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911Doctor
911Doctor, Doctor
Category: Health
Satisfied Customers: 5094
Experience:  Board Certified Emergency Physician
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This is regarding my father who does not have English language

Customer Question

This is regarding my father who does not have English language hence asking on his behalf.

Issue Concerns: Spine / Neurosurgeons

- 75 years old.
- Been active throughout his life with various sports.
- 1 car accident 30 years ago. Hit another car face to face at 80 km (no major problem).
- Height 1.75 cm. Weights 70 kilo (looks slim and very fit for his age).
- Had/has no illness.
- Nevertheless, has been having pain in L2/3/4 discs and gets a pain on his left hip.
- X-Rays shows that the discs have lime and the health gap is worn-down.
- Dr. suggested operation a year ago with an option that he can first try a Chiropractor.
- He has seen various Chiropractors in several countries and had adjustments.
- Pain is still there and he is ready for the operation.

Questions:
What are the operation-alternatives?
Which one is preferred? & Why?

Kindly add any other relevant-comment that you believe may be helpful.
Submitted: 3 years ago.
Category: Health
Expert:  911Doctor replied 3 years ago.

Hello and welcome to JustAnswer,

 

Hello. Prior to any surgery your father needs an MRI of his lower spine to see where the disc is protruding. This will make the decision about what surgery, if any, would be best.

 

The best option, and it would only be an option for certain kinds of disc problems, would be a MICRODISCECTOMY. This surgery is quick and the recovery also quick.

 

For other problems that are more complicated involving the disc a LUMBAR FUSION AND DISCECTOMY might be needed.

 

There are other procedures and other methods for relieving pain surgically, but the key is to define the exact problem. That is done with an MRI. Then, and this is the MOST IMPORTANT PART, your father needs to go to the BEST orthopedic spine surgeon OR neurosurgeon available for a consultation.

 

If he is going to have his back operated on he needs the most experienced surgeon with the best outcomes.

 

I am standing by if you have any questions.

 

And OBTW, i have had both a fusion and a discectomy for different reasons.... the fusion recovery is a long process.

 

best

 

 

911Doctor, Doctor
Category: Health
Satisfied Customers: 5094
Experience: Board Certified Emergency Physician
911Doctor and 5 other Health Specialists are ready to help you
Customer: replied 3 years ago.

Thanks for the last answer.

 

It seems that my father already has his MRI and I will be able to find out more by speaking with his doctor.

 

If they suggest the Lumbarfusion and Disectomy, I would like to know:

 

1. What is the difference with the method shown in the link/video that you have sent versus the method shown in below link:?

 

http://www.spineuniverse.com/clinical-trials/back-pain/superion-interspinous-spacer-lumbar-spinal-stenosis

 

2. If he needs Lumbar.... but does not favor a complicated/heavy surgery, how much would he be expecting from Microdisectomy!?

Expert:  911Doctor replied 3 years ago.

unfortunately, since i am not a spine surgeon, i can not get into the benefits or downside of either procedure. however, i CAN tell you this.

 

what you want for your father is for the disc protrusion to be isolated and easily reached by an operating scope. this would allow for the microdiscectomy.

 

a fusion is typically done if there is instability in the lower spine along with the disc protrusion. AND, if a fusion is needed, then each spine surgeon has his or her favorite procedure to do the fusion.

 

so the first question would be if a simple procedure like a discectomy will suffice. the recovery is simple.

 

he wants to avoid a fusion if at all possible, especially at his age, as it comes with many complications and once a segment is fused it is nearly inevitable that, sometime in the future, he will get another disc herniation and might require another fusion. before long he is worse off than he is now.

 

so, i don't know if i answered your question, but before agreeing to a fusion, i would ask very specifically if a less invasive and debilitating procedure can be done. also, if he has not had epidural steroid injections these can often provide great relief and buy time for the problem to resolve over time. most disc herniation pain resolves in a six month period.

 

these questions, and they are all good ones, should be directed to the spine specialist he eventually sees, but again, if a fusion can be avoided it should be.

 

does this answer your question?

 

best
Customer: replied 3 years ago.

At the beginning of my first question I had stated that the issue concerns Neurosurgeons hence assumed that an answer will be given to my first question regarding the difference between the implant and the one with the nail but I appreciate your honesty.

I also appreciate the other extended comments/suggestions you have made.

Perhaps you may try to answer my second question just a little better by pointing out what a patient may expect from Microdisectomy if his case needs the Fusion;

Would this mean that if the state of his case is approx. 8/10 while Microdisectomy would only provide say 5/10 relief and he would get the pain back within approx. a year?. Or, is this just an amateur thinking and the fact is that if he needs the Fusion, Microdisectomy would not mean anything? (simply, would Microdisectomy help before going into a heavier/complicated/kind of risky operation?).

Expert:  911Doctor replied 3 years ago.

I'm not sure i understand your question but let me try.....

 

A microdiscectomy is CURATIVE of pain caused by a herniated disc and would ALWAYS be the right procedure if there were no spinal instability which may have contributed to the disc herniation in the first place.

 

the reason to get a fusion is not because it gives a better result for pain from an isolated herniated disc, but because the spine, at that area, is 'loose' and needs to be fixed in place to prevent future disc herniations.

 

your father was in a high energy collision, certainly enough force to rupture a disc, and also enough force to cause small fractures in the spine and its supporting elements. however, it does not sound like the latter is the case.

 

if a micrdiscectomy is recommended GREAT!

if a fusion is recommended ask why. the recovery from a fusion is six months .from a microdisc about ten days.

 

does this make sense?

 

best

Customer: replied 3 years ago.

 

Thank you for your kind answer.

Expert:  911Doctor replied 3 years ago.

my pleasure. and best wishes to your dad for a simple surgery that fixes him!

 

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