Severe spinal stenosis: Would you do surgery?

I have been watching this blog and find it very helpful. My question is: ortho vs. neuro surgeon for spinal stenosis? My MRI shows a very narrow spinal canal that causes severe pain. There is literally no space in the spinal canal (L4 region). Thus far, I have 2 opinions, and I am 2 for 0 (suggesting surgery). One is from an ortho surgeon (who spent very little time with me to review the surgery and its outcome), and the other was a neuro (who spent a good deal of time with me). The problem I face is that the ortho MD is with a highly regarded bone specialty hospital in NYC, and the neuro is with a Community hospital in my state. I also am working through the Mayo Clinic's Spinal Center; however, this will mean an airline trip in-and-out, and a hotel stay. How much pain is expected post-op?

@eviggiano I'm glad to meet you. I am a Mayo spine surgery patient and I can tell you that the level of care at Mayo is phenomenal. If you have appointments lined up there, you'll be in good hands.

I also had to decide between ortho and neuro and I consulted 6 surgeons total of both specialties. In general, I felt that the neuros were more interested in the pain symptoms, and the orthos just moved right to here's what we can do for you. Of course, there are excellent surgeons in both camps, and my Mayo surgeon was a Neuro, but also with Ortho fellowship training in spine deformity, so he had the best of both worlds. Spine deformity is a condition where he may also call in an ortho spine surgeon to assist with a difficult surgical case.

You have to choose the surgeon who fits your needs the best and who's area of interest matches your condition. Pain is different for everyone, but when you decide to get onboard with a surgeon and go through a procedure, think of it as healing pain after surgery. I had cervical stenosis, and I found I could tolerate pain after surgery without drugs. The drugs nauseated me and constipated me. I just rested and relaxed. Lumbar spine surgery is a bit more involved because the spine is deeper in the body than in the neck.

We drove 5 hours to Mayo, and I did fine in the car on the way home. We were told to stop every 2 hours and walk to avoid blood clots which are a risk after surgery.

When I was researching surgeons, I always looked at any medical literature they published and for any videos they were in with medical information. One surgeon I saw who was supposed to be excellent was a consult for a pro sports team, so I thought he must be good, but he wouldn't take time to answer any of my questions and deferred that to his PA. I was not comfortable with that. When you get on a table in the operating room, you have to trust the surgeon with your life, and I need a doctor who will explain fully to put me at ease. The sports pro surgeon kept sending me quality of life surveys for 2 years sniffing for business, but no one at his office called me to follow up. He did about 10 surgeries a day at a half hour a piece, and I didn't want to be on his assembly line.

Here is a discussion where you can connect with other members talking about spinal stenosis surgeries.

– Severe spinal stenosis: Would you do surgery?
https://connect.mayoclinic.org/discussion/severe-spinal-stenosis/

Here are a couple of links to information you may find helpful on spinal stenosis care at Mayo Clinic:

– Cervical spinal stenosis – Mayo Clinic: https://medprofvideos.mayoclinic.org/videos/cervical-spinal-stenosis

– Mayo Clinic Q and A: Treating cervical spinal stenosis: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-treating-cervical-spinal-stenosis/

Jennifer

@eviggiano My situation was very similar. I had both a spine and neuro surgeon look at my images and both recommended the exact same surgery. I picked the spine surgeon based on other personal recommendations. To make a long story short, I had a C3-C7 ACDF done one year ago. It has NOT helped me at all, but the surgery and recovery were not bad. I did have a temporary palsy in my right arm immediately after surgery, which was quite concerning, but with PT it did get better. I do NOT think that my surgeon did anything wrong, in fact I am sure I needed to have the pressure taken off of my spinal cord. It is just my bilateral arm and hand pain that has not been helped. I wish you luck!

After 28 years of pain, botched surgery, epideurals, multiple MRI's, failed PT, wrong injection, and visiting supposedly best doctors e.g., Hospital for Special Surgery, I have sadly come to the conclusion that there is no effective treatment for Spinal Stenosis unless one is a professional athlete or a Hollywood star. I wish I was wrong but never engaged in reckless life style and had realistic goals for doctors to just bring me a point of pain free movement of a mild nature--but no one takes the time to listen and really follow through with the one exception of a PT I recently engaged. She can help with the pain but nothing is going to solve the spinal stenosis.

I know there must be some positives to surgery for spinal stenosis. I was a long time neurosurgery nurse and took care of hundreds of patients who had surgery for spinal stenosis. I have been retired for 5 years. I'm just going from memory but there were some positive outcomes but also some not so positive outcomes.

I'm facing a lumbar fusion myself with a follow-up neurosurgery visit on February 1st. My tentative surgery date is penciled in for February 21st after I get another MRI. I would really like to hear about some positive sugical outcomes.

My surgeon thinks that a fusion of L4-5 would likely give me the best outcome. She also said that she would refer me to anyone else for a second opinion. She said that I would likely get recommendations for a multilevel lumbar fusion. She added that she could certainly understand why another neurosurgeon would make that recommendation.

I'm at the stage where pain isn't the issue anymore. Apparently some muscles in my legs are no longer innervated. My paraspinal muscles have atrophied. The surgeon won't guarantee any improvement in my condition but says surgery may prevent things from getting worse.

I have tentatively agreed to the L4-5 fusion. My surgeon says ideally something should have been done 5 years ago but I wasn't a good candidate back then because I was taking a lot of prednisone. I was having a lot of back pain then and I think inflammation caused most of the damage. The good news is that I'm off prednisone now and I'm a better candidate for a lumbar fusion.

My surgeon thinks L4-5 is low enough down and won't have a negative impact on the vertebrae above L4-5. My surgeon also thinks most of the nerve damage is coming from L4-5.

psii
I'm mgv48 and I've dealt with Stenosis for 40 years. I started having problems when I got out of the Navy and held off as long as I could. In 2012 I finally underwent my first spinal surgery, and it was a catastrophe. The screws holding my fusion of L5/S1 started working their way out of the bone. After 7 months I went under the knife again to fix the problem but I ended up worse as the doctor took out the fusion hardware. I started complaining about the pain and he keeps telling me he doesn't know why. I finally went to Cleveland Clinic and had another surgery within 30 days. Thought this will end my pain, NO it did not. It actually got worse. Now I've already had 3 surgeries and it looks like I'm going in for my 4th surgery. My problem keeps getting worse and every 10 to 12 months causing additional surgeries. On January 15 of 2021 I had my 8th surgery. This was my worse recovery coming out of all my surgeries. The surgeon had to go back in to fix where they clipped my spinal cord because he didn't sew it up correctly. This 9th surgery was 12 days after my last surgery. Since then I've had quite a few complications. From my complications I now have Pulmonary Fibrosis. Now this doesn't mean you will have the same experience as me. I 've heard of successful surgeries and then again, I've heard of surgeries like mine. My recommendation is to be really sure who you pick for a surgeon. Check out the hospital's comments and recommendations to be sure they give excellent after surgery care. Cleveland Clinic sucks.

sorry to hear all this--my condition is like a mild sprain by comparison. Good luck !

I have Spinal Stenosis at L4 and L5. My orthopedic surgeon gave me two choices: surgery with no guarantee or stay on my pills Tramadol and Gabapentin. I have chosen surgery. I figure that even if it doesn't work, I've tried my best.

I checked on my surgeon's reputation. There were 4 comments; two raved about him and two thought he was terrible. It was mainly about his attitude and professionalism. Nothing about his quality of surgery.
I am in Canada and due to COVID-19, surgeries are backed up. Another reason is that suddenly, we have had a lot of shootings and the hospital that my surgeon works is responsible for looking after them.

He even warned me that I could be cancelled at any time. I replied, "Oh, I know another Surrey shooting." He was silent. I will report on my experience.

@mgv48 I wanted to welcome you to Connect. I am sorry your journey with spine surgery has not had an outcome that you had hoped for. Lumbar spine surgery is a more involved problem that cervical spine surgery because you have the pressure of most of your body weight bearing down on the hardware. L5S1 is the most difficult level to fuse for this reason, and any twisting or bending also increases pressure on the spine. The pedicle screws need to be placed precisely and at the correct angle into good quality bone, or they can pull out. I am a cervical spine surgery patient, and I have watched a lot of online surgeons presentations where this information was discussed.

I agree that choosing an excellent surgeon is a precursor to a good outcome. Of course the patient also brings any other health complications to that experience. We all have to do the best we can in weighing the risks vs the rewards, and surgery is always a compromise. Surgeons don't promise to relieve pain; instead they restore function as best they can.

In my search to choose a surgeon, I looked at their published medical literature and area of interests, and to see how they were judged in their own field by their peers. Are they teaching at conferences or have won awards at conferences for their papers?

I don't give patient reviews a lot of credibility. Patients can complain for any number of reasons, and may not understand the explanation of their issues or they may not ask enough questions. There can be personality conflicts with their providers or unrealistic expectations. I look at sources like Becker's Spine Review to see who's who and what are the current trends in spine care. They have a list of surgeons to know that they publish each year as well as information on hospitals. There is also the ratings form US News and World Report. The insurance companies know who the good surgeons are because they are approving treatment and paying their bills, so they review medical cases. That would be another suggestion to call and ask your insurance provider who their A list surgeons are within the plan.

I hope things get better for you in time. Scar tissue from surgery creates tightness and can cause pain. One suggestion I can give you when you are healed enough to be able to do it would be myofascial release therapy with a qualified physical therapist. I have done a lot of this and it really helps me.

MFR — Myofascial Release Therapy (MFR) for treating compression and pain: https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/.

Have you looked into Myofascial Release Therapy?

I have had 5 cervical fusions and getting ready for my 7th on C7 - T1. I have had great results with them all but I am afraid I have waited too long with this last one. I have been going to a pain clinic for 3 years and have had multiple injections. At first they helped but after a while they had no effect. The pain has gotten to the point where I can't hardly stand it. On February 8th I will have a discectomy/fusion ....severe spinal stenosis. Once I recover from that, I will have the same done on L3 -L4. Then hip replacement. This will be my 3rd surgery on my lumbar spine.
The best advise that I can give you is don't wait too long. I have nerve damage that can't be reversed. I will be 67 in March and have always worked and stayed active. I have come to a complete stop. Don't wait too long.