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  #1  
Old 12-11-2022, 02:02 PM
oldnoah oldnoah is offline
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Join Date: Oct 2020
Posts: 3
Default 4 Level Lumbar decision

My condition was pretty stable after recovering from laminectomy in 2000. In 2019, pain got worse, and mobility got a lot worse. I found that I'm not doing the kinds of things I used to do to keep active.

I talked to doctors at Hospital for Special Surgery in NYC. They ordered a CT scan, and found that where I originally had one herniated disk, I now have 4 disks degenerating. They offered fusion of all 4, and said that disk replacement was not possible due to the previous laminectomy.

In early 2000, I heard that disk replacement was possible, just not in the U.S. I started looking into German surgeons, and sent a fairly current MRI to three teams, each of which gave me a quote. But then COVID hit, and I didn't have the money for any of the surgeries they suggested. The MRI that I had was also over a year old by that point. So I waited, and saved my money.

At this point, I've got enough money, and I got a new MRI, so I went to my physiatrist and discussed the three quotes, and the new MRI. He's interested in the whole disk replacement in Germany thing, but he's concerned that the stenosis at L3/4 won't be addressed by the disk replacement.

All this, of course, is on top of plain old fear that the surgery will be painful, or that it will go wrong, and just plain fear of making a huge financial transfer to someone that I only know through the internet.

From what I can tell, these surgeries don't have any kind of "warrantee," so if it goes wrong, I have to pay for revision myself. I don't have that kind of money.

I don't really know where to start asking questions. But here I am.
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Initial injury 1996. MRI in 2000 showed severe herniation at L4-L5, with severe nerve impingement on both sides.
Laminectomy and partial discectomy in 2000, no fusion. Relieved nerve pain, but back pain remained.
Revision of same surgery in 2001.
Since then, Yoga, Chiropractic, PT, and Pain management with steroid shots and facet joint nerve ablations. And lots of pills.
Current MRI shows severe degeneration at L2/3, L3/4, L4/5 and L5/S1. Also shows stenosis at L3/4.
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  #2  
Old 12-11-2022, 05:00 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
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Hi Noah, I am just checking in to say hello. Any progress on your decision-making? What's the latest?
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #3  
Old 12-11-2022, 11:10 PM
oldnoah oldnoah is offline
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Join Date: Oct 2020
Posts: 3
Default

I just posted my introduction today. No changes yet. I was hoping for some kind of feedback, at least as far as how to make use of this forum. It feels rather intimidating.
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Initial injury 1996. MRI in 2000 showed severe herniation at L4-L5, with severe nerve impingement on both sides.
Laminectomy and partial discectomy in 2000, no fusion. Relieved nerve pain, but back pain remained.
Revision of same surgery in 2001.
Since then, Yoga, Chiropractic, PT, and Pain management with steroid shots and facet joint nerve ablations. And lots of pills.
Current MRI shows severe degeneration at L2/3, L3/4, L4/5 and L5/S1. Also shows stenosis at L3/4.
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  #4  
Old 12-12-2022, 07:50 PM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,668
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I'll offer what I can - You're correct. These surgeries don't offer any warranties. For a while there was a debate about foreign surgeons and the inability to sue them for malpractice. Laura and I decided that suing anyone for malpractice was a whole lot less satisfying than seeking the best surgeon to get it right the first time. Of course, that was at a time when a German surgeon might have complete 300+ ADRs and a US surgeon was in the realm of 15-30, so the gap in experience was significant.

Now, you can find US surgeons who have the same or nearly the same total surgery counts as the Europeans. My personal feeling is to continue to pursue the Europeans but that's my opinion and draws more from my concerns over the power that insurance companies have over the standard of care in the US than any worry about surgeon skill.

As for stenosis - I would suggest that you talk it over the with the surgeons. DO NOT consider handing money to any surgeon, US or European, if you can't get a consult with them prior to committing to surgery. You may have to pay for the consult but anyone reasonably ethical should be willing to have the surgeon speak with you before committing to surgery. If you can't get them to talk with you before you hand them serious money, you're not going to get answers from them after the money's changed hands.

Another concern about European surgeons - some offices are notoriously bad at communications, especially post-op. US offices are as well but you have the advantage of sharing a language and being on the same or similar timezones. Don't pursue a European surgeon if you're not willing to do a bit of chasing to get them to talk with you.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #5  
Old 12-13-2022, 11:03 PM
oldnoah oldnoah is offline
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Join Date: Oct 2020
Posts: 3
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Unless there's something new that I don't know about, replacement disks that are approved in the U.S. can't be used if the patient has previously had a laminectomy, which I have.
It was when I learned that the replacements that are available in Germany CAN be used after laminectomy that I started looking around on the internet and uploaded my MRI to the German teams.
If there are American surgeons that can do a replacement post laminectomy, I'd sure like to hear about it.
__________________
Initial injury 1996. MRI in 2000 showed severe herniation at L4-L5, with severe nerve impingement on both sides.
Laminectomy and partial discectomy in 2000, no fusion. Relieved nerve pain, but back pain remained.
Revision of same surgery in 2001.
Since then, Yoga, Chiropractic, PT, and Pain management with steroid shots and facet joint nerve ablations. And lots of pills.
Current MRI shows severe degeneration at L2/3, L3/4, L4/5 and L5/S1. Also shows stenosis at L3/4.
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  #6  
Old 12-14-2022, 12:11 AM
phillyjoe phillyjoe is offline
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Join Date: Jan 2013
Posts: 286
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I agree that European surgeons don't have the edge anymore over US except perhaps in complicated cases or revisions. So try to find US docs who do a lot of your procedure. Texas Back is certainly a place to start. HSS isn't really a high volume ADR shop as far as I know. And yes, it is easier to chase US docs post surgery that chasing Spanish or German ones. And finally, I don't know that your prior lamo disqualifies you from ADR (although it may give your insurer a basis not to cover it). Hope this helps
__________________
Pre Surgery:
C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis.
C4-C5:Midline central disc protrusion, significant. Mild canal stenosis.
C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis.
C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis.
June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona
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  #7  
Old 12-14-2022, 07:56 PM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,668
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Quote:
Originally Posted by oldnoah View Post
Unless there's something new that I don't know about, replacement disks that are approved in the U.S. can't be used if the patient has previously had a laminectomy, which I have.
One option would be to pursue a hybrid: fusion at whatever level had the laminectomy coupled with ADRs beside it, if possible. I've only seen that offered in one long surgery in Europe but it might give you the best chance of success.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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