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Posterior vs Anterior offered- complications with both. Thoughts?
Hi- have had severe spinal stenosis cervical to lumbar for 20 years. Pain comes and goes. Neck rarely hurts. Had lumbar hemi-laminectomy (was great!) in 2019. Cervical was told severe enough to not wait on surgery after incidental finding for carpal tunnel about 20 years ago. Was told go straight to hosp. Refused. Sought another opinion. Over a year not one dr agreed until the 4th said We treat the patient, not the MRi. Stuck with him until he unexpectedly retired during merger. Was never ref'd to assoc so did nothing 5 years. No pain. 5 years later, went for MRi- process started again. Went to Mayo, after they saw disc and said come right in. When i got there, they asked - "Where' the patient?" Said me, told they expected much worse. put on watch about 15 years. :Last year they said time is now. Would love to have them do it, but the follow up visits too far, 5 hours, expensive, hotels, etc. Sought opinion out here. Like them all, including one who did hemi laminectomy, but as years passed on, the drive constantly under construction hour + each way, too tough, and the actual hosp not great ratings, though the surgeon is top notch. Then saw one at main U hosp, fantastic, but again, the drive, which husb is strongly opposed to - (he has alot of serious issues) so local ones- one offered anterior C 3 -C6; another C4 -C7. Anterior. Closest one where all my docs re says Posterior only C5-6 Decompression Laminectomy with foraminotomies, Lateral Mass Fixation using screws and rods. DuPuy hardware ACR Plate Titanium. I already have bilateral badly worn shoulders, told yesterday need reverse shoulder surgeries. So going posterior a real pain- more so than average posterior which is a really tougher rehab,. longer on the table, more anesthesia. Anterior, problem is I have Esophageal Lichen Planus and get EGD w dilations several times a year for 5 years now. Jan and Mar this year with another planned in July to get more webbing- and check the esoph lichen planus and candida (from the oral meds) (Biopsied first at Mayo due to swallowing issues, burning mouth syndrome, etc, and they ref'd me to U in Chgo. Top notch gastro. But it's C5-6 where the worst webbing is, which is exactly also where the anterior plate would go (either surgery,) and the hardware there will also make it harder to swallow. The majority of pain for anterior is swallowing. I have lost signal at C5-6 -myelomalacia-totally crushed Realize adjacent segment disease is aa real threat-and C4 offered except in Posterior- and with likely chance of vertebrae up and down load making surgery again necessary- at age 71- just wondering- should i just live with the threat of being a quad as they keep warning me if I fall the wrong way, or accident. Or worse. Could affects lungs, etc. Current Tingling in arms, hands (had Carpel tunnel release L hand 4.2024- was great for 2 weeks, then started again- need R hand and if the cervial surgery doesnt work, maybe redo L hand. Ankles shot- need surgery. Have had bilateral knees and hips for many years. (2004 on knees, 2013 and 2017 hips) DJD since 16. More. I have enough pain- maybe thinking ignore the warnings and live my life- not put myself in more risk of the surgery which also opens me to more risk of infection up to 18+ % - when I have been dx'd with Colonized MRSA (clear at moment, can return any time, would be a nightmare if it got in bones) - and get recurrent UTI's. THe gastro says he can't tell me which outcome likely better (who diilates my throat- i thought maybe he had seen outcomes in people he stretches with Esop Lichen Planus(also have LIchen sclerosus- so autoimmune tuff w T2 diabetes an hypertension) living under high stress with spouse I love but has serious issues himself, so recovery going to be very tough, though I was told hosp stay could be extended if necessary- (Don't want that, but have to be able to fend for myself) or put in rehab (Also don't want. History of falling (17 times in 5 years, though it was gremlins or just not paying attn, always in a rush) Balance issues. I know I need the surgery, but - the complications terrify me. I am not taking steroids or NSAIDs due to gastro- this is making me crazy. So - should i just live out life without the intervention? Anyone outspoken enough to give an opinion? Not holding my breath. Thank you if you have stuck with me, here. Other issues may compromise my recovery, but that's another story.
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@chrisanon I do understand where you are coming from, but please don't forget to breathe. Long slow deep breaths can help any time you are feeling anxious. For me, that was very effective in learning to control my fear and spiking blood pressure. Spine surgery is a big deal, but then again, so is the possibility of living your life in a wheel chair, possible incontinence, and having to pay for caregivers when you are unable to care for yourself. Please do not let fear talk you into that possibility. I say this to you with kindness in my heart and understanding what it is like to have cared for my disabled parents in wheelchairs who cannot walk and facing my own fear of spine surgery.
Please don't let someone else decide for you how to proceed with your care. 5 hours is a long drive and I drove that same distance to go to Mayo for spine surgery and it was worth it. I also made that drive for follow up visits, although, I didn't need to because they would have had me get x-rays locally and send them in. All surgeons are not equally skilled, and there are good ones are at places like Mayo. Yes there will be some additional cost for a travel and a hotel, but if you have a much better recovery because of the expertise of the Mayo surgeon who gets more difficult cases in volume, you will have had a very experienced surgeon. You are worth it! If your husband is not on board to help you get there, have someone else take you, or fly to the Rochester airport. I think there is also Amtrack service that can get you there. The Mayo Concierge can help you find those types or arrangements.
You have what a lot of people wish they could have. You already have a patient history at Mayo and a doctor willing to help. That is sometimes very hard to find especially when you have a difficult case because surgeons don't want to risk a poor result on their statistical record. I was denied by 5 surgeons before I turned to Mayo for help.
"at age 71- just wondering- should i just live with the threat of being a quad as they keep warning me if I fall the wrong way, or accident. Or worse. Could affects lungs, etc."
You can deal with the fear. I did and I learned to defeat it. You can't let fear take away your options. If you do nothing and continue to get worse, it can become a problem with permanent damage. You have a choice now to prevent that. I tried to get help for 2 years even though I was terrified. In the end, after 5 refusals, I still had the best care I could have had at Mayo.
You must have a lot of questions. I will help any way that I can. What is your biggest concern at this time?
Hi Jennifer- Thank you for the very thoughtful response. Yes, breathing deeply does help. (I was practicing TCM for about 20 years, so get it. You are also correct that I must make this decision on my own- while researching amap, and taking all factors into consideration. Strong interest in science- so always curious. Atm, my larger concern is if I go with the posterior option- the risk of infection is significant-up to 20% more than anterior, and dead space after surgery between muscles cut, where infection likes to set in. I am no stranger to infection. With hip replacment compromised by the surgical room where others, same day, same surgeon, same room- got 5 infections- I ended up wearing a wound vac and repeated ER visits to debride the implant. PICC to the heart. So gun shy. That wasn't the only surgical mishap. Suffice to say, not my first rodeo. I am concerned about being colonized with MRSA- as well.
I have other concerns but - open to your input. btw- chgo metro here. you also mentioned 5 hours- interesting.
@chrisanon My Mayo surgeon said he does a first cervical surgery as anterior. If there is another surgery, he does that posterior because he doesn't want to introduce more scar tissue into an already operated area. To prevent a staff infection, I was asked pre-operatively to use the antibiotic ointment mupiroicin in my nostrils twice a day for a number of days as a prevention. I did not have any surgical infections. That works very well when I get sinus infections and if not treated, that will spread to my lungs, so I do this as needed and physically one side of my chest doesn't expand as well, so I have to watch it. My doctors are good with that. The surgical path is usually best chosen by the surgeon and depends on where the problem is that needs to be accessed. FYI, I was a scientist first doing biological research at the University of Chicago.
A wound vac is not a good thing to live with and surgeries for clearing infections. I know a lady who went through that with an ankle fracture. It is troubling to hear of an operating room spreading infections to 5 different patients on the same day. Yikes! I certainly would not go back there for more surgery. These are all things to bring up for discussion about how this is prevented when you are planning for surgery. You are just a few years older than I am and yes, we live in the same area. It is a beautiful drive to Mayo and across the Mississippi River bluffs. I just love going there, but have no medical reason to go. I did go for a conference related to my mentorship here.
FYI, I just heard that one of Mayo's excellent neurosurgeons, Mohamed Bydon, will be moving to the University of Chicago to head a new neurosurgery department there. That being said, I have no idea if he is available for patient surgeries. When I was picking a surgeon, it was between him and Dr. Fogelson and I went with Dr. Fogelson because of his research interests. I worked for a neuro-anatmist at U of C years ago, so I was accustomed to looking for medical literature online.
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I wanted to add some more comments after re-reading about your esophageal issues. One question I would ask about spinal hardware would be how to avoid issues there. There are some types of hardware that do not use a frontal spine plate, and instead the screws go into it in an angle for a fusion. I have no hardware because my fusion was done with only a bone disk spacer. However, I needed only one level C5/C6, and this is probably not an option for multi-level fusion. One question would be if a plate could be removed later? I don't know if a surgeon would do that, but it needs discussion.
Hi Jennifer- Wow. Thanks for the updates. The mention of Mohammed Bydon is terrific. I do thorough bio searching, as well-(learned from an earlier trade) I was advised to use mupirocin and Hibiclens a week prior-so yes. Great idea to use it for any time sinusitis. The concern about infection is colonized MRSA- and pockets left post surgery from reattaching muscles. Love the idea of asking about no frontal spine plate. I asked my gastro who performs the EGD/Dilation and he had no input. Not happy about that. I'm not a candidate for artificial disks-vertebrae too far gone. Fogelson's name familiar--I have the one surgeon who proposes Posterior only C5-6- (with decompression, etc mentioned prior) but that leaves me to deal with ongoing decompression in C4 -then keeping in mind Adjacent Segment Disease. (ASD) I see so many people just not happy with Posterior- so many complications- I hear you on Fear- and strongly practice The Laws of Attraction (Positive) -still......giving me pause.