Another Question/Lumbar

[Kathi49]

Sorry you guys I should probably be writing this on the spinal forum but there are a lot of "spineys' here too. :)

My husband is in a bad way with his back again. I have already said the L4/L5 is herniated and fragmented. To make a long story short, he is to receive a Selective Nerve Root injection on Tuesday. It may or may not help...don't know but I personally doubt it. But his PM mentioned a Laminectomy the last time we were there. What I want to know is...WHY a Laminectomy and NOT a fusion? I know the former is less invasive. But isn't there usually more issues down the road? I guess I have just read so many stories where people eventually had to have a fusion after a Laminectomy. I will say his other vertebrae look fine or rather just very mild bulges. But I keep visualizing a piece of bone removed only to have things collapse. But I could be way off base too. :) Any thoughts would be appreciated. He keeps asking me what I think and I really have no answers. But I WILL ask him PM on Tuesday what the reasoning is OTHER than less invasive.

[Mark N]

Kathi, a fusion should really only be done to stabilize his spine. As long as his spine is stable a surgeon will use a less invasive surgery to take care of the problem. I think in your hubby's case the surgeon is thinking he needs to clear out the fragment and reduce the herniation thinking his body would heal since his spine is stable.

[lobelsteve]

www.spineuniverse.com

Fusion is good for profit/stabilization. It is done 5x more in the US than in any other country. Back surgery is 90% successful. Those folks don't post here, and don't come in to my office. So all we see is the 10% that don't get relief.

For a procedure to be successful: right patient (with right diagnosis), right procedure, right time.

[Kathi49]

Thank you Mark and Steve,

First, I have to say I made a mistake...duh! It is his L5/S1. I don't know what I was thinking; probably my own problems from L4 to S1. :o We both have similar pains but different issues.

Mark, he hasn't seen the surgeon yet just his PM. And his PM didn't say or rather isn't rushing him into surgery just yet. He just happened to mention a Laminectomy in passing IF all else fails.

Anyway, my own PM mentioned a Laminectomy to me as well...awhile back. As in perhaps down the road.

So, thank you again you guys I just am NOT as familiar with lumbar.

I will let you know how his injection goes and post back after that.

[Nana4&cntn]

Kathi,

I am sorry I am of no help, i did close to a year of conservative treatment prior to being fused. My spine was unstable, Kind of like me:D

I hope you find the info you need, I wil say if fusion is done at anytime I would stay away from the cages they use for fusion! Long story.

I hope he feels better soon.

Take care,
Kathy

[Kathi49]

Thanks Kathy,

My husband has been doing the conservative bit for quite awhile now; probably about 3 years worth. With the exception of PT. Usually, it was an injection and he was okay for a LONG time. It was amazing to me at how long his shots did give him relief. And the only time he took meds it was usually Ibuprofen off and on OR Naprosyn. Or he would use heat or ice. Oh, and he still has that same dang bottle of it LOL! His PM said he has had a good handle on it for quite awhile now. It just happened to really blow out (fragment) when he was bending over to pick something up and sneezed at the same time. That's when he said he almost hit the floor and told me later he came close to asking me to take him to the ER.

I will make sure I tell him about the cages. But I don't think or I haven't heard of the spine group we go to ever using them. Then again, they might. I just haven't heard anyone else I know that goes there and has had fusions ever mention it.

I think it will probably be a Laminectomy in the long run. Right now it is just one of those things I don't know much about or what THEIR thinking is. I will find out more on Tuesday. :)

[GJZH]

Kathi,

This is just my opinion.... it is from articles I have read and messages posted on the forums about laminectomy on the forums.......I think laminectomy works for those people that have very minimal problems with their spines...I referred a friend's husband to a top doc in Philadelphia...He did a laminectomy at L5/S1 and he is out golfing...BUT laminectomy does not work in many, many cases...I had a laminectomy done first before my fusion...I feel they should never have done the laminectomy because I have so many spinal problems that the laminectomy could never addresss them and made things worse instead of better. ..I had this odd sensation of wiggling in my lower spine when going up and down stairs after the lami....It did not help with any of my problems .... It was about a year later that I had the fusion...

[Kathi49]

Gloria,

I very much value your opinion. :) I know you have been through the ringer. :(

I wasn't just thinking of the Laminectomy procedure alone; I was also thinking about his age, condition of the other discs, etc. So, okay, when I looked at the brochure on how it is done and different videos, I think...wow, there is just this open space left. Then I read further that even if some spurs are drilled out there is still motion and perhaps MORE nerve irritation. So, this whole thing just makes me want to ask...where is the STABILITY? And now you bring up the wiggling feeling. That is pretty much where I am going with this thread. Sorry, I am not stating this all very well. :eek: But you know what I am trying to ask or say. It just seems that even if they did remove a little piece of bone then there could be problems down the road as you are saying. Then again, is a fusion the answer? I really just don't know. I guess it will be the surgeon's and my husband's call. But I am letting him know everything I can find out. BUT...I don't want to come across as...here is another horror story either. You know what I mean. :) I guess I am just saying that I want him to be aware of anything and everything.

It was kind of funny last night because he wanted to know more about a Selective Nerve Root injection. So, there I was trying to explain one of those and I had to get out a picture and show him what they do. I didn't sugar coat it though...just so he knows the doc will elicit a pain response but it is just for a moment. He just couldn't differentiate between that and an ESI. I just told him look at this way...the doc is just going to target, NOT HIT, a specific nerve...looking for the precise pain generator. And then, of course, I told him I have had them myself. For me, they aren't bad at all. But everyone is different. And I think he is okay with it. I think he is to the point that he doesn't care...just do something. So, we shall see how this goes. It may very well be that he gets more relief...maybe not. But I am planning on asking his PM more questions.

Anyway, thank you again for your input Gloria. :)