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Severe spinal stenosis: Would you do surgery?

Spine Health | Last Active: Feb 22, 2023 | Replies (186)

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@jenniferhunter

@dadcue Hello, Dadcue, let me introduce myself. I am the patient who couldn't get a spine surgeon to help for a few years, and kept looking for a specialist to help me. Five of them turned me down who could have helped. My case had some confusing symptoms, so surgeons passed on me, and I feared that I would become disabled because of cervical spinal cord compression. As I see, you have a list of structural spinal problems and are exhibiting a degree of disability with drop foot and leg symptoms, and you have a surgeon willing to help who is frustrated because you deny the help they offer.

Could you explain what you mean by not wanting to "rock the boat" too much? I also see from other posts that you have been using prednisone long term for another health problem. This is something that needs to be fully disclosed to a spine surgeon because healing a fusion depends on the inflammation process to begin laying the framework to grow bone to join bones together that previously were separate.

From my perspective as a patient who was loosing the coordination of my arms, and with foot drop and walking with a limp, I knew that my future would be of advancing disability when I was older, and likely a wheelchair. I have been a caregiver to my aging parents in wheelchairs and their life was so difficult. I just can't imagine having a choice to prevent a disability, and the possibility of paralysis if a future injury should occur and not taking it.

Was I afraid? You bet. I knew I needed surgery and every morning for 4 months when I thought about it, my blood pressure shot up and my heart raced. Being caught in that trap was awful. Every time I was waiting for a new surgeon to walk into the exam room, I was really nervous, and when they were not interested in my case, I wondered what next, and I asked myself why I was doing this to myself, and being so afraid of surgeons? Fear can be overcome if that is what is holding you back. I started working on that, and I found answers that freed me from those chains, and about that time, I found a truly wonderful and gifted surgeon who changed my life and gave me back my ability to work as an artist.

I comes down to a choice between being afraid of surgery, or being afraid of the disability that will come from the advancing progression of a spine condition left untreated. I didn't want to loose what I had worked so hard for in art school and the ability to do what I loved to do. You have to ask yourself what is important in your life.

I have seen the posts of a young woman on facebook who neglected to have spine surgery. She is wheelchair bound and cannot take care of her child. She is in constant pain and has become a burden to her family who has to care for her and give up other things that they could be enjoying. Beyond that, they are broke because of her care and trying to sell possessions for money. If you cannot take care of yourself, that burden falls to someone else, a family member or a hired worker. Health insurance wouldn't cover that. If that hasn't happened to you, you may not fully understand how difficult life will be if you got to that degree of disability. I can also compare my injury of a severely broken ankle which was very disabling because of not being able to bear weight for months, and then rehab. I still have pain and weakness even 2 years later, and I think it takes a very long time to regain strength in walking. That was worse, and more painful than my spine surgery and for a much longer period of time. Of course every patient is different in how they experience spine issues and recovery.

What is different about Feb 2023? Is it a better financial or insurance situation making surgery a better option or do you feel like you are just ready to do it? Why are you limiting how many levels can be treated surgically when clearly there are other significant issues with recommendations from your surgeon?

There are many things to consider in the decision. What you need to know is what is the predicted advancement of spinal disease without intervention of everything on your MRI report. Multiple surgeries to address this later can add a lot extra cost and more scar tissue which can add to pain. What are the things that you are weighing in this decision? Have you sought a second opinion? Other surgeons may have different approaches to solving the problems. Please tell me how I can help you think about this spine condition.

Your surgeon may have an idea about when the window of opportunity is right for intervention with decompression surgery, but they don't know for sure exactly when the disability becomes permanent. There is a point of no return when nerves that are compressed simply die and dissolve. That could be damage that may happen anywhere along the pathway in the spinal cord and into nerves that service body parts.

Surgery at the lower end of the spine has a longer recovery time than my cervical fusion surgery because of bearing most of the body weight at that end, but I can tell you that the surgery with a good surgeon was worth it, and my life is better because of it.

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Replies to "@dadcue Hello, Dadcue, let me introduce myself. I am the patient who couldn't get a spine..."

I truly appreciate your response and feedback. I'm not afraid of doing surgery. I have had other surgeries in the past which were easy to face.

The decision to do bilateral knee replacements was easy. I was told that I would need a knee replacement at the age of 30 but I needed to wait until I was 60. I had plenty of time to prepare myself for knee replacements.

About 6 months after knee replacements, I had a microvascular decompression (MVD) surgery for trigeminal neuralgia. That was an easy decision because I had nothing to lose. The pain from trigeminal neuralgia could not possibly have been any worse than it was before the MVD surgery.

The above surgeries were all done about a year before sudden onset lumbar radiculopathy or sciatica. Surgery was called “urgent” at the time because of symptoms of leg weakness and foot drop along with the severe radiating leg pain.

The MRI that was done 5 years ago revealed the problems with my lumbar spine for the first time. I actually told the surgeon that I didn't know that I had a "bad back." I took a large dose of prednisone and the pain improved. The surgeon said surgery was risky because of prednisone. The agreement was that pain would determine whether or not to proceed with the extensive lumbar fusion. A second opinion also agreed that pain should be the deciding factor.

I have been off prednisone for several years thanks to a biologic medication that seems to control inflammation without prednisone. The neurosurgeon wants me off the biologic for the same reasons that prednisone made surgery risky. I don’t want to “rock the boat” by stopping the biologic for fear the autoimmune pain will return. The surgeon says I will be given pain medications for surgical pain but I worry about the autoimmune inflammatory pain just as much.

A bad surgical outcome is also a concern of mine. My knee replacements were complicated by extensive heterotopic ossification. An orthopedic surgeon actually advised me not to have any surgeries in the future. It isn’t clear that he meant a lumbar fusion would cause heterotopic ossification.

https://my.clevelandclinic.org/health/diseases/22596-heterotopic-ossification#:~:text=What%20is%20heterotopic%20ossification%3F,occur%20for%20no%20known%20reason.

My MVD surgery for trigeminal neuralgia also had an unexpected outcome. I think the neurosurgeon did the best he could under the circumstances. That neurosurgeon said I should ask God when I asked him what caused the problem that resulted in trigeminal neuralgia.

I realize that a lumbar fusion could be a good thing if everything went according to plan. I hope for a good outcome. However, surgery can make things worse too. I guess that is what scares me.

The "limited" lumbar fusion is the neurosurgeon's recommendation and not necessarily mine. I think the neurosurgeon was doing some negotiations to convince me to do surgery. However, it was mostly the surgeon's idea because L4-5 is the worst area.

I doubt I would ever do the alternative "extensive" lumbar surgery and I think the surgeon would refuse to do that.

I just need to hear about the positives because things can certainly be worse and I would rather not think about that.

Thanks again for your response. This surgery has been weighing on me for five years. I think it might be time to do it just to see what will happen.