Question on Disc replacement - Page 2

ReconDoc242 · 01-28-2008, 21:10

I used to be a surgical instructor at NuVasive, so my view is slightly prejudiced towards their products but here is my advise:
As it has been said prior, you will probably need to have a spinal decompression with fusion(that is an assumption, the diagnosis really should be made by a qualified orthopedic or neuro surgeon)
There are various companies that out on the market with proven products, and to tell you the truth, there is very little difference between products. The main difference is in the surgical approach.
Most decompression surgeries are done either via posterior approaches such as TLIF(trans-laminar interbody fussion) or PLIF(posterior laminar interbody fusion), or anterior approaches such as the ALIF(anterior interbody fussion). I will give you the pros and cons of these surgeries.
1. PLIF- this is the most common procedure and easiest for surgeons to perform. Unfortunately it is the most aggressive. Usually a 3-8in incision(size will depend on number of levels requiring fusion) is made directly over the spinous process. Then both laminas of the effected superior and inferior vertebrae are cut through and the spinous process is excised. Then they move the dura out of the way to get access to your disc space. After the disc is removed a cage is put in. Rods and pedicle/facet screw are then put in, and boom, your done. Hospital stay is usually a week. Recovery 6months to a year.
2.TLIF-this has gained alot of popularity in recent years. It is similar to the PLIF, but only one side of the lamina is cut and the spinous process is not excised. It is usually done through a minimally invasive approach and requires 2-4in incision, just off the midline of the spinous process. Hospital stay 3days to a week. Recovery 6months. Also, This surgery will usually require supplemental hardware such as pedicle screws and rods.
3. ALIF- this is done through the abdomen with the patient laying on his back, and requires the assistance of a general surgeon for the initial approach. He will begin my making a midline 8 in incision in the abdomen. He will go through the abdominal muscles. Then he will carefully move the peritonium over to the side. Now for the dangerous part... He will have to lift up the aorta off the anterior aspect of the spine. Now the disc space is accessible. The surgeon will then remove the affected disc and place a cage with some sort or an artificial disc. hospital stay time is 1-2weeks. Recovery time is 6months to 1yr.
4. XLIF(extreme lateral interbody fusion)- This is the newest surgery in the horizon and has excellent results so far. It is done with the patient laying on his side. The approach usually falls between the illiac crest and 12th rib. It is minimally invasive, requiring only a 1-2in incision. A set of dialators is put in to safely guide the retractor thru the psoas muscle. The disc space is the access and the affected disc is removed. Then a cage is put in for fusion. The hospital stay is 1 day since the is less then 50ml of blood loss. The recovery time is 6-8 weeks. The downside, its expensive.
As far as the advice about not getting treated for an illness, its simply bad advice. My friend you will only get worse if you do not get the proper treatment. Thats my .02 cents. Best of luck.
-Carlos

grog18b · 01-29-2008, 06:36

Thanks Carlos, much appreciated. Some of those options sound like they were developed by the Taliban...

Actually got the cold sweats on reading the first one, but felt better by the last. Being shot sounds better than a few of them. Whatever way, sounds like Grog isn't going to be a happy camper any time soon...

I'll advise on what the Doc says on the 20th. GROG

grog18b · 02-22-2008, 19:01

Well... Had my meeting with the Doc. He checked the latest MRI out, and seems the majority of my pain is coming from the degeneration of the bone to the rear and above the bad lower disc. He recommended the ALIF, and advised he has had a lot of success with this procedure, and that, by the time it affects any other disc, there will be new stuff available. (I went to Bajwa in Johnson City NY, if anyone here knows him.) Seems he's a pretty good Doc, and has done the actual disc replacements, and is on the cutting edge with the new techniques. He says hospital stay is 2-7 days, with a 8 week "gimp" time, then a 6-12 month to full recovery time. He gave me a book on the surgery, and... Well... None of it looks all too pleasant. Apparently, they gotta hook all sorts of hoses, and whatnot, to keep the engine running (or something) then I have the option of using my own stored blood, in case I need a transfusion, or someone elses... Never donated outside the military. Then I have the option of using some sort of bone protein for the graft, or having them take bone outta my arse. So, if I go with that option, I will have a sore back, front, and arse.
Good lord...
For the bad part... I have 5 months to retirement, the Doc recommends the operation soon, as my present condition is a little better than being hit by a truck every day, I have only two months of sick leave left, and a triple homicide trial coming up in July... I hate to let the guys I work with down, but I really have to get this thing taken care of. Every day is like a new experiment in the pain category. (Doc says most of the pain is from the bones that surround L5 grating against each other... Yes, it is painful)
I have a pretty high pain tolerance (once stood at attention on a fire ant hill, and paid for it later, and also ran a 5 mile run with a sprained ankle) so I'm used to dealing with pain. Major problem I have is... Being put unconscious, in a hospital, and being out of control. Funny as that may sound to some, it concerns me greatly. It's the reason I avoid alcohol, and avoided drugs all my life, until this back thing came around. I guess I'm also concerned about not being in control of my future too. The doc went over the possible "boo-boo's" and I'm hoping I don't end up on his blooper reel and have to lay in a bed for the rest of my life. Guess it's pretty scary stuff... I have to schedule the surgery on Monday, and he said they can get me in, in two or three weeks. (Another summer, shot in the keister)
Any advice from the brotherhood on dealing with pre-operative whatnot?
Thanks in advance, and yes I know...

Sucks to be me...

Red Flag 1 · 02-22-2008, 19:12

r

swpa19 · 02-23-2008, 16:27

GROG:

In 1962 the 1/4 Ton Utility Vehicle M-151 was introduced USAREUR wide. I had to "re-qualify" with this vehicle. Dont know why they couldnt just have added it to my licensce. These little devils had a very bad habit of just rolling over. Mine did. Flipped me out then rolled over top of me. The hood latched against the windshield, then struck me from left shoulder to right hip.

Bottom line here is: I opted not to have any surgery done. BAD mistake. As Ive gotten older I regret it on a weekly basis.

Do what you can now before it degenerates so badly surgery WONT help.

**The Reaper** · 02-23-2008, 17:16

Quote:

Originally Posted by swpa19

GROG:
Bottom line here is: I opted not to have any surgery done. BAD mistake. As Ive gotten older I regret it on a weekly basis.

Do what you can now before it degenerates so badly surgery WONT help.

I respectfully disagree.

I declined career ending back surgery in 1986, and did just fine.

I met a guy who had the back surgery my ortho recommended to me three years later, and he was crippled and medically retired.

I declined meniscectomies on both knees in 1996, and did just fine.

The day comes when I am in the shape Grog is in, THEN I might have the surgeries.

Till then, I will kick that can down the road.

TR

Red Flag 1 · 02-24-2008, 08:38

if it worth saying, it will be quoted.

grog18b · 02-24-2008, 18:21

Thanks Guys. Doc mentioned the possibility of nerve damage if I put things off much longer. The disc is digging into the spinal cord, and the vertebrae are grinding each other on the opposite side. No win, either way I look at it. Either I remain in constant pain, hopefully being able to get at least my 20 in, or I go for the surgery and roll the dice... Outlook is, either things improve, stay the same, get worse, or get much worse. The wife is all for it, as things for her, are bad too. I'd hate to see her in constant pain. GROG

Red Flag 1 · 02-25-2008, 13:02

if it worth saying, it will be quoted.

Red Flag 1 · 02-25-2008, 14:48

x

grog18b · 02-26-2008, 15:18

Looks like I have to hold off on the surgery until April. The retirement folks worked it out, so I can use my earned leave, to the normal retirement date. Oh well, more dental stress fractures. I can hang for one more month. Gonna be a tough month though. Thanks again guys. GROG

grog18b · 03-05-2008, 14:46

Surgery set for April 1st. I don't know if getting knifed on April Fools is a good or bad thing...

Red Flag 1 · 03-05-2008, 16:12

RF 1

grog18b · 04-17-2008, 17:18

To advise the brotherhood, and all those who sent me well wishes, the surgery went very well. I was up and around that night, and spent 3 days in the hospital. I couldn't stand another night of the screaming and crying, so I asked (begged) the doc to let me go home. They sent me down to PT to show me the proper way to get into and out of bed, and climb steps... Apparently they showed me the wrong way to get out, as indicated by the pulled groin muscle. I then endured the 1.5 hour ride home in the wife's Liberty. I know every dip, pothole, bump and curve intametly... Got myself one of those fancy lift chairs so as to be able to get myself upright and prone without too much pain.

The recovery is going well, and the disc pain is gone. Only pain is from the incisions and a bit of tightness where they put in the screws and rod. (Now I have two...

) I'm finally able to type a bit, so I thought I'd advise on my condition. Thanks all here for your support and help. It is much appreciated. GROG

Gypsy · 04-17-2008, 18:44

Continued best wishes for a speedy recovery grog18b!