Who should I trust?

[xiaoyu80305]

Hi,

I live in Boulder, CO. I was diagnosed with DDD (L4, L5 and S1) in 2005. Right now, I can't stand and walk for long period time without the pain on my right leg. My daily treatment are similar to DRX9000 (decompression machine) and yoga. I am planning to have surgery in 2012, but no decision has been made for the detailed procedure yet. I am open for all options.

CT report on 06/25/2010:


L3-L4: There is mild disc bulging. There is severe left facet degenerative change. There is moderate left and mild right foraminal narrowing.


L4-L5: There is severe bilateral facet degenerative change with anterolisthesis as above. There is moderate bilateral foraminal narrowing.


L5-S1: There is posterior disc bulging with endplate osteophyte formation. There is severe bilateral facet degenrative change. There is severe bilateral foraminal narrowing, right greater than left.


MRI report on 02/23/2010


L3-L4: Disc desiccation, moderate facet hypertrophy, and ligamentum flavum thickening resulting in minimal bilateral neural foraminal narrowing, worse left than right, are unchangeed. The central canal is widely patent.


L4-L5: A diffuse broad-based disk bulge combined with facet osteophytes and ligamentum flavum thickening continues to result in mild central canal narrowing, moderate bilateral ventrolateral recess narrowing, and moderate bilateral neural foraminal narrowing. The L5 nerve roots are moderately compressed in the ventrolateral recess as they course inferiorly toward the right and left L5-S1 neural foramina.


L5-S1: Disk desiccation and broad-based minimal posterior disk bulge combined with uncovertebral and facet osteophytes result in moderate severe right and moderate left neural foraminal narrowing. The degree of narrowing is largely unchanged since 2007. The central canal is widely patent.


I have visited three surgeons in Colorado and they all recommended me to have fusion at L4-L5 and L5-S1. One surgeon who is specialized for ADR told me that I am not a candidate for ADR.


The surgeons in Germany responded me with different opinion. Here is their response:


…...... Dr. Bertagnoli could already view your medical data. I am here to pass on his surgical recommendation.

Your l4-s1 degneration is marked

· L45 should receive an ADR – to preserve maximum mobility, and to prevent overload to higher-up segments.
· At l5s1 the extent of secondary changes makes it favorable to address this segment by a fusion.
Prof. Dr. Bertagnoli would perform both of these steps with one incision from ventral , using special non-profile fusion cages in l5s1. This will spare your back muscles from intervention by a standard screw fusion – and you need your dynamical structurs espl when preserving a mobile spine.

Who should I trust based on my CT & MRI results?

Xiaoyu,

[Jstuckey]

"L4-L5: There is severe bilateral facet degenerative change"
This would greatly concern me with an ADR. I'm still learning too, but I'm guessing those more experienced will say you will end up with facet pain. I'd get more opinions for your options, that may include facet surgery.

[xiaoyu80305]

Originally Posted by Jstuckey

"L4-L5: There is severe bilateral facet degenerative change"
This would greatly concern me with an ADR. I'm still learning too, but I'm guessing those more experienced will say you will end up with facet pain. I'd get more opinions for your options, that may include facet surgery.

Hi Joey,

Thanks for your input. I am going to show the email from German surgeon to my doctor next visit. I wish you the best for your surgical procedure in the fall!

Xiaoyu,