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Considering Surgery

I've been dealing with herniated L4-L5 disc for about  2 years now.  Diagnosed on MRI, circumferentially bulging disc.  Also have arthritic changes in cervical spine and hips.  I have an underlying neurological dystrophy called CMT which is genetic from birth which is a complicating factor and makes me wary of jumping into surgery without doing my own research into what I should do.  I had a consult with an orthopedic surgeon last year who said that if everything else I tried failed (it has, including pain shots), he would do a laminectomy, which is a 2 hr operation.  At that time, I was scared of getting into that, so continued to explore my options at pain management, but nothing has worked.  I also don't just want to throw pain meds or anti-inflammatory drugs at this, if it can be helped surgically.  

At no time did the orthopedic surgeon suggest microdisectomy. I had asked if there was a less invasive procedure he could do to fix my problem and he said, "lamniectomy is the least  invasive option."  Naturally, this bummed me out, and I haven't been back to him, although I did like him and his staff.  

So, is there a reason why I wouldn't have been offered  MD rather than a full two hr procedure?  I realize, lesser surgeries can fail, but so can bigger surgeries.  It is worth my time to pursue a md rather than laminectomy, given my underlying health issues of a neurological dystrophy.  I am wary of finding myself in even worse situation.  I do not have sciatica, no leg pain or burning or any of that.  I mainly hurt when I bend over, turn, or's more of a "mechanical" pain if that makes sense.  My back does not "ache" or have shooting pains.  But my back in the L4-L5 area feels like a horrible, massive injury type of feeling, huge pain/pressure on any flexion of the back in that area.  I am now desperate to get this alleviated, because nothing else has worked.  Had two sets of pain injections into the L4-L5, and only get minimal 2 week relief where I could bend over easier without as much pain or stiffness. I have given up on pain injections, as that does not work.  Thanks for any input about microdisectomy in my particular set of circumstances.


  • smartens162smartens162 Manitoba, CanadaPosts: 448
    An orthopedic surgeon specializes in surgical procedures of the bones, generally speaking.  So they recommend what they know.  Have you thought about a second opinion, one from a reputable neurosurgeon?  I can tell you that when I first herniated my disc L5-S1, I saw 3 different surgeons, each recommended a different surgery.  They recommend whatever it is THEY can do for you.
  • I will be getting several opinions, and will certainly keep in mind your suggestion to see a neurosurgeon.  I just saw my rheumatologist today and they said a surgeon would require a myelogram before considering a microdisectomy, to see if I am a candidate for that.  They also said pretty much what you have said, that every surgeon will probably have a different suggestion.  I'm just now starting on my journey thru this hell, and I can already see it's going to be a confusing situation that takes time to sort out all the conflicting information and get the best possible result.  
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  • I'm updating the thread I started here....hopefully it can benefit others who are going thru similar things.  I have now gotten a surgical opinion from an orthopedist.  He wants to do XLIF, which I am very unsure of.  I have been doing some research into XLIF and it seems like there's a lot of neurological complications or at least the potential for it.  I found at least one medical journal article talking about this factor and wondering if XLIF should even continue to be offered to patients.  .  I already suffer from a form of dystrophy, so  I'm wondering if XLIF would make things worse, particularly with the leg weakness I'm suffering from due to nerve/disc compression.  I have an appt. soon with a neurosurgeon, so I will find out more and update again.  If anyone has info they'd like to share about their XLIF experience, that would be great.  I've read many of the posts on the forum about XLIF.  Thanks again..
  • Adelthea17AAdelthea17 Seattle, WAPosts: 14
    I was told I needed an XLIF for my severe lumbar stenosis, and I was scared of it, too. Then I saw a highly regarded doc who felt I would get sufficient relief from a laminectomy to free up the compressed nerves. I went into surgery at 2:30pm on Dec 28 of last year, went into recovery at 3:30, was walking down the hallway at 6:30, and was home at 7pm.  Mine is a real success story, and i'm so glad I was able to avoid fusion. I can now walk normally without leg pain, although I'm still working on restoring muscle strength. 
    Two hours sounds like a long time for a laminectomy. Maybe he was referring to a traditional open laminectony. If so, perhaps you should see someone who does minimally invasive surgery. Recovery is much quicker.
    Some patients do need fusion, but it seems like some doctors have a one-track mind and think that any surgery involving the lamina has to be combined with fusion. Other doctors who are willing to try a simple decompression and avoid fusion if absolutely necessary. I found my doc by seeing who in my area was trained in doing coflex surgery. Although I wasnt looking to do the coflex, I figured those trained in the technique would be those willing to look past traditional approaches.

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