Question on Disc replacement

grog18b · 01-21-2008, 18:43

On the same note as the "Chronic lower back pain" thread...

My lower back has been getting much worse as of late. I have a very hard time getting to sleep, and if I do, I wake up at 0200-0300 because of the pain. It makes any task difficult, and it's hard to sit or stand for over half an hour at a time. I can do things, like lifting and working, but if I do something strenuous, I pay for it with back spasms later. I hate taking any meds, but need them frequently to reduce the pain enough to get to sleep.
I just had another MRI and when compared to last years, My L5 disc was bulging 3mm into my spine, and the MRI now shows it at 9mm. I've been looking into getting the disc replaced, and wanted to ask if anyone here has any experience with either having one replaced, or replacing one?
I've never had any type of surgery, and I'm set to retire from my LEO career in 6 months. To say that going under the knife concerns me is an understatement.
I have an appointment to talk to the surgeon that would do the procedure on Feb 20th, and will be making a decision then on what to do.

Thanks Brothers in advance, GROG

MiTTMedic · 01-21-2008, 19:04

I'm assuming that you have done any and all therapy/rehab before coming to the OR. After being in the Physical Therapy realm for 23+ years, I can tell you a few things. Truthfully, I figured I would be reading more than writing on this forum, but this is in my lane.
#1: A very small percentage of disc bulges (HNP's) require surgery. A good therapist can and will reduce the odds of the scalpel. It takes time and compliance on the part of the patient to be successful. You didn't mention pain in your leg from this, but I can assume you know what I'm talking about.
#2: Disc "replacements" are still in the experimental phase, and prognosis is not good. Problem is that they cannot regenerate themselves after micro damage, so they don't last long. If it were me, I would run & hide if the doc suggested it.
#3: What the doc should offer you is a partial or full discectomy. A full discectomy requires fusion of the two vertebrae. Sounds worse than it is. Most do very well.
I wish you luck, and let me know if you want more info. I'm not a surgeon, but I can advise you on the rehab end. It's hard to suggest much at this point because I don't have all the info about your case.

grog18b · 01-21-2008, 20:13

Thanks Mitt, I've done the PT route many times, for many durations, and could probably teach it if I had to

, and have tried numerous other treatments, and different types of PT. (Everything short of the holistic stuff and acupuncture stuff)

The disc started getting bad and muscles started spasming 6 years ago now. I was at the time in a good fitness program myself, and was in great shape. I woke up one night and it felt like my hip was out of joint, and in severe pain. No idea why, or how it happened. Don't remember doing anything that would have caused it. The muscles were seized up and I couldn't get out of bed. Doc sent me to a chiropractor, and he did the crack thing, and it still hurt like hell. After some meds and PT, the pain went away, and it returned to semi-normal. I went to PT off and on for 3 months at a time, many times, and would then get back into my own PT routine when I felt better. It seemed to relieve the problems at first. There were a few episodes where the spasms returned. One of them when I was bending over the sink washing my newborn daughter. Glad the wife was there to get her. I figure it was just a bad angle, and with the weight of her, I crumpled to the floor, and couldn't move for a couple hours. Another incident happened when I was walking in deep snow, on a hunting trip. Same thing, back seized up, and crumpled, crawled 500' back to the house and lay in the doorway for 5 hours until the wife got back, and drug me to the car, and a trip to the hospital.

I've tried the chiropractic route, and even tried the Lordex spine decompression. It felt good at first, then after a week, the muscles were spasming so bad on the table, it was very difficult for me to get up afterwords. I could live with it, if it were only a matter of doing PT and feeling better. Since the disc got worse, PT aggravates it and the muscles will just lock up or spasm if I try to do much at all. Even trying to go slow, stretching and using stim, and heat, it relaxes it for an hour at the most, then it's right back to hurting. I use flexarall and Hydrocodone 10/650 when the pain gets unbearable, and hate using it at all. It's been a rough 6 years, and the last year has been the worst. Big problem with the meds is, I can't take them and work, so my department says if I "choose" to take them I can't work within 8 hrs and if I do, I have to use my sick leave... So I can get relief using meds when I get home, to get to sleep, but have to be in pain all day. (Another reason to avoid the meds)

As far as the discectomy goes, I have two brother-in-laws that had that done, one down in Bethesda MD at the back and spine institute. His was the worst, and they had to go in twice, to remove more disc pieces from his spine. (I guess it shattered?) He is laid up now, and they just told him that due to scar tissue, they can't operate on him again. The other in-law is almost in the same boat, and is back to the pain. They felt better at first, and recovered pretty fast, but they are both in rough shape now, and they are 37 and 40 yrs old. I don't know if I like the idea of fusion, as I've heard it is hard on the discs above and/or below the fusion. My L4 is already bad and bulging. I think a fusion would just move the problem up in my particular case, that's why I was looking at the replacement route.

Unfortunately, I know I need to get something done, just concerned about being able to function afterwards...

I value everyone's opinions, and thanks much for your input. GROG

...oh, and I attribute all this to too many parachute jumps...

Haven't lost my sense of humor yet.

CDRODA396 · 01-21-2008, 21:15

I had a buldging disc between L5/S1. At that time they only had one BackButcher working at Womack on Bragg, and he did rotations between Walter Reed and Womack. I hurt it in Iraq, returning in May, and had a rotation in Sept for AStan. Since I needed something done right then, they let me go out to Moore Regional Hospital in Pinehurst. Cant remember the dude's name, but when I researched him, he was recognized as one of the top 5 BackButchers in the country.

This is what he told me then. There is a range of options for a bad disc...do nothing and pray, physical therapy, steroids, micro-discetomy, full blown discetomy (micro being done with the scope, through a 3/4" incision, full being through a big incision) and fusion.

According to him, the only major difference between the treatments is how fast you get relief (do nothing very slow, fusion immediate)...BUT, in the long term, whatever you do you're screwed, in 10-15 years, no matter which one you opt for, you are going to be sucking.

So, I went with micro-discetomy and six weeks to the day from surgery was unloading a C-17 in Khandahar...4 and half years later, I'm wishing I hadnt chased quite so many jumps!

And thats all I know about that, dont know if it helps or not, either way, I FEEL your pain daily brother, and wish you the best of luck whatever you decide to do.

**Kyobanim** · 01-22-2008, 04:39

Quote:

#2: Disc "replacements" are still in the experimental phase

Only if you're an insurance company. They'll do anything to get out of taking care of their clients.

The procedure has been approved by the FDA for 7 years. They have been doing this surgery in Europe for over 25 years. I have researched this exstensively as my wife's surgeon wants to do this.

Just make sure the Doc has done this before and ask lots of questions.

**Eagle5US** · 01-22-2008, 05:40

Sorry Grog,

Outside my lane Brother...I too have significant back pain, yes it keeps me up at night and prevents me from standing for long periods of time (I HATE standing still in the OR for hours).

The only thing I have to offer you is plank and bridging exercises in your interim to help in building your core muscles. They have helped me considerably.

Some other things to "investigate"...
-"reinflation" of your disc
- fusion (as previously stated)
- a good pain management specialist for direct disc injection therapy

Back surgery traditionally has about a 10% chance of making things better, a 40% chance of things staying the same, and a 50% chance of making things worse. Time, and your body's unique response to the procedure, will be the only indicator.

Good luck in whatever decision you make.

Eagle

grog18b · 01-22-2008, 06:14

Thanks all. I'm currently in another physical therapy program, to maintain and strengthen until my appointment on the 20th. Thanks Eagle 5 and CDR. I have some research to do on the re-inflation and want to be educated prior to my visit. The Doc I have the appointment with has done the replacements before, many times. The micro-discetomy might be a better option. I know if I can get that 9mm removed, the pressure would be off the spine. Re-inflation sounds interesting too. (Be nice to get back to 6'2"...) With looking at my MRI, it doesn't appear that there would be too many options. The disc looks like it's overhanging the bone below it like snow off a house roof... Kinda curls around the bone. It even looks like it hurts. (My doc looked at it when I brought the films in and said "Holy S*&^") Guess that means it's bad?

I know even minor relief would help, and as a co-worker said when I described my symptoms "How can you live like that?" I'll keep you all updated on the decision and progress. Hopefully I'll be in the 10% that this stuff helps. The odds sound pretty bad, but I guess the only thing worse than I feel now, is not being able to feel at all, or not being able to walk. Thanks again Bros. GROG

**Eagle5US** · 01-22-2008, 06:20

Let us know how things progress for you. We are all family.

Eagle

swatsurgeon · 01-22-2008, 16:50

Just to add my 2 cents.....I do the anterior exposures for the neurosurgeons. We did a study of our own patients and this procedure (see URL) makes for some really happy people post op.

http://www.spineuniverse.com/display...rticle508.html

good luck....just another way to offer relief and ask questions to be a better informed patient.

ss

**Eagle5US** · 01-22-2008, 16:54

Quote:

Originally Posted by swatsurgeon

Just to add my 2 cents.....I do the anterior exposures for the neurosurgeons.

Damn...is there ANYTHING that you DON'T do

Eagle

swatsurgeon · 01-23-2008, 06:37

Quote:

Originally Posted by Eagle5US

Damn...is there ANYTHING that you DON'T do

Eagle

Eagle,
I don't get to do what you do, what you've done (and where you've done it...hush, hush)............. but I'd love to try!!

ss

grog18b · 01-23-2008, 13:19

Thanks much guys. I have a lot to consider and research. Just discovered my insurance (Blue Shield) does not cover the disc replacement, as it's still considered experimental.

(As the insurance nazi says "No disc for you.") They apparently started a 10 year study in 2004, and will make a determination after that. Whoo Hoo, another 6 years of pain, meds, or knife it out and fuse now. Hmmmmmm, decisions, decisions. The disc replacement is a 20 grand + procedure, so no way my poor soul is gonna come anywhere close. Last couple days it's gone downhill fast, and there are very few positions, sitting or lying that come close to "comfortable". I'll keep the research going, and appreciate the recommendations. GROG

**The Reaper** · 01-23-2008, 14:07

What is your local VA hospital like, and do you have the back injury listed as a service connected disability?

TR

clapdoc · 01-23-2008, 14:51

Thanks to a drunk driver I have had 2 spinal fusion surgeries in my neck. c-5/6 and 6/7. The docs replaced the disc with bone out of my hip. To tell the honest truth, the bone being removed hurt a lot worse that than the neck surgery.
The docs tell me that the lower you go on the back, the worse any surgery is.

I still ride horses, bale hay and do farm work but i am about 80% of what i used to be.

just get good advice from more than 1 surgeon.

clapdoc sends.

grog18b · 01-23-2008, 15:44

TR The closest VA hospital is in Wilkes-Barre, about 2.5 hrs from me. I haven't heard fantastic things about it... Unfortunately, not a service connected disability. When I ETSd the Army in 1990, I was in fantastic shape, and maintained it throughout my LEO career, until the disc went out. So, either I have to look at other options the insurance will cover, or sell a few kids...

20 grand is a pretty big horse pill to swallow, especially with retiring in 6 months.