What helps spinal stenosis besides surgery?

Posted by sakota9 (Joan) @sakota, Jul 17, 2020

I also suffer from bursitus in my hips so I go in for infections. The shots help both my hips and my back. Today, thought I would look for things on the internet and then discuss with my dr. I came across an article for a neuromd Its a device you wear on your back and helps with the pain. Its been FDA tested and approved. Has anyone checked this out. I don't know if insurance covers it or not ...... I am getting tired of the injections and those really are just a temporary solution. I'm 76 and don't think I want to go thru surgery and my dr said that doesn't really help. So if anyone has one of these things or know about them, would appreciate your input. Besides the back am also dealing with copd and lung cancer........Life is like a box of cherries......I just keep getting the sour ones......... Hope you all are doing ok......andhave God, family and friends as your everyday support...........

Interested in more discussions like this? Go to the Spine Health Support Group.

rita9876 | @rita9876 | Nov 20, 2022

In reply to @jenniferhunter "@migizii Am I understanding you correctly, that you saw an orthopedic spine surgeon at Mayo for..." + (show)

@jenniferhunter

@migizii Am I understanding you correctly, that you saw an orthopedic spine surgeon at Mayo for a collapsed L3/L4 disc and they said no to surgery, but another surgeon since then recommends surgery if conservative treatment fails? It sounds like you have not improved with physical therapy, etc. Have you seen a spine neurosurgeon? Both otho and neuro can be spine surgeons. Do you have other health issues that would make you a poor surgical candidate? One problem of being on "Medicare", if you are not on genuine Medicare, and are on a "Medicare Advantage" plan is that Mayo might not accept that. A patient I know just ran into that. Not all Mayo campuses take original Medicare (if I'm not mistaken). I think Rochester does take original Medicare. I called them and asked that question and I chose a Mutual of Omaha Medigap policy to go with it so I could be sure I would be covered if I needed further treatment at Mayo. It's time to sign up for next year's insurance, and perhaps you can change it so it is acceptable at Mayo.... worth a phone call anyway. I think you probably could get other opinions at Mayo if the insurance coverage was not an issue. Also in MN, you can see Mayo trained surgeons at the Mayo Clinic Health System in some other towns.

Here is a large question list I compiled about spine surgery, and not all may be pertinent to your case.

~ QUESTIONS ABOUT SPINE SURGERY ~

What type of surgery are you recommending? Why? What is the specific anatomic lesion being addressed?

What is the natural course of my condition if it is not surgically addressed?

Why does the surgeon recommend this specific procedure? What are the potential results for this surgery? Why am I a good candidate for this surgery?

What is the source of the pain that is being addressed? How do you know this?

Please explain the procedure in great detail.

What products and implants are used? Is everything to be used FDA approved for this application?

What are the chances that the osteophytes will regrow? If so, what will minimize that chance?

What are my non-surgical options?

What are the different surgical procedures that can address my problem?

Can the disc be saved?

What would you recommend if I was your friend, wife, sister, or daughter?

How long will the surgery take?

What are the side effects, potential risks, and potential complications?

Please explain the risks and how they relate to me personally.

Reactions to implants, metal sensitivities, plastic sensitivities, toxicities?

What happens to artificial disk as it wears? How long would it last? Any not made of metals?
Are the metals used the same or different within the implant?

How great is risk of adjacent segment disk degeneration with a fusion? Are there other discs that show degeneration now that could become problematic in the future? Do you think I will have a problem in the future on adjacent levels?

Do I have to have a metal plate on my spine? Is there another way to stabilize the spine?

What if, during my surgery, you encounter a different spine issue than you expected?

What is the risk/benefit ratio (the chance of a bad outcome as weighed against the chance of a good outcome)?

Do any of the materials used increase my chances of getting cancer?

What are the standard safety procedures to insure my safety during the surgery?

What are the safety cross check procedures during surgery?

What kind of imaging is used during the procedure and how does it tell you what you need to know?

Are there electrodes on extremities (neuro monitoring) making sure the nerves are functioning?

Do I need to donate my own blood? If yes, why?

Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, What are their background and qualifications?

Can I talk to other patients who have had a similar procedure?

Who else will assist you in the operation? What are their background and qualifications?

What are the long-term consequences of the proposed procedure?

~ QUESTIONS ABOUT THE SURGEON ~

How many times have you done this procedure?

Are you fellowship trained in spine surgery?
This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.

If I want to get a second opinion, who would you recommend?

Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?

~ QUESTIONS ABOUT WHAT TO EXPECT AFTER SURGERY ~

What kind of pain should I expect after the surgery and for how long?

How long is the hospital stay?

May a family member spend the night with me in the hospital?

How do you manage the pain in the hospital?

Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?

Who can I call if I have questions after the surgery? What is the process for communication?

How often will I see you after my surgery?

What symptoms would warrant a call to your office?

What symptoms would warrant immediate medical attention?

What limitations will I have after surgery and for how long?

How long should I wait to bathe?

How long will I be out of work? School?

What kind of help will I need when I return home?

When can I drive again?

When can I resume normal (light) household chores?

What expectations do you have for my recovery?

How soon after the surgery can I start physical therapy?

So that was a lot of questions.
Here are some other discussions to check out:

Podcast about Spinal Stenosis
https://connect.mayoclinic.org/blog/podcasts/newsfeed-post/spinal-stenosis-1/
Spine Lumbar Fusion Surgery
https://connect.mayoclinic.org/discussion/spine-lumbar-fusion-surgery/
Are you considering getting some other surgical opinions?

Jump to this post

You mentioned that both Otho and Neuro surgeons could do stenosis surgery. I consulted both for my stenosis. Both are at Mayo. I like both doctors. Both recommended complicated surgeries. However, the proposals differ in one of the 3 aspects. Could you provide some input to how you would have choose one over the other? Thanks!!

Jennifer, Volunteer Mentor | @jenniferhunter | Nov 20, 2022

In reply to @rita9876 "You mentioned that both Otho and Neuro surgeons could do stenosis surgery. I consulted both for..." + (show)

@rita9876 I don't understand what your choice is and what would be different or what your general health is like. In the end it is only your choice. We can discuss it and maybe that will help you digest the details. Can you tell me your history, and how your spine arrived in a condition that would warrant surgery? What do you think are the benefits vs the risks of each surgery? Did you ask each surgeon how they view the other's recommendation? Since they are both at Mayo, you could do that and I'm sure it would be acceptable to both of them to ask. I wouldn't be comfortable asking them to critique each other if they were from different medical centers, but Mayo truly is a team approach. They can probably both see the others records anyway.

rita9876 | @rita9876 | Nov 20, 2022

In reply to @jenniferhunter "@rita9876 I don't understand what your choice is and what would be different or what your..." + (show)

I saw the neurosurgeon after being under the care of the authopedic surgeon for a while. Neurosurgeon said his approach is similar, but he will start from L2 and down to hip, but the authopedic surgeon will start from T11 and down. He noted that every doctor will have their own approach. I suppose one couldn't do the other's surgery. It is just hard to decide. I was curious as to what factors people consider under similar dilemmas.

Jennifer, Volunteer Mentor | @jenniferhunter | Nov 20, 2022

In reply to @rita9876 "I saw the neurosurgeon after being under the care of the authopedic surgeon for a while...." + (show)

@rita9876 So your choice with the orthopedic spine surgeon is they would add 2 extra levels of fusion at the upper end and is that going down to the sacrum at L5 / S1? Either way it sounds like a big surgery with a lot of levels to be fused. Are they using rods to stabilize the spine? Did this doctor give you a reason why they wanted to do the 2 extra levels? Did they show you the MRI and explain why? This is what surgeons should do. Often the discs next to fused levels can become affected because of extra stress put on them because movement isn't normal anymore. It is possible those extra 2 upper levels have an intermediate issue that is expected to get worse, but that is a question you need to ask the surgeon.

The neurosurgeon has the more conservative approach. If you have never had spine surgery, this will be a big change. What are the symptoms that you have right now that concerns your surgeons? Did either of them expect that you may need more spine surgery in the future? Do you have a spine deformity such as scoliosis that needs a curve correction? My spine surgeon at Mayo Rochester was neurosurgeon, Jeremy Fogelson. I mention that just in case you have seen him, as I think he is an excellent surgeon and kind person. Dr. Fogelson is a deformity expert and has a long track record of educational excellence. I would highly recommend Dr. Fogelson. I do think the surgeon's area of interest should match what you need to have done. I have no say here, but let me know what you think.

kaptainkat | @kaptainkat | Nov 21, 2022

In reply to @eviggiano "Hello, I am also on this journey to seek different MDs to get answers to my..." + (show)

PT has been a godsend for me and my sciatica.

WITH my roll-a-tor, I could barely make twenty feet to get the newspaper from mid driveway.

That was then. This is now. A six-minute endurance test got me EIGHTH HUNDRED SIXTY NINE FEET!!!!!

I am starting my FOURTH extension from Medicare from petitions from me, my therapist, and my pain Dr.

Cervical issues are a 'rider' via the pain Doc for the primary issue of the sciatica. And my therapist has been able to provide routines for both that I continue at home.

I can and DO repeat about 80% of my 'gym' exercise here at home. I don't have elastics. Besides walking, I have not needed to whack my neck (an 'activator' chiropractic method I picked up) or try to pull my head off (a traction technique I gleaned).

I will do near anything to avoid 'the blade'.

Jennifer, Volunteer Mentor | @jenniferhunter | Nov 21, 2022

In reply to @kaptainkat "PT has been a godsend for me and my sciatica. WITH my roll-a-tor, I could barely..." + (show)

@kaptainkat That's wonderful that through physical therapy you have gained so much more strength and function. I did chuckle at your description of traction.

However, if you have a deteriorating spine and discs that have lost strength and integrity, the "WHACK YOUR NECK" move might be just the thing to put you on a collision course with "the BLADE". Seriously, all I had to do to pop a disc ( also known as a herniation or rupture) was to turn my head, and yes, I actually heard it POP and my head suddenly turned further. My disc was weaken from a prior whiplash injury some 20 years earlier. If you are applying pressure, that could happen so easily. The rupture set in motion rapid growth of bone spurs and compression of my spinal cord... and yes... I met "the BLADE", the nippers, and the power tools under anesthesia of course, but that was a very good thing and I got my life back. I was even curious enough to look at the table of shiny instruments set up just for me in the operating room. I was the center of attention on that stage. It is expensive, and then there is Medicare to deal with which I have now too. You may want to discuss what things are safe for you to do with your physical therapists and doctors. They are experts in how to avoid surgery and your advocates when it is necessary.

You may be interested in this discussion in the Spine Group:
---Chiropractic Treatment for Degenerative Spine
https://connect.mayoclinic.org/discussion/chiropractic-treatment-for-degenerative-spine/
Stay strong!
Jennifer

pablo81 | @pablo81 | Nov 21, 2022

In reply to @theparrottrooper "Hello Joan :) I also suffer with spinal stenosis. Over the years I’ve tried a chiropractor,..." + (show)

I had Vertiflex installed at L2/L3 in June 2022. No relief. It may prevent worsening over time so I am told. Sounds logical.

pablo81 | @pablo81 | Nov 21, 2022

In reply to @jenniferhunter "@pablo81 My 80 year old cousin just had a laminectomy on his lumbar spine. That does..." + (show)

Data suggests that most open back laminectomy surgeries are unnecessary. Removing bone is not good for the stability of the spine.
Usually a laminectomy at one level places additional strain on level below because of loss of spinal integrity which results in followup surgery a few years later. You may get short term relief but undesirable long term. Of course how much bone is removed is a key factor. I have had a endoscopic discectomy on l5/S1 for sciatic in 2019. It is minimal invasive i.e. no cutting and it worked well. A major concern is that doing a triple laminectomy will exacerbate my problems as I cannot visualize how my spine will be protected with such a large portion of my spinous processes removed. I am balancing all of this with my tolerance for pain and thus far I am okay with the pain levels.

migizii | @migizii | Nov 21, 2022