Should I do it?
 

Hi all,

I've been reading lots of your stories over the past several weeks and I am both inspired by what I see and worried (which I see as a good thing). I am considering having ADR in December 2020 with Dr. Zigler at TBI, but I thought I would see what folks in this community might think.

A bit of background:
I've had back pain for about 11 years now. It started with yard work in my late 20s and has been triggered by all sorts of things since then. For several years, I went without a diagnosis or imaging, so I just thought I had to deal with back pain. I've been going to a chiropractor at least once a month since 2010 maybe. Then, the "back attacks" started getting a bit more frequent (2-3 times per year) and took longer to recover from. I had imaging done in 2018 that showed herniation at L4-L5 and DDD at L3-L4. Injections ordered, but not received due to insurance and other complications. My back got marginally better, so I just went on. I completed PT that summer/fall and it helped a bit. (As a side note, I've been in PT three times since then with good/ok results.)

Latest issue:
December 26, 2019, my back "went out" for the 20th time (that's just a guess - maybe it's been more). However, this recovery hasn't been like the others. For several weeks, I was walking with a cane, didn't sleep well, and needed lots of oral steroids, ibuprofen, etc. In February, I was referred to a neurosurgeon at my university hospital. He ordered more imaging which showed basically the same thing as two years ago (herniation at L4-L5 and DDD at L3-L4). He said I was not a candidate for any kind of surgery and to call me when (not if) my back went out again. [He is known for being very, very conservative in his approach.]

I had two steroid injections in May and they helped for a couple of days. I started PT again in May as well and it has helped a bit, but I am still not as active and mobile as an average person in their late 30s. I have a current prescription for meloxicam and tizanidine, and I use them periodically (not together) when I'm having a bad day.

Several weeks ago, I contacted Texas Back Institute and spoke with Dr. Zigler. He's offering a two-level ADR (more below). Right after that, I contacted a highly-rated orthopedic surgeon in my area who said he could offer me a minimally-invasive fusion procedure. He told me he knew of the research being done by Zigler et al. at TBI and respected their work. While the ortho surgeon doesn't do ADR himself, he did say he would agree that I'm a good candidate for the surgery.

Today:
As I mentioned, my day-to-day is not what it was even a year ago. I'm not in a ton of pain every day, but my quality of life is diminished. I met with Dr. Zigler via telehealth and he suggested a two-level ADR of L3-L4 and L4-L5 using ActivL with keels. His opinion is that I am a good candidate for this procedure given my age and other factors. He also said we could go the hybrid route if necessitated by insurance, but I am not inclined to do that.

As a side note, all the folks at Texas Back have been incredible to work with so far. They are very responsive, courteous, and kind. I have met with Dr. Zigler twice now, the second time to ask a ton of questions about the procedure (subsidence, adverse events, the device, etc.). His bedside manner is second to none, he is empathetic, and he obviously knows is stuff. It's comforting to know that he's done so many of these procedures and that he's right here in the US should I need him again. The second time I met with him, he asked about my back, of course, but also about how I was doing in Covid and how my campus (I'm a professor) was returning to class, etc. He is really SO nice!

tl;dr:
I've had back pain for years. Two-level ADR using ActivL has been recommended for me by Dr. Zigler. Should I go forward with the surgery?

Thanks for any feedback, suggestions, or advice!

Kevin

I am being set up to talk with Dr Zigler soon. I have just a bad L5/S1 disc but pretty bad burning feet and both hips kill me. I received SI joint and L5 facet blocks on both sides that cleared up my central back pain so the jury is still out if any disc surgery will work. One surgeon said leave it alone and my leg pain is from something else. A pain doc at U of Michigan said not coming from back. When I put my back out 6 years ago and again last year, the leg pain and feet burning started. MRIs are benign. Big mess.
I guess I am in the same boat. I have generally mild pain, but can’t function well at all. But will a disc surgery work?
I would hate to see myself in 5 years though when I turn 50 at this rate.

Kirk
 

Sorry to hear that you are getting mixed assessments. Given the fact that your symptoms started after you incident and reading your symptoms one would conclude it's your back. Also, if you had an MRI laying down, that may explain why it look benign. Have you had a discogram? Not pleasant and not always conclusive anyway. There ate upright MRI across the country now. But my insurance only pays for one once without getting a preauth. Good luck to you!

Upright MRI is highly valuable... Diagnosed four different protrusions in my thoracic spine (minor but don't feel so minor)...

If you can't find an upright MRI within travelable distance, you might see if a weighted MRI is available. It's a prone MRI but has a backpack-style arrangements of straps that can apply force between shoulders and feet to load the spine for imaging. They were the thing maybe ten or more years ago when everyone first realized they needed to load the spine to get good imaging and upright MRIs were still vanishingly rare.