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Deciding on Surgeon For Multi-Level Laminectomy. Requesting Input.
49 y/o male who overall is very healthy. However, I have hereditary/degenerative stenosis. I've had acupuncture, 3x physical therapy, 4-5 steroid injections and still have terrible lower back pain/leg pain/horrible achiness/issues walking-standing longer than 10 minutes/weakness etc. Latest MRI results are below. Obviously very freaked/nervous about this potential surgery/in the future needing more surgeries.
Surgeon 1: Highly respected, really liked him, does minimally invasive, suggesting laminectomy at l3/l4
Surgeon 2: Highly respected, a leader on doing endoscopic tubular laminectomy (difference between this surgery and the one above), suggesting laminectomy at l3/l4 and l4/l5.
Questions:
- I "like" surgeon 1 better; that shouldn't play in my decision, right?
- Do I need to worry about anything significant long-term if I go with surgeon 2 who will do a laminectomy at two levels?
- Lastly for anyone that might know: Is endoscopy/tubular a significantly "better" surgery in terms of results/recovery time? And - it is time to finally do this, yes?
Thanks so very much in advance!
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IMPRESSION: Degenerative changes are seen superimposed on a developmentally slender spinal canal. The findings are most pronounced at L3-4, where there is moderate to severe spinal canal stenosis with moderate bilateral subarticular stenoses, which have worsened since the MRI dated XX/XX/2024. Moderate to severe left and at least moderate right neural foraminal stenoses are noted at this level.
L3-4: There are mild to moderate bilateral facet degenerative changes with mild ligamentum flavum thickening and a moderate diffuse disc bulge. Moderate to severe spinal canal stenosis and moderate bilateral subarticular stenoses have worsened since the MRI dated xx/xx/2024. Moderate to severe left and at least moderate right neural foraminal stenoses are seen.
L4-5: There are mild to moderate bilateral facet degenerative changes with mild ligamentum flavum thickening and a mild diffuse disc bulge. Moderate spinal canal stenosis and at least moderate bilateral neural foraminal stenoses are seen.
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Dr. Elder Rochester Mayo clinic, amazing recovery was slow pain was significant but outcome is more than I could have ever imagined, no pain now from T3 on down 20+ years of pain now none, best wishes on your surgery
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3 Reactionsekin81076, personally I would proceed with the minimally invasive tubular laminectomy. You might read this https://www.nature.com/articles/s41598-025-28949-9 with careful attention to the limitations of the study.
When we agree to these back surgeries we are often unaware of the muscles that must be cut through or retracted (which is no small trauma to the muscle) to get the the surgical site.
I almost never choose the more personable physician suspecting that sometimes a person on gets one great skill in a lifetime. But, if I were the patient in this situation, I would want to avoid the longer recovery, the muscle disturbances, the bleeding of the traditional approach.
Nice to have two good choices.
Bless your surgery.
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2 Reactions@ekim81076 What you need to know is what risks are associated with surgery and kind of look into your future. Laminectomy does have a possible risk of weakening the spine, and a surgeon would likely then do a fusion. Your surgeon will have to answer how specific risks relate to you and with any other health conditions that you have.
I think the “tubular “ approach is minimally invasive. My surgeon was kind, compassionate, and also excellent in his skills, so I don’t think that a more abrupt personality guarantees he’s better at the job. Get as many opinions as you need to make a well informed decision. A surgeon should have a lot of experience with cases similar to what you need.