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Personal quest seeking Coflex over fusion

I spent the last decade plus looking at multiple approaches to my back problems that started with numbness in both thighs. I wasted six years before thinking about any "medical procedures" and so I hope this post will help others that are similarly dragging their heels. --I also did lots of PT, daily core strengthening, and a daily visit to the Jacuzzi tub.

After prodding from my wife (thanks Hon!),  I finally had an MRI done and the diagnosis three years ago was severe stenosis at L4/L5. I was also warned of the possible on-set of Cauda Equina Syndrome (e.g. losing control of everything from the waist down… that can become a permanent condition after 18 hours) and since I travel a lot, didn't relish the thought of emergency surgery overseas. Went through the 5-step insurance protocol for surgery and investigated several alternatives. The bottom line is that I just had Coflex inserted at L3/L4 and L4/L5 with limited decompression surgery. The constriction was something over 90% at L4/L5 and after 2.5 weeks of recovery so far, everything is on the upswing and the opioid use is on the downswing. But the most important thing I wanted to communicate is the tortuous path to finally get this more up-to-date treatment.

I do research for a living and so used the same approach to make the decision whether or not to move ahead with the Coflex procedure/limited decompression surgery. I considered steroid injections, standard fusion, and the so called x-stop. I read some very good studies on various approaches and Coflex v. fusion (use Google Scholar ...and don't let the fancy paper titles scare you) and they are even somewhat readable once you wade through the jargon (..which I have heard others say is a technique to keep people from communicating effectively... ). My conclusions were as follows (Please note that I am not a medical professional and these conclusions were for my personal decision only!!)

(1) Steroid injections are OK, but some studies show that they remove the pain reflex action and patients think they are "fixed" when in fact they are not. So patients tended to abuse their backs thinking everything was OK and ended up doing more damage. So the recommendation from that study was to minimize the number of injections and if there is a structural problem as indicated on an MRI, fix it with surgery instead of masking it with injections. Patient outcomes were better in the long run. But because of insurance protocols, I did have two injections. One lasted 3 months, the second about 1-2 weeks. (2) Sometimes fusion cannot be avoided and there are people who are starting to use robotic micro-surgery that uses the MRI coupled with robotics to be more precise in the stud placement (very, very, new). But even at that, I am a fairly aggressive downhill skier in my 60s and so I was concerned with transferring the stress that would now be concentrated above and below the fusion and eventually taking out those joints also. The effect can continue to propagate and require even more fusions. Having talked to four surgeons, none could guarantee that this effect would not happen. In addition, they usually remove the back side of the vertebrae (the so-called spinos process) which concerned me that the spinal cord would be less protected as nature intended. (3) X-stop was no longer available at this time. I talked to the inventor and personally, I did not see any difference between this device and fusion as it did not have the "springiness" of the coflex device. The x-stop and similar devices are intended to limit range of motion which I did not want.

---So I went with Coflex. Although there is some restricted rotational movement along the spine, the "springiness" is maintained at each vertebrae in the up/down direction. So that unlike the fusion procedure, the stress the entire spine takes stays distributed.

Getting the insurance (a very major national company) to pay for the procedure is a story in and of itself. We finally won in binding arbitration after six months of appeals. Insurance companies claim the procedure is experimental, but I supplied 4-5 detailed studies that were “peer refereed” (the gold standard in research) and argued in a synopsis that in fact Coflex is a proven technology. --The latest five yearlong study shows that outcomes were statistically significantly better than the fusion procedure, were lower cost in the long run, required less time in surgery with lower blood loss, and had fewer re-surgeries. The binding ruling that came back is that Coflex is not experimental and so they were required to pay.

Coflex is not a silver bullet that fixes everything and it may not help everyone. The original pain disappeared right after surgery. But recovery is slow (6-10 weeks) with many ups and downs.... especially as nerves/muscles realign and pain signals start getting through again, but I am very hopeful on the final outcome. Like I said, two and a half weeks have elapsed and am weaning off the opioids and hopefully can start PT in another month. ---And am still convinced that I made the right decision even though I still have my “peak pain” days ….just as my surgeon said would happen.  --Next year, I hope to hit the "steeps" and "chutes" ski slopes again, but my surgeon says I may want to hold off on the Volkswagen size moguls on the infamous "Face" since I am not getting younger. –Oh-well, but life does have to change somewhat as we age.







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Comments

  • engr, thx for your post, how are you doing now, almost a year later?

  • Great story! Glad to hear you are improving. Just had microdiscectomy jan 9 and doing well. Still need a more invasive procedure for Spondylolisthesis. Some day they'll figure out how to do spine transplant! I've been saying my whole life I'd be first in line.....

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