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What helps spinal stenosis besides surgery?
Spine Health | Last Active: 1 day ago | Replies (193)Comment receiving replies
@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.
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@jenniferhunter
Thank you very much for taking the time to converse with me on this.
Sorry, for the late reply due to a lot of holiday activities and visiting families.
Re. "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?"
-> Yes, pretty much, at least that is my understanding. Below is the exact wording from the doctors, I would like to know if my understanding is incorrect, therefore the direct quote. Thanks!
Ortho's plan: "3-stage surgery over 3 days. Stage 1 would be a posterior lumbar decompression at L2-3, 3-4 and 4-5 with screw placement from low thoracic T11 down to the sacrum and a TLIF at L2-3 and L3-4. Stage 2 would be an anterior lumbar decompression instrumented fusion at L4-5 and L5-S1 with the assistance of our vascular surgery colleagues. He would use NuVasive base cages as instrumentation for the anterior surgery. Then, stage 3 would be the remainder of the procedure with any additional decompression that was needed and then instrumentation from T11 down to the pelvis. We would request BMP and allograft for all 3 stages."
Neuro's plan: 2 stages. "Based on the numbering of L6 as the transitional segment I think she would require at least an L5-6 and possibly L6-S1 ALIF if we are able to mobilize that segment and break up the autofusion followed by multilevel posterior column osteotomies and fixation from L2 down to the sacrum and pelvis."
Re. "What are the symptoms that you have right now that concerns your surgeons?" Currently, I am unable to walk or stand without pain. I have had a lot of conservative treatments, PTs, Chiro, injections and so on. I came to Mayo June of 2021 looking for help. After initial assessments, I saw an Ortho surgeon in Aug. of 2021, then a neurosurgeon Oct. of 2022. Both surgeons said my deformity could only be corrected by surgeries. The Ortho surgeon mentioned, scoliosis is in the future, developing. The Neurosurgeon, said I have a lot of curvatures which are off.
Re. Dr. Fogelson, I did not get to see him even though I requested him after reading people's comments about him. I was told that his schedule was full and was unable to see me.
In terms of doctor, I like both of my doctors. The ortho surgeon seemed very good. He spent quite a bit of time with me during our consultation. His office has also been very responsive to all my questions since last fall. I am currently on the 8th dose of the bone density building medicine, Evenity. The neurosurgeon also was personable and also spent a lot of time with me during consultation. The ortho surgeon is listed as working in the spine area about 20 years and the neurosurgeon is listed as in the spine area about 5 years.
Thank you so much for your assistance. I know I am the one that need to make the decision eventually, but conversing with someone who has been through similar surgery really helps. I appreciate all of your inquires, as they help me to think through my issues.