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    When is enough, enough?
    raiderrip posted:

    I posted this in another back pain community and have not had any response in over a week so I thought I would move it here...

    I have been through two back surgeries. The last one they put a clamp on the fins of the vertebrae to help hold them apart (hope my technical terms aren't too much for because I don't have much disk left. I have been on pain meds for a few years now and recently the pain has become worse. The whole purpose of the pain medication is to avoid surgery but, I know that as bad as my back is, it has to be doing damage to my nerves. I have numbness in my big toe and the ball of my foot and recently developed the all too familiar nerve pain down my other leg. My questions are... when does it become dangerous to keep covering up the pain and not fix the problem? You here so many stories where people say they came out worse after surgery so if I do have surgery, will I only end up worse? If I don't have surgery will I eventually loose feeling in my leg or worse? Any advice or suggestions, a course of action to take, something that will let me know that its getting dangerous to wait.... would be greatly appreciated


    davedsel responded:

    Spinal surgery has only a 50%-60&% success rate for pain relief and up to an 80% success rate for improving functionality. It is extremely complex, major surgery with many risks. This is why it should only be a last resort after other treatments have been tried.

    Usually doctors wait to do back surgery until you can barely walk or lose control of you bathroom functions. If the latter happens, get to a hospital emergency room right away.

    There are many other methods of pain managements such as injections, rhizotomies (burning of the nerves), hydrotherapy, etc. I personally can only take enteric coated aspirin and a muscle relaxer for my serious spinal conditions that cause major chronic pain. I rely more on a good recliner, a good bed (my choice is sleep number) and chiropractic adjustments.

    Your doctor that diagnoses your spinal conditions should be a spinal orthopedic specialist/surgeon or spinal neurologist/neurosurgeon. They are the best doctors for knowing what is causing your pain and for recommending effective treatments. You can also see a pain management specialist that is a physiatrist. These doctors go deeper and offer a wide variety of treatments.

    I pray you can find answers and relief soon.
    Click on my username or avatar picture to read my story.


    raiderrip replied to davedsel's response:
    Thanks Dave. I have been through two rounds of the spinal injections with very little to no success. I tried the pain management doctor but, it felt like some kind of factory.. The doctor asks the same questions every time I had a appointment and I would give him the same answers. They weren't "doctor questions" they were conversation questions like, what do you do for fun.... I told him that I had been through the spinal injections but he didn't even miss a beat saying that they would schedule me for another. Its like most of what I said went in one ear and out the other. Don't get me wrong, he seemed like a good doctor but I guess he had so many people to see that it had just become a routine. I ended up calling and canceling my appointments with him. I am very comfortable with my family doctor and he listens and has been very helpful.

    Thanks for the reply, it gives me things to look for that let me know when its time to take a serious look;

    meaningfulc1952 responded:
    Hello Raiderrip:
    Wow, it sounds like you have been through the ringer! I am really sorry too. I have been through hell only it was my jaw.
    I have had 6 major jaw replacement surgeries. The first one was in 1983 and the last one was in 1995. The one in 1995 lasted for 13 hrs. I am not kidding either.

    First, let's me very clear. I went to 7 different oral surgeons before I had any type of jaw surgery. I wanted to be sure that
    I was doing the right thing. What I did not know that they would be putting a jaw joint replacement in me on both of the sides of my face that had dangerous materials in them made by Vitek which was based in Texas a long time ago. The FDA shut them down in around 1990 and also recalled the Vitek jaw joint prosthesis. I actually had my Vitek jaw prosthesis removed and I gave it to the FDA for more investigating. It took more than a year to get the report back from them. The report showed that it caused many severe problems to my body and would continue to no matter what.

    My thoughts about your back are this: I would get more than 1
    opinion from several orthopedic drs. I would also make sure that you have your x-rays and any other type of records to take too. All of this is very important to take to any new dr. for a
    consultation. Then after you have seen more than 1 dr. for a
    discussion about your back problems then I would do some research on the computer if you have one. The key to you protecting yourself with any dr. or surgery is knowledge. I did not have the knowledge before my jaw surgeries. They never told me the name of the implant that they were going to use and never told me that I would have a life of chronic to severe pain the rest of my life.

    Your main job is to learn everything that you can possible absorb. This will protect you the best that it can. Then if you have a spouse or a good friend I would recommend that you discuss this with them and get their feedback. You never know
    what someone else might have to say. Ask a family member if you can or someone that knows that you have been going through all of this and you are not sure what to do.

    After all of that, then you probably will decide what you should do. My husband had knee pain that was horrific and he put off having a total knee replacement for years. He finally had both of his knees done but not at the same time. These days he can walk as normal as anyone and he also rides his bike 3-5 times a week and goes on long bike rides as long as 4 hours on a Saturday. Not everyone has that good of an outcome, but his attitude really helped him too. I need to let you know that he is now 65 years old and rode 65 miles on his bike this past week because it was his 65th b'day and he wanted to prove to
    his self that he could do this.

    I hope that I have given you a lot to think about.

    Anytime someone has back surgery I have heard a lot of negative things about it. Are you taking strong pain meds for now? I mean are you seeing a pain mgt. dr.? If you are, are you
    getting the best pain control possible? Is there any option other than back surgery?

    Please get back to me about your situation. I really do care and would like to know how you are and what you decide to do.

    Good luck,
    meaningfulc1952 responded:
    Hi Raiderrip,
    I have a reply, but I re-read what you wrote. Apparently you
    did not have a very good pain management dr. That is my
    opinion. Most pain management drs. would be prescribing some type of pain meds. Did you ever get any prescribed from
    your pain mgt. dr.? If you did not, then I think that you should
    look for a different pain mgt. dr. and discuss all of this with a new one. You never know what a new pain mgt. dr. might have to offer you. Just a thought. OK?

    Good luck,
    cweinbl responded:
    After 43 years of chronic back pain and four failed spine surgeries, including multilevel fusion, I've learned a lot. Sometimes, there just isn't an answer. Even when there is an answer, it may not work for you. Be careful and only go to a fellowship-trained spine surgeon.

    A fellowship-trained spine surgeon is an orthopedic surgeon or a neurosurgeon who has completed a fellowship in spine surgery. This is typically three to four years AFTER a residency. There are not a lot of these people around, but many can be found at or near teaching hospitals. Remember to only go to them if they have completed this fellowship.

    I obtained coinciding opinions from two fellowship-trained spine surgeons. I had surgery with the one who created and ran the fellowship in spine surgery at Case Western Reserve University. During my first surgery with him, a laminectomy, a resident accidentally gouged out a piece of my right S1 nerve root, leading to a permanent increase in pain and radiculopathy. Like an idiot, I failed to ask if the fellowship-trained surgeon would be doing ALL of the surgery HUMSELF. A rookie did me in.

    My second laminectomy there included multi-level fusion, because so much bone had already been removed. The recovery was slow and very painful. I developed significant fibrosis (scar tissue) and never recovered. Twelve years later, at age 51, I had to retire from a very rewarding university career (2004). My fellowship-trained spine surgeon did not order PT (to prevent fibrosis) after I came home.

    Spine surgery is about 60% successful for pain. That places it among the worst odds for success among all types of orthopedic surgery. It should always be a last resort option.

    Always try everything that a comprehensive pain management program has to offer first, including biofeedback, meditation, injections, acupuncture, decompression, PT, even hypnosis. If all of those fail, try the spinal cord stimulator or the intrathecal infusion pump. If all of those fail, then you might (and I emphasize MIGHT) consider surgery.

    Good luck
    77grace responded:
    Hi raiderrip ,
    Well it looks like you have gotten a lot of great info so far !!!
    I agree that surgery should be the last resort !It really depends what the problem is !If it is fixable or not !Mine is not fixable so I go the pain meds route ! Definatly get several opinions !
    As far as it being dangerous to be onm pain meds. It's not !I have been on them for over 10 years!
    Only your Dr. can tell you if it's dangerous to wait or not !Is it going to cause Paralasis or something like that ?
    Take care ,77grace
    Peter Abaci, MD responded:
    Making decisions about spine surgery is one of the most confusing things that a patient can go through. In some cases, a person can consult with several different doctors and get a different opinion from each one. I have seen many questions run through a person's head, like "Will I get paralyzed if I don't have the surgery?" I thought I would pass on a few general thoughts on spine surgery for you to consider while navigating your situation:

    • Overall, we probably do way more spine surgeries in this country than we need to.
    • Outcome studies on low back pain with aggressive rehabilitation have been just as good.
    • Consider spinal fusion surgery for a stability problem but don't expect it to be pain cure.
    • Once you have had one spine surgery, the chances of having more latter goes up.
    • If there are no neurological emergencies going on, then there shouldn't be a reason to rush into anything.
    • I wouldn't think of spine surgery as a way to get the problem "fixed." Us humans are way more complicated than machines, and nobody can reverse age-related changes.
    • When making a decision, find a doctor who considers the whole person and not just the x-rays and MRIs when making recommendations.
    • When making a decision about something invasive, consider not only the immediate effects of the treatment but also the long-term outcomes and effects. This too often gets overlooked.
    • There are many different ways to improve pain management beyond surgery and medications. Try to consider all of your options.

    Good luck in working through this problem!
    raiderrip replied to Peter Abaci, MD's response:
    Thanks to everyone for the replies. If I distill it down, what I come out with is "026.
    I should consider surgery as a last resort.
    Signs that I may have to have surgery are, major weakness or loss of use of a leg(s) or I get to the point nothing will relieve the pain. But, if I lose control of my bathroom facilities I should seek help immediately.
    Surgery is a pretty much a 50/50 shot as far as making things better.

    I may look into PT or some other type of treatment to help with the situation.

    What is really scary is thinking where I will be in 5 or 10 years (I am 51). Will I be able to still get around when I turn 60 or will I be in a wheel chair or flat on my back most of the time? Where will my pain be in another 4 or 5 years? I know it's anyone's guess but, with some of the problems I have now, I can only hope I can maintain my current level and not degrade too much. Man, I don't even want to think what I will look like if I make it to 70! Maybe I should consider retiring (I have a very stressful job) as early as I can and enjoy being able to get around while I still can.

    Thanks again.
    annette030 replied to raiderrip's response:
    The answer to your question is,"No one really knows." Any person who tells they do know, are just guessing in my opinion. Survey should be your last option. Again this is my opinion.

    The last time I had a herniated disc in my neck, found for sure by MRI, the symptoms I was having essentially went away after several years. There is always hope.

    Take care, Annette

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    Peter Abaci, MD , is certified in anesthesia and pain management by the American Board of Anesthesiology. Dr. Abaci received his undergraduate educat...More

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