Advice on a possible 5th operation on my spine.

[Tom Odda]

Before I ask my question I shall give you a brief history of my operations.

1st Op, level 2 Discectomy L4/L5, L5/S1

2nd Op, Decompression, Laminectomy.

3rd OP, Discectomy L4/L5.

4th OP, Level 2 fusion, L4/L5, L5/S1 (no metal work just synthetic bone grafts.

Unfortunately June this year I started to develop sciatica down my leg left. This is now so severe i've lost all feeling in my left foot and cannot move my toes towards me and I also struggle to pull my left foot towards me. My pain management specialist referred me for an MRI scan and I recieved the results a couple of weeks ago. Now to my surprise the scan revealed a disc prolapse at L5/S1 which is the same level I had fused. The pain management specialist showed my scan to my spinal surgeon who was also very surprised. Apparently he has only seen two patients who have suffered a disc prolapse at the same level as the fusion and I happen to be this 2nd patient.

So my question is has anyone else suffered a disc prolapse at the same level as the fusion? Or know anyone else this has happened to? I have googled this and found nothing!

Thankfully i have an appointment to see my spinal surgeon this coming Monday. The only postive thing from this episode is the speed of recieving a diagnosis. The whole procedure of recieving an appointment for an MRI scan, getting results, appointment to see spinal surgeon has been less than 4 weeks. I waited nearly 2yrs for this during my first episode!

I will add that apart from my spinal problems I also require an operation on my right hip. Last October I was diagnosed with hip impingement syndrome with a non spherical femoral head and poor acetabular coverage. However the surgeon will not perform this operation until my back problems are resolved. Apparently I will require extensive physiotherapy after this OP and my pain from my back will prevent this from being successful.

Finally I will say that im sick and tired of being in pain but im also sick and tired of operations. I live on my own and find it very difficult to move around. Im basically hanging onto my crutches just to walk from my bedroom to my kitchen and I live in a small ground floor flat. I must admit all of the above has had a detrimental effect on my mental state because I find pain, Operations affects me mentally and not just physically. Also the stigma attached to people with a bad back doesn't help!

 

[Ricky King]

Hi, sorry for not commenting on this earlier. I did not seen this thread.

First of all, I am sorry to read all this. You are very unlucky person.

Secondly, they have made a full discectomy, put a inmassageplanetody spacer and they did not used stabilization and fixation hardware? Insane... Nobody does this any more. It's well known that usage of hardware during spinal fusion procedure improves the outcome and IMMEDIATELY stops painful spine movements!

To get a successful fusion (now I talk about fusion of spinal segments that is a result of spinal fusion surgery), it's necessary to remove as much as disc is possible (annulus, nucleus and posterior ligament). Not removing enough of this elements cause:
1. Further pain causes by degenerated disc
2. Unsuccessful fusion of segments
3. Herniation of non-removed parts of disc

If surgeon removes all disc content, re-hernation is impossible. This implies that your surgeon did not removed enough.

Maybe a good way for you to go would be a spinal injection near the nerve that causes your recurrent sciatica!

Good luck!

 

[Just Jess SUSPENDED]

Keano16 - you say some strong things about the surgery this person has received. If what you say is true, would that be grounds for taking legal action against the surgeon? Would you be someone qualified to be an expert witness in such a case?

Ogothorpe - Is it just possible that this approach is leaving the cause of your problems intact? Local correction can sometimes just move the problem around the body, or simply not make it go away at all if the maintaining factors are strong. I'm prepared to bet that your doctors haven't said anything meaningful about cause, except perhaps to say you're stuck with it.

 

[*June Bug* (MC)]

No, I don't think there is any space for legal actions. Surgeon did not do anything against the law. He just did something against and opposite to common sense and current principles of spine surgery.

 

[Gwathannen]

Well, 'insane' is quite strong, 'nobody does this anymore', well clearly there's one surgeon who does. It looks to me as if you're bringing into doubt the competence of the surgeon on the basis of a difference of opinion.

I would suggest that you are a little more cautious about seeding such thoughts in the minds of a patient, who may be in a marked state of vulnerability and distress, and about whom you know virtually nothing.

There are two principles of professionalism to which I feel it worth adhering:

1) Don't attempt to assess a patient you haven't seen (Robert Winston describes this as a hallmark of a foolish doctor).

2) Be respectful of colleagues - what goes around comes around.

If you really think this person's doctor has been reckless, foolish, incompetent, out of date, unskilled, improper; then those things ARE grounds for complaint and possible legal action. Be prepared to see such accusations through.

Because they are serious professional defects, suggesting such things out of line may also be grounds for professional complaint, discipline or legal action, so you'd better be certain that what you say will stand up if challenged. In the context of HP they are also moderation issues.

More importantly, such information may be highly influential to a patient, or even quite distressing. So please think of the effect on them, and not just the promotion of your own theories.

 

[Zach N]

This are not my own theories. Based on evidences and facts, I have supplied a patient with some honest information.

 

[Prime96]

Okay, I believe in evidence too: show us the evidence that this surgeon's approach is 'insane' or out of date and that will be the grounds for a complaint and possible legal action.

 

[apples]

*** Mods Post ***

I would like to remind posters to keep on topic, i.e. the original question.

Also readers should take into account that this is a public forum and the views expressed should only be taken as opinions and not medical advice.

On behalf of the moderators,

Myarka.

 

[Jordan Galloway]

Thanks Myarka, but I'm not sure which aspect this relates to specifically. What is the correct way to object to the tone or content of a post, without going OT?

IMHO offering specific advice and slagging off colleagues known or unknown are both unacceptable.

 

[mohammad m]

You know I spent a long time thinking about the list of operations and just wanted to add that I feel like I am almost the 'control ' here to ogothrope's operations, I have been offered many and had none because I want an MISS not some harsh hatchet job.
But, there are some increasing similarities about the operation list that may indicate that even if I had had the ops I would still be facing the next? I have had several mri's that show the degradation over time, so would the first op have actually negated the need for the second more complicated one, or the third or fourth? I am now wondering.

Did I have a lucky escape?

 

[Turdo, Hand Held.]

Thanks for the interesting replies. I would like to add a few more details about the fusion especially after reading the replies.

When my surgeon suggested the fusion that I had in May 2009 he did suggest a fusion by using metal work. However I wasn't keen on this and asked if it was possible to perform a fusion without using metal work. The reply was yes by just using the bone grafts. Now the reason I didn't want the fusion using metal work is based on my experience back in 1996 when I had my first operation. The patient next to me in the ward had just come out of surgery for a spinal fusion on the day of my admission. In all my years I have never ever seen anyone in such extreme pain. This scared the life out of me because of course back in 1996 I was only 25yrs old.

Now of course I have the dilemma of opting for either the less painful discectomy or the fusion via metal work. Im not really worried about the pain if I opt for the fusion because during my last operation they gave me a PCA to use which made a massive difference to my post op pain. If I opt for the discectomy im told there is a risk of further prolapses in the future. However if I choose the fusion this should prevent further prolapses at this level but the surgeon warned me of the risks of the screws becoming loose plus its a much bigger operation with many more risks.

Im just so nervous about having screws being placed into my spine. The main reason is im convinced there is some hidden problem. Having a problem with my hip also cannot be down to just bad luck. Like i've said previously my niece has also had spine problems and recently been told she has Necroses of the hip!

All I know is I cannot carry on as I am because I just cannot cope with this pain especially living on my own. However I see pitfalls with either operation and quiet frankly im sick and tired of going into hospital for various treatments. If I tally all my operations and procedures since 1996 then I have had 10 GA in the space of 14 yrs because i've also had 2 other operations that were not related to my spine. Now considering I need at least another 2 operations (Hip,Spine) you can see why im so fed up. Basically what I want is a miracle i.e perfectly healthy without any more medical intervention. Someone once said to me "I supposed you get used to going into hospital" and my reply was "No if anything it gets worse".

 

[pinkandprettyp]

Ogothorpe, if anyone needs a second opinion from Mr Knight it sounds like it is You.

 

[nick h h]

Depending on severity and location of your current pains and problems, see your surgeon, see another one (second opinion) and surf about SCS - Spinal Cord Stimulator. After so many surgeries, maybe you can be a candidate for this.