Considering L5/S1 ADR
 

Hello! I'm back here after ten years.

After "selective endoscopic discectomy" by Dr. Yeung in Phoenix on March 14, 2006, I have tolerated minor to moderate lumbar pain and occasional sciatica depending on the time of day, my activity level, etc. To relieve the pain, I've learned to lie down frequently or stretch my back by dangling my legs between two chairs.

My pain is aggravated by my job as a pilot which requires much sitting and bouncing around in turbulence as well as lifting heavy bags. Compared to many people with back pain, I know that my complaints sound minor, but for a person to work as a pilot, the FAA requires very good health.

On February 9, 2016 I stood up from a chair and experienced numbness and tingling in my entire left leg and pelvis area along with moderate lumbar pain. The numbness is continuous, but has improved a bit over the last couple weeks.

Last week, I returned to the Texas Back Institute where, ten years ago, I discussed with Drs. Guyer and Zigler the possibility of ADR. My X-ray shows that my L5/S1 disc is mostly gone, as I already knew. I had an MRI and have an appointment scheduled this week with a surgeon there.

Any information and advice from anyone in a similar situation would be appreciated. Thanks in advance!

Generally, is the ADR recovery experience affected by the degree of disability prior to surgery? In other words, by taking a proactive approach and not waiting until I'm not able to function due to debilitating pain, can I expect the recovery experience to be better? Or do ADR patients experience difficult recoveries unpredictably or randomly?

To separate things a bit: recovery from the surgery will, of course, be easier the more fit and healthy you are. As your pain increases, your overall health will suffer and you will see the effect in recovery time.

As your disk height decreases, your likelihood and severity of distraction pain will increase.

Your likelihood of a good outcome is affected the longer you go as your body starts changing other structures to account for the damaged disks. Facets, for instance, do suffer the longer you hold out with damaged disks.

The converse, though, isn't always true. Treating early doesn't guarantee a good outcome or fast recovery. I'll admit that I don't remember hearing of a person who had a good and quick recovery who was on death's door prior to surgery but that's strictly opinion based on limited anecdotal information.

timing
 

I scheduled my surgery exactly for the reason that if I did not soon, my L5-S1 would auto-fuse. Once that happens, your ADR option goes away, or so I had been told.

Thanks
 

Thanks, annapurna and Romakis.

Hi Tom
Speaking from my experience, my functioning pre surg doesn't seem related to outcome (yet). Meaning, I have read stories of folks on here who had more debilitating issues than myself, who had easier recovery. On paper, I did everything "right" - lots of exercise and Physio preop, weight loss, good diet, lots of mental prep....and while I had a very "easy" few weeks right after the op, I am now functioning worse (3.5 months out) than I was preop. I've been proactive in Physio and do as I'm told, but bursitis, distraction pain and other new issues are getting me. I still have hopes to turn the corner.
So...I think there is a random element. But, I feel personally had I waited even longer for surg, that things mentally and physically could've made recovery harder. Hope that makes sense.
Best wishes with your decision

Getting an Epidural Injection
 

Thanks, Disc replacement 2015, for the information.

I saw a surgeon today. The MRI shows three affected levels. (I knew this, but hoped there had been some magical improvement to the two higher levels after ten years.)

We discussed the possibility of one or more ADRs or a fusion and an ADR. She said insurance will cover only one ADR.

Considering my relatively mild symptoms - leg numbness and moderate lumbar pain - she thinks I will improve with the help of an epidural injection. We'll see...

Not wanting to do a fusion for the purpose of saving money, but, instead, to seek the best outcome, I wonder how people are doing with the fusion plus ADR option compared to having two ADRs.

Just my opinion, but if your back pain is mild and it's mostly tingling/nerve impingement you are dealing with, you may benefit from a bone preserving decompression. Maybe you could get an opinion from a doc who does IO Flex, as it preserves bone and would allow a more aggressive option in the future.

The spine can somewhat stabilize and pain can diminish from a degenerating spine, and I wonder if that's what your body is doing....

Also, if you get relief from dangling your legs, you might want to hop on an inversion table and see if that works.

Thanks
 

Thanks, FutureRobot, for the information and advice. I Googled and found that that technology is available here in the Dallas/Fort Worth area. I'll keep it in mind. Ten years ago, I had to travel to Phoenix to find minimally invasive surgery.

Speaking of decompression and dangling legs, I remember that for a few weeks after my discectomy, when I would let my legs hang, relieving pressure, my spine would separate so much that I would lose vision and feel like I was fainting. It was really crazy. I think that stretching my torso was actually sucking the blood out of my head. I'm not making this up. Haha. Has anyone else experienced this? I assume that on an inversion table, this would not happen.

No you'll be fine on an inversion table; I use one every night to deal with my tingling. I have no numbness, just very mild back pain and mild tingling right now in my foot. I would feel silly getting a surgery with my symptoms. The inversion helps to calm it down before bed. Maybe go to a store and try one for 5-10 minutes...but don't go all the way yet as it will give you a head rush.

Since you sit all day, I would take it as a positive that your back pain is mild. If you can limit the nerve pain, you may be able to continue having a good quality of life.

It wouldn't hurt to get an opinion on the IO Flex, I've heard great things. Maybe it will give you another 10-20 years before you have to do something major, and who knows what technology may bring by then.

When you say tingling, is it the pins and needles type or the kind of "half fallen asleep/buzzing" type?

Considering Dr. Bertagnoli
 

Here's an update. (Not sure whether I should still be posting in this Introduction thread.)

I had a ESI, which helped to temporarily reduce the already not-too-bad lower back pain, but had no effect on the leg numbness, which I didn't expect anyway.

Then I followed up with the TBI surgeon and had a discogram of L3/4 and L4/5 which both had pain to level 7 on the scale. I followed up again and the surgeon explained that pain is not expected in a discogram of normal discs, which surprised me. Anyway, I knew the discs were not normal from the MRI, etc. The discogram pain was not my usual pain, which I told the doctor during the procedure. Despite this, his report stated that the L3/4 pain was "concordant," so I wasn't very impressed with him. I discussed this with my surgeon and she seemed to agree that the concordancy part of the test was questionable. Also, L4/5 leaked badly during the discogram.

I could go into more detail, but the end result was that the surgeon basically said, sorry, we can't help you. She previously told me that each ADR not covered by insurance costs $70,000.

So, I sent all my records to Tim to send to Dr. B. The interesting thing is how the TBI doctors never suggested a trip to Europe for multi-level ADR. I've refreshed myself from my online research ten years ago and have learned of the disappointment with insurance companies and the FDA. Maybe doctors just assume that everyone is educating themselves about their options. Maybe they have policy or legal reasons for not being able to recommend going to Europe.

Anyway, I'm waiting for a recommendation and cost information. Any recent information from experiences with Dr. Bertagnoli would be appreciated.