Orthopedic surgeon or neurosurgeon?
 

Hi all! I've long had spine and joint problems so I'm not new to surgery but I am interested in knowing folks' opinions/preferences! About 20 years ago, I had a cervical diskectomy with fusion and it was done by a neurosurgeon. About 11 years ago, I had a laminectomy at L5-S1 and it was also done by a neurosurgeon.

My biggest problems that led to those surgeries were neurological. Numbness and tingling, loss of feeling, loss of motor skill in leg and arm, etc. So it made perfect sense to have a neurosurgeon do the work!

I've been struggling with back pain for about 3 years now and it's unrelenting. The neurosurgeon who did my laminectomy told me I'd likely need to have the disk space fused and worked on within 5 years. It's been 11 years so I've done pretty well! But an MRI showed absolutely no cushion left and my vertebrae are grating bone on bone. It needs to be fixed.

I'm having no neuro symptoms. It's strictly back pain. I've consulted an orthopedic spine specialist and he's recommended fusion and back stabilization that he says will resolve the problems for good. I've responded well to the previous surgeries so I think it will go well. My internist is wondering whether I should go to a neurosurgeon instead.

What do y'all think? I have surgery scheduled for May 22 but I still have plenty of time to consider everything.

hi
 

I had most of my surgery performed by an ortho/neuro spinal team at a major teaching hospital. I still came away from the surgeries with more pain and ultimately more damage. Surgery is a crap shoot. I am not saying that it isn't sometimes needed. It does come with its risks. Best wishes.

Yep, back surgeries are a roll of the dice. I've been fortunate that my prior two surgeries have helped a lot. I hope this one is successful, as well.

It's a personal preference that i've had Neurosurgeons. I prefer them because they have a bit more experience in the neurological side of things.

Just remember that surgery does NOT necessarily relieve PAIN. Surgery is ONLY for mechanical problems. It is not intended for pain relief. So you could end up with the same pain or worse. If you do get pain relief, you'll be getting a bonus. So just don't go into surgery EXPECTING pain relief cause you might not get it. :(

I wish you the very best. Please let us know how you come out, ok? God bless & take care. Hugs, Lee

Thank you, Leesa! What you say is true but, to be honest, I don't think many of us would agree to surgery if it wasn't for some pain relief. If I didn't have any pain or symptoms from the collapsed vertebrae, I probably wouldn't have even known there was a problem and consulted the doctor!

That said, I'm not expecting a perfect result. Any improvement will be appreciated. :)

As Leesa said
 

The surgery is most effective in correcting structural problems. Of course, a nerve decompression feels so good if needed........until the new spurs and scar tissue cause compression. :rolleyes: While my lower lumbar looks like somebody put an errector set in there, I am a mess from newly aquired damage. I think your best bet is to have an ortho/neuro "tag team" do the work and take advantage of the specialized skills each brings to the table. Best wishes.

Facing fusion triple curve whole back????
 

Hello, I am new to Neurotalk. I have justed completed a series of "studies" including a really interesting and scary SPEC CT (3D color imaging of my spine) and soon will face what my physical therapist and one spine specialist told me is a needed fusion. I have read that where there is a triple curve the whole spine needs to be fused. There is one PPT presentation I found on line created by a surgeon at Cedars Sinai in LA where the patient had the triple curve and spondolisthesis as I have (the "Spondo" diagnosis was in 2011).

Early this year I started limping (Left leg) with attendent pain and also really frightening muscle spasms in both legs and my abdomen. Yesterday there was pain in the arch of my right foot that continues today.

Has anyone had a whole spine fusion or is anyone able to identify with the spasms (I understand they are the body's attempt to compensate for the pathology of the lumbar spine).

SOMA does not seem to help at all anymore and the Hydorcodone prescription is low dose and it is the same one I have had since 2003. No one is giving me more pain medication. I even went to a pain management (Anesthesiologist) and they offered me only steroid injections (Is it Cortisl?). I did that once about four years ago and the physician told me he was afraid to do the injection because of the curvature of my spine but evidently did it...it had no effect. Maybe he did not really do it at all. Anyway that is not a long term solution and now I am in a lot of pain all the time.

I also live alone (Well, with my Great Dane, my German Shepherd and a Standardbred boarded nearby). I do not know if I will have problems managing initially after such a surgery. I do not have any family here and they are very busy with their own lives anyway. I also find it hard to call on friends to help with such things.

I just recently learned that I am facing whole spine fusion and that has dramatically increased my fear. Any insights would be appreciated so much. Thanks!

BTW I see evidence and comments by so many young women who have had spinal fusion and who have scoliosis. I cannot help but wonder why it is so prevalent. I think they are very fortunate to have been diagnosed at a young age. I was not diagnosed until 2003. I am nw 63 which will probably make the surgery a little harder on my body so I am taking lots of immune enhancing supplements, etc. to prepare and trying to do my physical therapy but sometimes the pain weighs one down so emotionally that finding the will to push through with PT is hard.

Thanks again.:confused:

Assuming you have had multiple opinons, do what you must do. Get plenty of help from friends and loved ones. I would ask someone to take the dogs for two weeks after you get home. Don't get me wrong. I am a dog person and their company is theraputic but you don't need them romping about and possibly knocking you about when you get home. Take care.

Neurosurgeon or Orthopedic Spine Specialist
 

[QUOTE=Teatime;873431]Hi all! I've long had spine and joint problems so I'm not new to surgery but I am interested in knowing folks' opinions/preferences! About 20 years ago, I had a cervical diskectomy with fusion and it was done by a neurosurgeon. About 11 years ago, I had a laminectomy at L5-S1 and it was also done by a neurosurgeon.

My biggest problems that led to those surgeries were neurological. Numbness and tingling, loss of feeling, loss of motor skill in leg and arm, etc. So it made perfect sense to have a neurosurgeon do the work!

I've been struggling with back pain for about 3 years now and it's unrelenting. The neurosurgeon who did my laminectomy told me I'd likely need to have the disk space fused and worked on within 5 years. It's been 11 years so I've done pretty well! But an MRI showed absolutely no cushion left and my vertebrae are grating bone on bone. It needs to be fixed.

I'm having no neuro symptoms. It's strictly back pain. I've consulted an orthopedic spine specialist and he's recommended fusion and back stabilization that he says will resolve the problems for good. I've responded well to the previous surgeries so I think it will go well. My internist is wondering whether I should go to a neurosurgeon instead.

What do y'all think? I have surgery scheduled for May 22 but I still have plenty of time to consider everything.[/QUOTE

I would opt for the Orthopedic Spine Specialist (Assuming he did not go to medical school in Afghanistan!). You have seen neurologists/neurosurgeons and you still have problems that were not addressed because presumably because of their area of expertise. I think you can ask to have a neurologist attending when you have the surgery so in that way you could perhaps have both. Also you might see a neurologist now (Maybe a different one) before your May procedure. Hope all goes well. Sometimes the expertise of the surgeon makes all the difference. Make sure you have the most highly qualified physician you can.

I like Spine's suggestion of an neuro/ortho tag team.

Doc

My last surgery was a 360 degree, three level disc./lam...cages, rods, yada yada. That one actually involved three surgeons. The ortho/neuros wanted a vascular surgeon to take them in and bring them out. I got documentation that the actual surgeon did the work as opposed to "supervising" a fellowship doc. I really don't have a problem being worked on by a fellow as long as the supervising surgeon is standing over his shoulder, not just on call in the building.

Wow. :eek: If you don't mind my asking, how did they do that - anterior/posterior/both?

Did they use titanium yada yada or the new synthetic composite yada yada? :p

Doc

A 360 is both anterior and posterior. This was almost seven years ago and they used titanium yada yada. ;) I am told that the quality of my spine is much like someone with cancer of the spine. The ortho's sub specialty is spinal cancer. That sounds like a rather limitted area of interest but he gets patients from all over the country. Typically the anterior repair is done first. My location required going in between two major blood vessels that were very close together and considered risky. Enter the vascular surgeon. My understanding is that the neuro work was done from the front along with the lion's share of the clean up of old scar tissue and osteophytes. I was then rolled over and fused posteriorlly. The final step before closing was to drop in a grenade. :rolleyes: Both incissions were 12 inches. I don't remember much as my pain doctor arranged for a pain specialist to take care of me until I could be transfered back home to a rehab hospital. :D. When I say that was my last surgery, I mean it was my last surgery. At 63, I can't tollerate anymore of that major spinal surgery, regardless of circumstances.

I hear that. When I was DXed (in my 40s) the ortho told us I have the spine of a man in his 90s - whoopie. Not a candidate for surgery regardless.
You got me. Root Beer all over my screen, keyboard, notebooks... everything. :Doh:

Fascinating story, though - thanks.

Doc

I would only ever trust a neurosurgeon to operate on my spine having had my first neck surgery carried out by an othopaedic surgeon. His approach was far more rough than the neurosurgeon. He took a huge chunk of bone from my hip when he did my fusions and he didn't secure the fusions with a plate or screws to support it. The lower fusion didn't take and It had to be done again. The second time around was by a neurosurgeon and he took a small chip of bone from my hip and I wasn't in nearly as much pain as I had been the first time. So without a doubt stick with the neurosurgeon. The spinal cord is part of the central nervous system - why trust it with anyone else?
Libby

If you are reasonably close to a teaching hospital, the repair could be done by a spinal ortho/neuro tag team. Each one does what he specializes in and you get the advantage of both perspectives. This does not mean that they are neccessarily in the same practice. Often it is just two surgeons who work well together. While the bulk of the surgery may be structural, a decompression might be involved. I would prefer having a neuro do the decompression.

Interesting side note.......you see both surgeons while in the pre-op mode. Generally speaking, the one you see first is the one who "takes the lead" and you will be interacting with more. Best wishes.