Transthoracic micro discectomy
 

I am in the awful predicament of facing surgery on my thoracic spine. I have a ruptured T7/8 disc which is pressing into my spinal cord centrally. I tripped about six weeks ago and had another MRI which showed that it had moved further into my cord. I have a numb left foot and terrible tingles in both legs accompanied by nerve pain down both legs. My neurosurgeon is concerned about the protruding disc causing permanent damage if left too long. He also said that the fact that it moved further showed it hadn't started to calcify and it would be unlikely to resolve without surgery, the risk being it could move even further into my cord.
My main concern is post surgical pain relief. I had a cervical disc replacement surgery four years ago and having had previous fusions etc with discs rupturing and had to do it with just panadol of all things for pain relief post surgery. I can't take morphine or pethidine or any drugs from their families. My surgeon has told me it will be very painful surgery - what are the options for pain relief? I will have to have this disc removed. I feel sick within myself and it is very painful as it is along with the tingles etc.
Just wondering if anyone has had this surgery and what was done for pain management eg nerve block etc
Also how long did it take to recover?
Thankyou
Libby

Hi Libby, Welcome to NT.

If I may, why can't you take opioids, and is it any/all opioids or just some/most (or do you know)? This is important, as that class of meds is usually the best option/gold standard for post-surgical pain.

You can find the whole pharmacopeia by googling: post surgical medication

(I prefer to recommend search criteria to provide a more well-rounded perspective on a question rather than specific links that might be biased or incomprehensive.)

Chronic neuropathic pain is often treated with gabapentin, Lyrica, and/or topiramate. I don't know of post-surgical pain being treated with those, as they can take some time to build up to efficacy.

You might try googling: post surgical neuropathic pain

HTH,

Doc

Hi
 

Perhaps you might consider a referral to a pain specialist ASAP. My own personal opinion :D......surgeons are not the best choice for managing post op pain. They really don't want that job anyhow as their waiting rooms tend to be filled with pre-op and immediately post op patients and don't have the time or room for the post op patients who will be dealing with ongoing issues while they heal. A pain specialist will be trained to sort out which medications will give you the best relief without causing problems per your history. It would be best to have a plan in place before the surgery. For that matter, if there have been medication issues in the hospital when you were immediately post op, you could request that your pain doc manage your pain while there. It is done every day. Best wishes.

I don't disagree with any of that, but doesn't it seem that dealing with post-op pain should be the responsibility of the guy cutting (causing the surgical pain), and part of the whole surgical package? It's not some PN doctor who's cutting into the patient - it's the surgeon. Since most PM docs come from anethesiology anyway, maybe it should be part of the anesthesiologist's purview(?)

Asking a PM doctor to deal with pain caused by another seems like cleaning up someone else's mess. And unfortunately, when surgery doesn't work as expected, it winds up that way anyhow.

I don't know... just rambling a bit.

Doc

Thankyou for your reply. I have had morphine, pethidine, omnipon, toredol and endone and they all give me excruciating headaches and nausea. That was why when I received my artificial disc, they decided all I could have was panadol because the action of being sick in itself is not desirable with surgery to the neck. The plus side was that I had a clear head, the down side was that it was extremely hard coping with the intense post surgical pain.
At the moment having been told that the thoracic surgery would be far more painful than anything I have experienced previously, due to the different layers that would be disturbed just to access the site and the fact that the thoracic spine is continuously moving due to the act of breathing, I am concerned. Not sure that I could do this one with just panadol. It took a lot of higher order skills and many long walks to get into the right frame of mind prior to the surgery. At the moment I am not allowed to go for walks etc because I have a numb foot and trip which could cause the disc to move further into my cord.
Libby

[Thankyou for your response. I have decided to consult the anaesthetist who would be looking after me and post op care. I can't do that until I have a definite day for surgery. So I am going back to my neurosurgeon on Monday week to ask questions and get the referral. In the mean time I will discuss this with my GP who returns from holidays next week and see if she will refer me to a pain specialist. It is a bit of an awkward situation. I know the disc can't be left where it is because I can feel pain when I breathe and the neuropathic symptoms although they have been reduced due to nortriptyline are very unpleasant.
Libby



QUOTE=spine95;878768]Perhaps you might consider a referral to a pain specialist ASAP. My own personal opinion :D......surgeons are not the best choice for managing post op pain. They really don't want that job anyhow as their waiting rooms tend to be filled with pre-op and immediately post op patients and don't have the time or room for the post op patients who will be dealing with ongoing issues while they heal. A pain specialist will be trained to sort out which medications will give you the best relief without causing problems per your history. It would be best to have a plan in place before the surgery. For that matter, if there have been medication issues in the hospital when you were immediately post op, you could request that your pain doc manage your pain while there. It is done every day. Best wishes.[/QUOTE]

Well Doc, as usual, I agree with you. Perhaps I have had bad luck with the surgeons who have worked on me but NONE of them wanted to do post op pain. Most referred me on at four weeks post op. With that in mind, I made certain I had one in the wings who was familiar with my back and had a reasonable relationship with the surgeons. At this point, I have had the same pain doc, physiatrist, treat me since 2000. He has the bigger picture relative to my problems and is a real blessing post op. It's good to have a safety net. Have a good day.

Ah... when "post-op" was mentioned, I was thinking about the first few days following the procedure to deal with pain from the procedure.

Residual pain, once that from the surgery itself has worn off, I guess would be appropriate/logical to hand off/back to a PM specialist, physiatrist, etc. until it's determined if rehab will work or the surgery failed, or whatever. Sometimes surgery is supposed to alleviate pain; others it's just supposed to (hopefully) keep things from getting any worse.

Nothing is ever easy. :(

Doc

HI Libby. I have a family friend who had a similar situation and had an excellent surgeon perform the surgery. The recovery was not bad at all from what I saw. It may really depend on the person who is operating though.

I hope this helps. Also, please let me know and I can find out the name of the surgeon if you need it.

Best of luck!

Thankyou for your reply. My surgeon is considered to be the top of the field in Australia. He has already operated on my neck and I trust him completely.
He did say that this would be far more major surgery than the others on my neck because of its location. How long did it take your friend to recover and did they have residual chest pain from the surgery itself?
Libby

Hi
 

Hi Libby are you in Sydney? What hospital are you having surgery at? Do you have any arm/ hand symptoms??

I am sorry for the delay in replying to you. Yes I am in Sydney. I had my surgery on 10th July at Dalcross at Killara. I consulted the anaesthetist and icu dr prior to surgry and did some drug trials and discovered that I could tolerate a very low dose of fentanyl. So between that and digesic every six hours I have been uncomfortable but able to cope. It is scary when you can't tolerate the main forms of pain relief. I have had immediate relief from the pins and needles, tingles and horrid nerve pain down both legs. They told me the herniation was very big so I was extremely lucky really that it didn't comromise my cord.
While my chest is sore frm the surgery, I realize now just how sick that rotten disc made me feel. My main problem was in my legs and I still have numbness in my left foot which will take some physio as well as time to regain. Not up to much, unbelievable tiredness:) and exhaustion but it hasn't been two weeks yet - things can only get better from here. Libby

I was referring (or meant to) immediate post op as well as the weeks or months thereafter. When I think about it, I guess I want my pain doc's immediate input because he takes all of my issues into considertation. I have had some bad luck with the surgeons managing the pain, When my body feels it has been violated, surgery for certain, I have a Fibro flare from #@&%. If not addressed properly and quickly things get real complicated. He has given the surgeons notes that covered were most effective and what problems to look out for. He was ignored. After that happened twice, he told me I could have another pain doc who he had worked with numerous times manage the pain, immediately post op. They had a phone conference, discussed my various pain issues, surgical history, what to look out for (various post op infections), and how to best treat them. I was so greatful to have that safety net last time because I ended up staying up at Norton for two weeks due to a nasty bacterial infection, UTI and candida flare due to the antibiotic. I was so relieved to get out of there and transfered to the rehab hospital back home. Again, I am rambling. Have a good day.

On the mend - slowly
 

Well it is coming up to three weeks on Tuesday of this week since surgery and although still uncomfortable from the surgery it is such a relief to have relief from that dreadful nerve pain and electric tingles. I am aching terribly through my ribs which is what I was told to expect but considering how sick I felt before surgery, I really am very lucky. I have a lot of physio work to do to hopefully regain sensation in my left foot which is still really numb in part which makes walking difficult. I really don't want to trip and risk a fall at this stage. I am still wearing a fentanyl pain patch - just the 12 microgram one and taking digesic every six hours*as I was advised to do for another week so I am very grateful to have found a pain medication that I can tolerate even though it is only a very low dose, it has made a difference.
It is so nice to be on this side of the ordeal. I do wonder if I will ever feel normal again whatever normal is going to be but I think that it is to be expected to feel like that after such huge surgery.
Libby

Hi Libby, I am so glad to hear you are ok. I have sent you a PM.

Aussie:)