migraine headache (and that the symptoms are not from another disorder), there is no anatomical abnormalities that account for the pain. The doctor can even order bloodwork -- CBC (complete blood count) and CMP (comprehensive metabolic panel), and these labs will show absolute nothing.

Is migraine headache real? Absolutely, but according to the present state of medical knowledge, this real pain doesnot have its origin in an anatomical abnormality.
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Old 06-18-2019, 07:36 PM
 
25,967 posts, read 32,962,923 times
Reputation: 32145
My mother had a spinal fusion in August 2015. One of the "best doctors" around for this particular surgery. She wound up with a dural tear that they did not discover until 3 days later. I can't even describe to you all the things that happened to her because of that. It was a nightmare. 2 hospitals, several infections, wound vac, flap surgery, rehab. She finally came home 6 months after her surgery, in a wheelchair. Had a hospital bed for 6 months. It was hell for a year after. She'll never be back to where she was either.

Be very sure about your decision.
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Old 06-18-2019, 07:52 PM
 
Location: DFW - Coppell / Las Colinas
31,970 posts, read 36,594,800 times
Reputation: 38543
Quote:
Originally Posted by greatblueheron View Post
Get a second opinion!!
Yep... My father had spine surgery from a crappy Surgeon and left him a Paraplegic.

So much damage to his spine they had to install a Morphine pump and he died 18 months later. It was a terrible time.

Wish we had seen some specialist and gone to the very best Doctors for 2nd opinions.
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Old 06-18-2019, 11:10 PM
 
Location: Moore, Ok
78 posts, read 65,456 times
Reputation: 269
We think this guy is top notch and has an extremely great reputation in our area. We luckily got in with fabulous people and I think it will go great.
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Old 06-19-2019, 12:03 AM
 
Location: Florida Gulf Coast
4,404 posts, read 5,917,359 times
Reputation: 7116
As far as the spine being a "mystery" to doctors, I think the mystery is whether surgery will actually help. My own lumbar diskectomy didn't help at all. The next step I was considering was a fusion but first, I got an opinion from two top spine orthopedic surgeons in city teaching hospitals. First was going to do it but was out of network for my insurance. Second said my disks were all too degenerated and that he wouldn't do a fusion unless the disks above were healthy enough to support the fused disks. I later got a tie-breaker opinion from a neurosurgeon, who agreed with the second doctor. When I got the medical report from the first doctor, the one who was going to do a fusion, his last sentence was "My only fear is that she won't have relief from her pain." WHATTT?? Why would I embark on a huge surgery with a six-month recovery period (at the time) unless I was pretty much guaranteed it would stop the pain.

But nerve pain is a tricky thing. I've seen/read about too many people who've had one back surgery after another. The first one may help but later problems develop with other disks, and it starts a slippery slope. Anyway, this is not meant to discourage you because of course the dropped foot is very serious, but don't jump into it without doing your research, asking a LOT of questions, and getting a second opinion. For example, I have nerve damage down my arm from degenerated cervical disks. I can no longer lift my arm properly, and now that has resulted in "scapular winging", where the shoulder bone juts out when I lift my arm. A neurosurgeon had recommended a cervical fusion. However, he couldn't guarantee that would resolve the arm problem. Since I was no longer having acute pain, I decided against the surgery...too afraid it would kick up some other nerves in there. He said some surgeons try to scare you with the "possible paralysis if you don't do the surgery" line, but he's not one of them. I appreciated that! So make sure you ask if the pain and dropped foot will definitely be resolved. Good luck!
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