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Old 04-07-2009, 09:57 AM   #2 (permalink)
Jean-Paul
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Join Date: Oct 2002
Location: Little Rock, AR
Posts: 15,100
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Wow... that really sucks. I am particularly worried that your traveling may exacerbate your condition.

Have you been to a neurosurgeon yet? If not, I would suggest doing so. You may be a candidate for a spinal fusion.

Some things to ask if you do indeed need surgery. You may just have a bulging disc pressing on a nerve, but the joint may still be pretty stable. If that is the case they will do what is called a "lum lam" (lumbar laminectomy). That is where they simply cut away the piece of bulging disc, and it should bring you pretty immediate relief from pain.

If your joint is extremely unstable they may have to do an "instrumented" case. It is a pretty invasive surgery where they dissect through muscle, remove the spinous process and ligament of flavum, and then they scrape out all of your disc, then put in a piece of cadaver bone or a synthetic bone material called PEAK. The joint is stabilized with large peticle screws and rods. Depending on the doc you will probably get either a "T-lif" or a "Plif".

The results are actually pretty good on those, but it will seriously interfere with a fitness program. The recovery is pretty rough. Try to avoid it if you can. If you have more than one level that is unstable they can do 2, 3 and even 4 level fusions. You don't sound like you're that bad off though.

Check around the surgeons and see if any of them do a new(ish) procedure called a "facet fusion." There are only two companies nationwide who can provide the bone and instrumentation for it: TruFUSE or NuFIX. They are both pretty similar. The thing I like about these procedures is that they can be done minimally invasively or percutaneously, which means MUCH less dissection.

Basically they just tap a couple of bone dowels into angle-drilled holes in your facets. Recovery is a lot faster, and the result (IMHO) is better. The main difference is that you have to wear a back brace for about 6 weeks post-surgery. This is only a problem because relief from pain is so immediate that patients can be tempted to skip it and start to be active before the bone has fully fused, causing the dowel to back out.

I hope you don't need surgery at all, but if epidural injections are touching this problem you may have to. If you can get a neurosurgeon as opposed to an orthopedic spine surgeon I would recommend that. I'm just picky when it comes to my spinal cord I guess.

Update us in this thread when you have news either way. Best of luck to you.
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