Hi everyone

[Kerry F]

Hi everyone,

I'm new to this forum and definitely glad I found it. My goal is to find out if disk replacement surgery is right for me and if the doctor I currently see is the right person for the job.

Here is a brief history of my issue:

In 2002 (at 28 years old), I herniated L4/L5 & L5/S1. Since then, I have tried everything you can imagine: every kind of physical therapy, steroid/epidural shots, facet injections, nerve stems, IDET, acupuncture, etc. I was in extremely good shape at the time-- running about 25 miles/week. At this point, there is nothing left for me to do besides some kind of permanent procedure-- which is the only thing I think will have any kind of effect.

I currently try to hold down a full-time job while in pain everyday. My back problem has caused so much pain in my right hip (mainly the hip flexor) that I pretty much limp around. It also seizes up my neck, where it "catches" and causes a stabbing pain between my shoulder blades. I have to take pain medication just to get through the day. Needless to say, I'm at the end of my rope. I'm not sure I'll have a job to come back to afterward, but that's out of my control.

I'm wondering if anyone can shed some light on this: how do I find out if my doctor is the right person for the job? What is his success rate, etc.? I will give his name if anyone wants to know-- I figured I would hold off until then.

Thanks in advance and hopefully I can be an encouragement to some of you along the way!

Kerry

[annapurna]

First, where are you? What is your situation? If someone recommended a good surgeon in another state (assuming you're a US patient) could you travel to that surgeon? Another country?

These seem somewhat advanced questions on first glance but having said that you're a two-level patient, you're already looking for the best surgeons. You're likely to have to travel to see one, as there aren't that many that are safe for a double level or hybrid ADR/fusion.

[Harrison]

Hi Kerry, sorry you are here....I hope we can help. Sorry to task you as you make you way through six years of posts! But when you can...

- please add a signature, 3-6 lines about your spinal condition. You mentioned this in your post, and that's great. This signature will automatically appear when you post. See in the upper left: User CP > Settings & Options > Edit Signature > Create it > Save

- Do you also have cervical issues too? I wasn't clear about this -- I hope it's OK!? Have you had imaging studies or your lumbar or cervical spine yet?

- After you get your feet wet (ours are wet again in Mass.! ), we can talk through any other issues by phone.

[Kerry F]

Thanks so much for your responses. Sorry it took me so long to get back. Between my job and doctor appointments, I have very little time.

After getting new films, things are worse than I thought. Hopefully, my signature will show up below with the main problems. I just finished trying a MedTronic electrostimulator- which was like putting a band-aid on a hatchet wound. So I made an appointment to see the best surgeon I could find in Dallas (Dr. John Peloza). Within about 2 minutes, he said he couldn't (wouldn't) be able to do anything for me- and can do anything (ADR, fusions, etc.). He said 4 levels is just too many to deal with and that nothing he could do would help in his opinion. He just gave the number of some pain management doctor here in Dallas that does some cold laser therapy- which isn't FDA approved and all out of pocket.

Needless to say, I am beyond discouraged. I finished my MBA last December and now have a good job, and I'm at the point where I don't think I can sit at my job anymore; however, I have to have the insurance it provides me.

Because I'm only 35 and in good shape, I don't think people (including the doctors I see) understand the severity of my situation. I can barely stay at my job and have to pop Hydro-codone like it's candy just to function.

Annapurna,

To answer your question, no one has recommended a doctor outside of Dallas to me. I keep getting warned about the dangers of fusing/doing cages on 4 levels, but no alternatives are offered- which leaves me with no solution. I'm aware that I can find someone to operate on me, but after hearing all this, I don't know what to do. All I know is that I have to do something.

Any ideas or direction would much appreciated.

[Kerry F]

Does anyone have advice for someone with problems at 4 levels (per my signature)? It's very difficult when you're 35 and look like you're in great shape. It just turns into a lot of "don't do this" or "don't do that"- without offering any suggestions. It's heart-breaking.

My most recent Doctor appointment/experience is detailed in my last post. Any help or advice would more appreciated than you could ever know. Thanks.

[jss]

Kerry,

Condolences on the terrible situation in which you've found yourself.

Like you, I've had four levels done; C4/5 fusion 2000, C5/6 fusion 2002, C3/4 and C6/7 ADR 2009. Also like you I am active; I've just finished my fifth marathon and am continuing to train for a full IronMan in 2011 (I'm 47). UNLIKE you, my problems have all been cervical; which tends to have better outcomes and easier recoveries than lumbar. With each surgery a level adjacent to the symptomatic level was showing a problem, but because it was asymptomatic at that moment in time, I deferred treatment.

I have a couple of thoughts... Are you symptomatic from all of those levels? Do all of those levels need to be addressed right now? Or can one or two be addressed now to provide you relief, and then the others addressed later when they become symptomatic? I suggest that for the hope that when the adjacent levels become symptomatic, and they possibly will, there may be better treatments than are available today.

Like you, I am in the DFW metroplex. My double ADR was in Spain, but both of my fusions were in the DFW metroplex and I almost had a single level ADR here in Dallas. Below are the surgeons I have seen and recommend. Two have operated on me twice, I also consulted with the third about my condition before my double ADR; and I trust all three of them implicitly (even though they gave me three different opinions on treatment):

Dr Richard Naftalis (fusions in 2000 and 2002: but he does ONLY fusions; Dallas, TX)
Dr Jack Ziglar (almost did my ADR, but I didn't like the prosthesis he used; Plano, TX)
Dr Pablo Clavel (Spinal Kinetics M6 double ADR, Barcelona Spine Center - Barcelona, Spain)

Naftalis and Clavel are neurosurgeons, and Ziglar is an osteopedic spine surgeon; a world renowned spine surgeon BTW. If you want to continue to pursue other options, while I am unfortunate enough to have had first hand experience with all three of these gentlemen, I do highly recommend all of them.

sigh...

Good luck, Jeff

[Kerry F]

Hi Jeff,

Thanks for the words of encouragement. To answer your question..."no", I do not feel that all 4 levels are causing me problems. Before I had the IDET procedure in 2003, my discogram revealed that most of the pain was coming from L4/L5 and L5/S1. I've got an appointment with Dr. Blumenthal's PA tomorrow (Texas Back Institute). He's the one who treated me back when this first started and did the IDET.

My guess is that his PA will order another discogram. I've also got an appointment with Dr. Richard Rhim at the Minimally Invasive Spine Institute next Monday and I'm about to make an appointment with Dr. Andrew Konen at Pinnacle Pain Medicine to discuss pain management options. I'm just trying to talk to everyone I can.

If I had to guess, a new discogram will probably look much like the old one; and Dr. Blumenthal will suggest a combination of a new disk and a fusion. At that point, I will have to decide if this is the best option for me.

Any thoughts?

Thanks again.

[2 Young 2 Hurt Like This]

Hey Kerry,

I'm curious about the IDET you had done and and how your body reacted to it. I had one many yrs ago and it only made my pain worse.

Sounds like you have a lot going on. Base off your prior disco, if I were you and could get away with it I would most likely go with getting they Hybrid surgery. Fuse L5-S1 and ADR L4-5. From what I've read on here along with other sites and docs it seems like a solid fix for those levels.

Just take it one step at a time and try not to get discouraged.

~Liz

[jss]

Originally Posted by Kerry F

If I had to guess, a new discogram will probably look much like the old one; and Dr. Blumenthal will suggest a combination of a new disk and a fusion. At that point, I will have to decide if this is the best option for me.

Any thoughts?

Thanks again.

Having never had lumbar problems I don't have much knowledge of those procedures. If you do decide on lumbar ADR, I would encourage you to carefully research the different artificial discs that are out there. Discover the problems unique to each device, the problems that each device was developed to address, determine the effects of an adjacent fusion on each device, what is the expected longevity of each device with the type of wear and tear that you intend to subject it to, etc... My experience with cervical ADR is that a doctor will offer only one or two devices, requiring you to select one of those. I suspect the same is true of lumbar ADR.

Selecting the right device for you is, or at least should be, a very big decision. It took me almost a year and a half of research to decide which disc was best for me and then to determine the best place to have them implanted. I sincerely hope that your outcome is as good as mine.

Good luck, Jeff

[Juli]

Hi Kerry,

I had a fusion at L5/S1 and also ADR at the two levels above in 2005 and it worked great for me. I was fairly young, not as young as you (41), but being so young may be a good thing as you may not have any other contraindicators that some people who are older get. I would suggest finding the best doctor and then looking at devices as a secondary issue. For multiple levels, the best doctor you can find is by far the most critical. I used a patient network service to get my film to the doctors I wanted to talk to, and then, after they reviewed them, they called me on the phone to discuss and make sure I seemed like a good candidate before I traveled to got examined in person.

You can go to the surgical outcomes thread to see my story, as it may be very similar to what you have going on. Please let me know if you have any questions, but I would recommend picking at least a couple of very good doctors and seeing them both, to have two firm opinions, before you make your decision. Even the best doctors do not always get it right 100% of the time, and each case is unique.

Good luck!