New Member w/ Interesting Situation

[VPDcurt]

Hello there,

I've been reading the forum for a few days now and decided that it's time to get a little bit more involved. Here is my situation: I am a current 4th year medical student and I was doing fairly well until July 2009, when I herniated L3/4 for the second time. The shooting pain down the back of my right leg was absolutely horrifying...I was limping everywhere for a good month or two - so much so that people would ask, "are you alright?" and other things of that nature. I've always been fairly active in terms of working out (usually low impact every since my first injury in 2000) by doing things like stair steppers and ellipticals and have been able to deal with the pain whenever it bothered me. I've still managed to do the stair stepper in my free time since this most recent injury; however, due to my crazy schedule, I haven't exactly had much free time. My pain is usually around a 2-4, but occasionally spikes to a 5-6. I am very good with pain - I've had 5 surgeries in my life (2 of which were on my spine) and have never used pain meds - not even immediately post op. I once tried vicodin a while back during a flare and hated the way it seemed to slow my cognition while barely doing anything for the pain.

I'm currently applying for residency positions in the northeast. I have the month of Mar off essentially, am doing a pretty laid back rotation in April, and I will graduate on May 22. Residency starts anywhere from June 7-June 21 or so. Needless to say, I'm kind of in a time crunch if I'm going to get something done. I am currently scheduled for a two-level ADR (prodisc) at L3/4 and L4/5 this Fri, Mar 5 (crazy, I know). I initially felt like I needed to get this taken care of prior to June, as my residency/fellowship will last anywhere from 6-10 years. However, I've been doing quite a bit of research and there are many things that concern me with respect to this approach. For one, I was reading my doc's pre-op note and it states that I am having back and leg pain - I haven't had any back pain my entire life! It's all leg pain. Sounds like there has def been a misunderstanding of some sort. Second, I have not had a discogram (ever). I'm concerned that I'm gonna wake up on Fri afternoon with two ADRs and still have the same/similar pain. Third, the MRI explicitly states the presence of the disc herniation at L3/4; that same disc looks dark on MRI with some loss of height but only mild foraminal stenosis. There is mod/severe spinal canal stenosis at that level (it's a pretty decent bulge). L4/5 still looks hydrated, but has been operated on before and recently bulged/reabsorbed so my doc said, given my circumstances with residency coming up, it would be prudent to replace that disc as well since he'll already be in the abdomen. He did state I would required fusion at L4/5 if he could not place the prosthesis. Furthermore, if he cannot remove the L3/4 disc debris in the canal from the anterior approach, he might have to flip me over intraop and clear those fragments posteriorly. So in theory, there is a chance (albeit a small one), that I could wake up on Fri afternoon with L3/4 Prodisc and posterior decompression due to the fragment along with an L4/5 fusion - and my pain might not even be gone because no one is exactly sure where it's coming from!

Interestingly, my pattern of pain is more consistent with L5/S1 (I remember herniating back in July 09 and I was totally shocked when the MRI came back with an L3/4 herniation; I would have put my money on L5/S1 without a doubt). I've been thinking a lot about this today and I really don't feel too comfortable moving forward with this on Friday. I did have an injection at L5/S1, which helped the pain for a couple of hours (and further clouded the picture).

Sorry this is so long, but in a nutshell, I'm concerned that I am rushing into this way too quickly given all of the uncertainties, simply because of my impending residency. I am in pain but I can deal with it as long as I'm not making things worse for me down the road. Revisions of the prodisc don't seem too promising at this point either and there is no telling how long the implant will last in the first place.

I have my doc's cell phone number and I plan on calling him first thing in the morning...and likely canceling the surgery. Let me know if there are any other questions. I know this is long and prob very convoluted, so I apologize in advance. Hope all is well. Take care.

[Toebin]

VPDcurt,

I'm no expert but if you have ANY doubts about surgery ... now is the time to back up a bit and take a second look.

There are ways for your medical team to search out the pain generator in your case, and it sounds like that is a piece of the puzzle that you have issues with. It might be prudent to take a closer look prior to going through with the surgery. It might only delay things by a few days and you might have a much better picture of what is going on.

BTW, have they done any bone density studies on the area to be repaired.. it's always a good thing to know your bone health before they start removing and replacing things.. Just a thought ... and again shouldn't add a large time delay.

Good Luck to you in your decision process and please let us know how things turn out !!!!

[kimmers]

VPD, I understand you are in a hurry to get this problem fixed.
But you might want to take a step back and make sure you have identified the pain generator and are sure there are no contraindications to ADR.
Like above, a bone scan, eventhough you are young, will rule out osteopenia/osteroporosis. X-rays, which you may have already have done, to make sure no vertebrae are slipping over each other.
A discogram, which I fully believe in, can pinpoint the disc as being the cause of the pain.
ADR is major surgery. You are young but this is still major major surgery. I would get a second opinon or have your surgeon get you the above tests. I know I even had my facets ruled out with facet injections. All this takes time, but you only have one back and you want to get it right.
Maybe you have had these tests, but I wouldn't jump into surgery until you have identified any/all pain generators.
Good luck and I hope everything falls into place.

[2 Young 2 Hurt Like This]

Hi,

You mentioned that you only have the leg pain. I was suggested by my 2nd opinion to get a Microdiscectomy. At most it maybe a one night stay and its aimed to fix leg pain. They go in and take out the part of the disc that is pressing on the nerve that is causing the leg pain. Here is a link that will explain more.

http://www.spine-health.com/treatmen...-spine-surgery

This personally wouldn't work for me. I'm not convinced this is a permanent fix but it should buy you some time to research more and get you threw your residency.

I only know what you've posted but if I were you I wouldn't jump into getting a ADR. I've known for a year that I need a 2 level ADR @ L3-4; L4-5 and I am still researching my A$$ off. Even if you have the ADR surgery the recovery process from what I have been told is 6 months to a year and you have to take it very slow and listen to your body. Either way if you get it now or later it doesn't change the recovery process.

I've had A LOT of time to think about this surgery and for me I hope it will be the final step of the last 4 yrs of pain and the 1st to the rest of my life. I do not take it lightly and I am also in a time crunch. My trial is in June and I have to figure out what I want to do and get it done ASAP. At the same time I am not going to let that rush me into something that will land me in over my head.

Sorry if any of this comes off harsh or bold. I'm just being honest based off what I've learned and know 1st hand.

I wish you the best of luck

[2 Young 2 Hurt Like This]

Woops I feel like a dummy. I just read your signature. I see you've already been there done that with the MicroD.

[VPDcurt]

Thanks for the replies. I canceled my surgery for now. Yeah I've already had the MicroD at L3/4 - spoke to my doc today and he said, since the herniation is so large and there is scar tissue in that area already, he wouldn't recommend microD again as it may not alleviate the leg pain, will create more scar tissue, and will likely adversely affect the disc height even more. I'm scheduled for a discogram on Mar 16, but after reading articles regarding more rapid degen/herniation in discogram patients, I'm strongly considering canceling that as well; the L5/S1 disc is "pristine" as my doc puts it (i've seen the MRIs and it does look perfect). My doctor (who is amazing) just called me a few mins ago and asked if I wanted to meet with him tomorrow am to discuss my plans...so I'm gonna do that. Hopefully that will be informative. We'll see.

[2 Young 2 Hurt Like This]

Oh thank goodness! I am happy you canceled and your doctor is willing to work with you!

Let us know what happens

[VPDcurt]

After discussing things with my doctor, I've decided to put surgery off indefinitely. I'm gonna wait it out until I really can't deal with it anymore. I felt like I was rushing into things and that is obviously not a good idea with anything, let alone back surgery. My hope is that I can hold out long enough for the next gen discs to get FDA approval or at least until someone devises a better revision plan for the prodisc (i.e. not fusion), at which time I will hopefully either be done with my residency or it will be during a time in which I can take a year or two off for research (which is part of my plan regardless of my back pain). Hope everyone is doing well. Take care.