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Surgery or medication?

2

Comments

  • Keith,
    What was your recovery like. I am 5 weeks post-op and my biggest issue is moving from one position to another--I feel like my spine is going to pop and is unstable. Then there are the pain episodes throughout the day that make me want to die. When did it get better for you?

    Chuck
  • I took my pain meds every 4-6 hrs for some time and layed on an ice pack alot which helped. I was then put on Lyrica 75 mg 3 times a day that also helped alot. Walking is one of the best things for you so walk at least 2 times a day and hit the ice pack as much as you want and it should get better. Stay positive and get plenty of rest and things should start getting better soon. I can't remember what week things started getting better but whe it did everyday was a little better from that point on. Good Luck

    Keith
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  • Well, I saw the surgeon Monday. He confirmed that my diagnosis is DDD (from the MRI, discogram, x-rays, & CT scan), there is no stenosis or herniation (no pressure on nerves visible by MRI). Two levels are affected, L4/L5 and L5/S1.

    He gave me two options:
    1) Two level fusion: ALIF or minimally invasive TLIF
    2) Hybrid: TDR (total disc replacement) at L4/L5 and ALIF at L5/S1

    The hybrid option is because he thinks there may be evidence to suggest that the so-called domino effect of adjacent levels degenerating after fusion, may be eliminated with disc replacement. And since TDR is not FDA approved for two levels, he suggested having TDR at the top level and fusion at the lower level.

    After doing some reading, thinking, and discussing it with my boyfriend, we both believe that the hybrid surgery is worthwhile and the choice for me. Now, my insurance won't pay for TDR, and the surgeon said it will be ~$8000 :jawdrop: . But we feel that my health and well-being are worth the extra cost to us.

    The disc replacement that he said he would likely use is the Prodisc. He has also done Charite (sp?) disc replacement, but I don't know what the difference is, and why he would choose one over the other.

    I now have some additional questions to ask, now that I have had time to think.

    -For the fusion - what type of graft material will be used (my own bone or BMP)?
    -Prodisc discs come in 2 sizes, I would assume that if the smaller one doesn't fit then he would do fusion at both levels.
    -What is the expected lifespan of the Prodisc?
    -Is there anything I can do before surgery to make recovery easier or faster (exercises, eating)?
    -With TDR, how often do they need to go back in because the disc moves out of position?
    -I also want to get a better idea of recovery - how long with restrictions?, before going back to work?, climb stairs?, wear a brace and what kind?, PT?
    -Will my boyfriend be able to be with me all the time, in the hospital?

    The surgeon said that recovery would be 3-6 months, but I'd like to know how long before I could reasonably be expected to go back to work (I know that every person is different, but I want to know more than just a vague 3-6 months). Because now I am concerned about my job. I can apply for FMLA, but that will only protect my job for 3 months (and it doesn't even have to be the same job).

    My workplace has a donation vacation program, where people can donate vacation time for people who don't have enough time off of their own to get them the point of long term disability. For me this means getting to 4 months. The other stipulation to the program is that the employee needs to have at least 1 month of their own leave first.

    Based on all of these various concerns, I am thinking of scheduling surgery for the end of March or April. By then I will have 6 weeks of my own vacation time. I will apply for the vacation donation program, for extra time off (hopefully enough to get me to 4 months and long term disability - if I need it that long). This will also give my boyfriend and I enough time to have the funds necessary for living expenses if I am not getting paid (the $ for the TDR will have to go on a credit card).

    I did find out that I can do some of my work from home, so I am hoping that might be enough that my boss will keep my job open for me. Even if I don't get paid during the entire time I am gone, I could continue to do some work for 10-15 hours a week. It would give me something to do, to relieve boredom.

    But I need to look at the big picture. I am not, not going to have surgery for fear of losing this job. At present, I don't even do all that I was hired to do, my job has been scaled back to administrative work because I couldn't handle the stress on my back from the lab work. By having the surgery, I can go back to my full profession, even if it has to be somewhere else.
  • I haven't had surgery as of yet but have done a lot of research on the ADR surgery, It appears they have been having a lot of issues with the disk migrating out of the disk area and causing issues with other back area. Also, if they have to go back in to remove it, there have been issues with some major blood artery's sticking to the ADR which causes extreme danger in removal and possibly no removal if too dangerous for a surgeon to pull it. Either way, they would then have to do a fusion anyways.

    Even after all that, I myself am still interested in the disk replacement more than the fusion but will wait awhile until more progress is made.

    PS: They are developing a ADR disk that has a silicon like surface which will prevent the blood vessels from sticking.

    I didn't see in your post you mentioning if you have short term disability at work. Usually company's who offer long term have the short term kick in first, for your sugery.
  • Short term disability is a voluntary program, and unfortunately I didn't sign up for it.

    It sounds like maybe I need to do more research on disc replacement.
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  • i had a discectomy and 2 level fusion. i also had sacral tumor that was biopsied. I was on narcotics for 2 1/2 years and all I wanted was to get my life back. Using BMP increases fusion rate to 95 percent. That was good enough odds for me. my dr removed discs and rreplaced them with bone and bmp. Not easy surgery, mine was almost 8 hours. But have faith in your Dr. Have faith in yourself and a good support group and you will do fine. My pain was not found until discectomy. I had to fight the insurance company and was denied twice. The second timne I was denied I called the CEO of my health ins co. Got things done then. Let me know if I can be of help. Good Luck
  • I had a couple surgeries and feel awesome, but I'm still around. Not everyone uses the forum while they're feeling crappy and then says peace out soon as they feel good. Lol :) I'm not going anywhere.
  • I also had BMP with my fusion and was showing signs of fusing at 2 months post op! :) BMP is an awesome thing. Except when Drs use it in the Cervical area, for which it is NOT FDA approved. Silly drs. Ugh. Haha.
  • dilauroddilauro ConnecticutPosts: 12,813
    is something that many people are looking for a formal and one time answer. Unfortunately, the spinal column and its relate problems is not black and white.
    There are so many different variables when it comes to disc problems, nerve problems and more. No member on this board is qualified enough to give you an answer that is fool proof.
    You hear opinions based on personal experiences.
    You need to go into lengthy discussions with your doctor(s) about this. Waying the pros and cons of each, what happens if you just delay surgery, what else could happen, etc.
    Then the final answer will have to come from yourself, once you have everything laid out on the table
  • Hi Treefrog,
    I will add my opinion too.

    Ulimately the decision is yours but with hindsight i would say this.
    I think surgery should be a last resort, only as I am a walking example of some of the complications. My first operation was 23 months ago and I am still not out of the woods. This is a huge chunk of my life, on hold while I hope for a better place after recovery.
    I was not offered pain pills. My surgeon sad they would not work. I don't know, but I do take them now and they take the edge of it.
    So, unless you have a mechanical problem that will cause serious issues, Like CES, I would push myself as far as possible on the medication.

    Either your symptoms will settle or they won't. There will be a break through point on the medication and a trade off with side effects. Can you tolerate them, yes / No?

    You may decise you don't want to be like a zombie, you may find you can take the pills with out too many problems. You may buy yourself a few more years. You may not.

    One day you may say -"enough, I can't go on like this" and that, imho, is when surgery is your next step.

    I hope that makes sense. It is very hard writing it.

    Good luck!
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