Back Pain Forum - Laser Spine Surgery


Laser Spine Surgery

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Mel11

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Hello Posted: 03-28-08 16:59pm


Hello everyone Years ago I have been diagnosed with DDD at C3-4. It was not bad, once every couple of years I get sever pain in my neck for about a week. This pain is really bad, you wish you can cut your head off and it is not relieved by sitting or laying down. Because it is infrequest it is not a concern, however, my lower back is. I was also diagnosed year ago with DDD at L3-4 and L4-5, actually nothing shows of L4-5 disc on xray. The advise I was given is put up with the lower back pain for as long as you can, and for years I learned to cope. I use voltaren, the neck pain comes only every few years. I have several neuros, pain management clinic, therapists. Actually, the neuro and pm doc can not really diagnose were the pain is coming from ? Decpite MRI's, CT Scans, discograms and xrays they could not diagnose the source of pain. DISCGRAM: Years ago when I did the test, they would inject the saline and ask me if this is the pain ?,no, how about now?, not really, how is this? May be. It was very inconclusive. But, when I got up and stood, OUCH , THIS IS THE PAIN. This time when I do the discodram I’ll ask to do one injection at a time then get up and stand after each injection. Now, I get the lower back pain only when I stand or walk for three minutes and the pain is in lower back, not in legs, or thighs or hips. The pain always relieved when I sit down. There is continuous very slight numb sensation at the upper skin surface of my left thigh ( continuous meaning, all the time even while rested ). My lower back pain is getting worse and I have made the decision to do something. I am scheduled to see my neuro next week. I have not seen him in two years because I was hoping to lose weight and see if that help. Needless to say I did not lose weight . This time I ask him to do new MRI, discogram, etc. I’ll ask what he can do and get his opinion of the laser places ( I can guess what he will say !). Called United Health they said Tolli and microspine are in the network, LSI and Bonati are not. By the way, the reason I had to put up with pain, at 45 I had AVN and had to have THR - total hip replacement. Now I need to take care of my lower back. Question: Has any one complained from pain in lower back only (no lower extremities issues). In so far as open back vs. laser center, nothing is perfect the out come is 50-50. But when it comes to which laser center the choice is not clear. Mel

RichT

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CONGRATULATIONS MEL!!!! Posted: 03-28-08 18:05pm


Hello Mel, CONGRATULATIONS on posting the 1000th post on this thread Mel. Thanks for all that you have shared in your post. We learn from each other. It is truly amazing all the wonderful spineys who have contributed so much on this thread. And it keeps on rolling!!! RichT

tjh299

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alsgodoc Posted: 03-28-08 18:30pm


i need some help again if you don't mind. we couldn't go to chicago for standing mri, but had a regular one done, and was wondering if you could tell me if anything sounds like it needs to be address by surgery? Sagittal findings: There is minimal, grade ! anterolisthesis of L5 on S1. no associated fracture. Verebral bodies demonstrate normal height and signal intensity on all sequences. the conus medullaris is at L1-L2, and the spinal cord demonstrates normal signal intensity on all sequences. There is mild desiccation, loss of height, associated endplate irregularity, and a likely annular tear at L5-S1. Signal void and soft tissue enhancement in the posterior papspinal tissues on the left is consistant with postoperative change. He has lower bakc pain that runs from his back down the back of the legs, all the way to his toes. the left side is more prominent than the right. but he has narrowing of the right lateral recess with compression of the traversing right S1 nerve root. could the mild to moderate bulge's that he has on level L2-L3, L3-L4, and L4-L5 and bilateral facet arthropathy also on those levels be causing him more pain than the L5-S1 issue? I hate to see him in such pain . I sure would apprecaite your opinion. Have you had any flooding like missouri? We live close to the meramec river, but far enough that we didn't get any damage. There sure are alot of people having to clean up a big mess, hopefully the goverment will help. Thanks for taking time to respond. Mary

RichT

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Posted: 03-31-08 19:09pm


Hello Mary, In my opinion it is for your husband's doctor to interprete the MRI report and the MRI images, rather than any of us "spiney's". With the above said - "He has lower bakc pain that runs from his back down the back of the legs, all the way to his toes." Mary, I can only speak from my experience. For me when I had pain going down my leg it was determined both from the MRI and from the pain I had that I had a pinched nerve at L3/L4. May I encourage your husband to talk to his doctor and his doctor's thoughts regarding tryiing an epidural injection. SOOooooo very glad that you did not receive any flood damage to your home. Take care. RichT

littleonefb

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wow, so many posts. Posted: 03-31-08 19:55pm


Hello to all, I'm amazed at how many posts are here now and I've sure got a lot of catching up to do and maybe some responses to some as well. Give me some time to catch up. Fran

RichT

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Posted: 03-31-08 21:34pm


Hello Fran, We have missed you!!!! Look forward to your spiney thoughts. RichT

algosdoc

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Posted: 04-01-08 06:39am


I agree 100% with Rich. An internet forum is no place to try to reinterpret a written report of a MRI that a. may not correlate to the visual images since each radiologist has their own interpretation of the images and b. may produce extraneous and conflicting interpretations that may not at all correlate to your physical symptoms.

littleonefb

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Mary Posted: 04-01-08 07:13am


I also agree that you need to have your husband's spine surgeon explain the findings on your husband's MRI to both of you. MRI reports are only 1 part of a diagnostic evaluation of spinal problems. It is a tool that a good doctor will use to help match the symptoms to the findings. Many people have various degrees of bulges to their spinals discs and they mean nothing, unless the correlate to symptoms that patient exhibits, such as pain, weakness etc. It is quite possible to take those MRI films to several different radiologists and to several different spinal surgeons and some of them or all of them may have different interpretations of them. I had that experience when seeking other opinions before my spinal surgery. I actually had a total of 5 different diagnosis and 5 different interpretations of my MRI results. Plus I had a 6th one from my original spinal surgeon. I returned to my original surgeon for my surgery, because his diagnosis, and interpretation made the most sense to me, my husband and a friend who is a nurse, and I felt the most comfortable with him. My suggestion to you is for you and your husband to sit down and discuss the results of your husband's MRI and if you are not satisfied with his/her answers and or plan of treatment , then I would seek further opinions until you find a doctor that can help your husband. Glad to hear you had no flooding damage. Fran

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Financial Costs of Laser Spine Surgery Posted: 04-01-08 07:42am


Regarding the costs of surgery mentioned in a couple of posts here for LSI and what Algosdoc says the costs are for him. This is really very disturbing to me. Specifically Plasma Disc Decompression. My mind is just blown away at what LSI charged fenarrito for a plasma disc decompression and that didn't include travel to and from Florida, housing, food etc. Never mind the fact that it is not a laser procedure My math calculator came up with a figure of $16,000. And Algosdoc stated it shouldn't be much more than $5,000 maximum. That is $11,000 more at LSI and this procedure is covered by insurance when done by spinal surgeons that are not part of the laser facilities. The most a patient would have to pay would be a co-pay if that is required for sugery and day surgery procedures. A friend of my husband and I had this done 2 months ago at a major Boston MA hospital and they just got the insurance paid receipt info last week in the mail. BC/BS of MA paid the bill in it's entirety minus their $75 co-pay. Including the doctor's bill, the total bill was an even $6,000. Again $10,000 less than LSI. That really disturbs me to no end, especially considering that they did not do anything differently than any other spinal surgeon would do that does not do laser spinal surgery. Just leads me to ask these questions? What is up with the incredibly high charge for this type of procedure? And why would anyone go to any laser spine facility for this procedure and pay such a high price for it and have to pay for it out of their own wallet? Fran

littleonefb

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Re: LSI
Posted: 04-01-08 07:56am

beetle-sac wrote:

Matt:

I received a Percutaneous Arthoroscopic Discectomy (L3-L4 bulging) in August at LSI and had good results. My Surgery was performed by Dr. Weiss, with a consult by Dr. Wolff. My initial exam/eval was completed by Dr. Rothman who seems to no longer be there. My initial payment was $5000.00 less than yours, (although they have 100% of any insurance payments from my BC/BS etc.); I was scheduled on a very short term basis (I guess I replaced someone who canceled out).

On the day of my surgery I was taken wonderful care of by the OR staff, the Nurse Anestitist, and the Anesthesiologist Dr Hamburg. The surgery took just about 75 minutes, and then they moved me to the recovery area to sober up. Around an hour later I walked out of there without the usual pain in my leg/groin/shin.

I walked around our Hotel complex, and the following day visited SeaWorld with my 9 year old son and my wife. I needed to rest frequently - but I was considerably better. I also visited Dr Kellogg, and learned several things from him that have helped me quite a bit.

After returning home to New Jersey I completed 8 weeks of physical therapy to help me stand and walk straight; and gradually succeeded.

Now for the down side; after about 3 months of being TOTALLY PAIN FREE, I had the misfortune of getting out of the recliner / couch incorrectly and pulled something. I could not stand or walk without alot of help for a week, and it's now been over 8 weeks - I'm getting a little better every day, but it's still there. The Pain seems to be coming from L4-L5 according to my pain specialist. The next step is steroid injections in a couple weeks.

I have not been in touch with LSI for quite a while; a few weeks post surgery I needed a renewal script for my PT and they sent it right away, but they have not followed up with me at all, so much for the phone calls every few weeks to check on me... (I've heard this from others, too).

Another down-side is if I need an additional surgery it will be another cash payment of $14,000 or $15,000 minimum - which will take at least three magic tricks and a miracle to come up with...

Well, theres my tale-of-woe.. I sincerely hope that you're final result will turn out far better than mine, and on the plus side - my son is still talking about Sea World, and yep I would probably do it all over again tomorrow..

Best Regards,

Mike B (Beetle)

PS: For my friend RichT, theres my progress report!! Hope all is GREAT with you!!

My Dx: L3/L4 HNP-Bulging (Repaired LSI) * L4/L5 HNP-Bulging w/ Stenosis & DDD * L5/S1 Advanced DDD (Black Disk)

Mike,

Sorry to hear that you now have continued or new problems since your surgery, but I am not surprised to hear that LSI has not continued to follow up with phone calls to you.
I to have read on other sites that they don't follow up as they say they do.

It may be that they will be willing to do more surgery for you and free or reduced prices, but it would still entail travel to LSI and lodging again.

I would consider staying local and trying the ESI for now and see how that works out. If need be, you might prefer to stay local for further surgery and have your insurance pay for it this time.

Fran

littleonefb

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Re: Opposing Sides
Posted: 04-01-08 08:39am

RichT wrote:

Hello Babs,

Welcome to this forum and the great people who post and try to help others. And of course a very special warm welcome to this thread.

An EXCELLENT question!!! No different today than it has been for the history of mankind (or more appropriately for humankind). Any time in history that someone has steped out of the "box" they get stomped on by the "establishment". It never ends. I have been there, so I know.

It is the "establishment" of the traditional way to treat back pain against a newer way. The medical establishment "controls" the procedures "approved" by the insurance companies. The laser docs control their turf by not openly publishing. Both are in error.

Just think what Galileo went through saying the earth rotated around the sun rather than the "establishment" and church saying the sun rotated around the earth.

Hope this gives some perspective.

"Keep it coming." Babs, I can't imagine this lively group of spineys every slowing down. lol They truly "energize" me. Something those I meet face to face with don't even come close to doing.

RichT

Rich,

I see the issues of these opposing sides very differently and put the reason for them totally in the hands of the Laser spine doctors.

Insurance companies have legitimate reasons for denying payment for laser spine surgery.
They want to be shown that it really is an effective treatment for spinal problems and not some kind of experimental procedure.
They are asking for proof, just as any other procedure or surgery would be required to be justified.

To qualify for insurance payments, the laser spine surgeons would have to do proper studies to verify their procedures "work", are equally as good or better than traditional spinal surgery and warrant being done and paid for.

Insurance Companies will not accept various information provided from foreign countries, so called testing. They require the studies be done here under the regulations of this country.

As it stands right now, the laser spine facilities are not interested in doing any of these studies to verify that what they say is true about their methods of doing surgery. They are not interested in providing the information to other doctors, unless they are employed by one of the facilities and trained in their methods.

This would lead one to believe that they prefer it this way. They get to charge the exorbitant fees that they do, advertise on the web in the fashion that they do and make it appear that their methods are far superior to traditional spinal surgery with the slick websites and all but sure fired promises that they can fix your problems and prevent fusions and all the rest that they claim.

As for reluctance of traditional spinal surgeons to accept laser spinal surgery as a new method for spinal surgery.
It's not really fair to make that kind of claim. In so much as there is so little information available to traditional spinal surgeons on the surgery, it's no wonder they are suspicious, wouldn't recommend it, or say it is any good. They aren't allowed to find out anything about it really. It is kept a closely guarded secret. The information that traditional spinal surgeons find on the subject is not much more than the patient finds out from going to their websites.

Until the laser spinal surgeons are willing to do what is needed to have their surgery methods accepted by main stream medicine, accepted for payment by insurance companies, they will always be looked at with great suspicion and distrust.
Only the laser spine surgeons can change this situation, and until they are willing to do so, the opposing opinions will continue to exist.

It certainly makes me wonder why they continue to create this problem, all the while making millions of dollars off the patients, many of whom can't really afford the surgery and go deeply into debt to pay for something that may or may not be the best surgery for them, though they are led to believe it is a miracle cure for their spinal pain.

One other thing I would point out as well. The more is look at various other spinal sites on line, I find more and more people that have had laser surgery and have had poor results; and those results are coming from all of the laser spinal facilities, not any one in particular.

Fran

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littleone Posted: 04-01-08 15:15pm


Hey there, I just read your post and am very happy to see you are interested in my fees from LSI. I noticed that you didn't mention that I also received a laser facet nerve "removal" on two levels. Maybe the procedure on the nerves is why my fees were higher than you thought they should be. I don't know. What I do know is that I have been thoroughly satisfied, so far, with the service I have received and feel I paid a fair amount to have a group perform a medical procedure on me. If I don't get out of this pain I'm in I will probably have a different view at a later time. I was told by every conventional Dr./Surgeon I interviewed not to go to LSI. So I tried to find some dirt on any of the staff involved with the institute. I couldn't find any except that Dr. Kellogg, PT Dr., had at one time been listed as an MD on the LSI website yet he is not an MD. I went straight to him and confronted him about it and he said it was a web master's mistake and he had it changed. Who knows? Maybe bull, maybe not. There are apparently several qualified and very great surgeons around the US that could have done this procedure as good or better than LSI, and for cheaper, but I found LSI not them. By deduction I can only come to reason that LSI spent more on marketing than other surgery centers and therefore have a reflective price. I did receive a check for 1k for lodging. Are there things I would have changed about my visit to LSI? Of course. I will list a few for those considering a procedure. That is why we are here, right? This all depending on the idea my procedure has taken me out of pain and allowed me to surf, jog, and lift again. Right now I'm still in pain from the procedure. 1. I would have better researched PDD before I went to LSI a. I was only well researched on discectomy 2. I may not have had the nerves burned off in my facet joints a. I needed more time to research that procedure 3. I would have gotten more patients telephone numbers for my own follow up questions a. Right now I only have 2 people's numbers that I met getting a PDD at LSI b. While at LSI I spoke to at least 50, probably more, people who were with someone having, having, or had had a procedure there (not one complaint from them) c. There were 2 people who had been flown back to have follow up or reparatory surgery by LSI, and one that had PDD that wasn't successful, I think 4. I wish to God I would have gone there years ago I am sure I would have changed other things about the whole escapade, and probably will be changing some things in the future, but over all I can't say it has been bad at all. My progress is as follows: Healing and hurting, hoping and praying, feeling desperate and wondering...I am sure I will heal and be happy, any other outlook would be detrimental to my recovery. If anyone can give me a success or failure story for PDD please do, I am starved for information. Thank you, Matt

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to all that replied Posted: 04-01-08 18:59pm


I wasn't wanting anyone to operate on my spouse, he has a pain managment dr. that we will see friday, but was curious to have an opinion, just as fran said , that go to 5 doctors; get 5 different opinions. It's just nice to be able to talk to other people about problems. My spouse doesn't even know that i have mentioned anything about his condition. So it's not like i'm telling him that this is what they said on the thread. This is what we have to do. Give me a little bit of credit, i'm not the kind to see or hear something on the web and think it is gospel, cause we know that's not true. No hard feelings for alsgodoc, was just asking for an opinion, causing he has had very good information about things that could help. Thanks anyway!!!!!!!!! god bless Mary

algosdoc

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Posted: 04-01-08 20:47pm


No problemo. One absolutely must have the patient in front of them to make an accurate diagnosis from MRI films so that clinical correlation may be made. A radiologist's interpretation of the MRI is yet one step further removed from the truth. (remember, radiologists are technicians, not clinicians....they rarely ever examine a patient)

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Some Thoughts Posted: 04-02-08 18:45pm


Hello Fran, You have been most fortunate to have a SUPERB traditional spine surgeon. They are far and few between. I know that from the many posts i have read, and also from my personal interactions with traditional spine surgeons. Joe (Joebob) saw 12-13 traditional spine surgeons and they all pretty much said there was nothing they could do for him to reduce his pain. That he had to learn to live with it. Joe as you know had surgery at the Bonati Institute. In our/my last communications with Joe he was living life to the fullest and coaching ice hockey. AND his health insurance paid a goodly portion of the costs for his surgery at Bonati. Fran, I think it unfair to "label" the laser spine institutes as TOTALLY bad as you have. Yes, they market themselves and their services. Yes, their fees may be higher than some others. HOWEVER, other traditional spine institutes also market themselves and some I'm sure charge more than Algosdoc does. True, the laser institutes have not published thier procedures in the accepted medical journals. However, to be fair, I doubt that all traditional spinal surgeons publish all their procedures. In addition, it is possible that they have tried to publish their work, but that their submitted manuscripts were not accepted by the established "club". I know how it is when an "outsider" tries to publish in the "club" journals. It is almost impossible to do so. Regarding surgery failings - I do not have information on that from the laser spine institutes, nor do I have it regarding traditional spine surgery facilities. A "successful" surgery outcome is a most difficult thing to quantify. There are just SOOooo many factors that can enter in. You have your thoughts, and it is fine to share them. That is what an open forum is all about. And I will stand by the thoughts I shared in my post that you quoted. RichT

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Posted: 04-02-08 19:33pm


Hello Matt, Thank you for all that you have shared with us. I was most impressed with your open honest thoughts. "Are there things I would have changed about my visit to LSI? Of course. I will list a few for those considering a procedure. That is why we are here, right?" YES Matt, that is precisely why we have forums and are here. To be able to share our concerns, thoughts, advice with each other. I liked every point you made in your list. EXCELLENT food for thought for everyone. Okay, lets flip the coin to the other side - traditonal spine surgery. Every single point you made in your list would still apply in my opinion. When I asked my traditional spine surgeon EXACTLY what was he going to do during his proposed surgery to my back his reply was "Two fusions and perhaps a laminectomy. Really can't say until I open you up". WELLLlllll, that may all be true, however, I needed and need a better reply than that!!! Fran's doc from what she has shared with us told her everything in detail. I only wish we all could have a doc like that. A side note - About this time last year all the spinal surgeons and my to be pain mainagement doctor at the institute got together and the surgeons discussed what surgery they should do or not do regarding my messed up back. From what I am told opinions varied greatly. After much discussion my PM doc spoke up and said "Hold it! Don't you think we should first give some nonsurgical options a try?" The surgeons agreed (probably reluctantly so). My past two epidural injections have kept me functioning. (Translated - I can still get my hands dirty in our gardens, twist, turn, bend, and lift "weights".) Tomorrow morning I go for my third epidural. Hope like the others it too keeps the knife away from me. I wish you the very best in your recovery Matt. RichT

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Rich T Posted: 04-02-08 19:55pm


Just a note for you , on tomorrow's journey, GOOD LUCK and I WILL BE THINKING OF YOU!!!!!!!!!!!! Mary

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Posted: 04-03-08 10:43am


Hello Mary, Thanks for your thoughts and concern. The epidural injection went well this morning. No back pain at this time, but of course that is because the lidocaine hasn't worn off yet. Tomorrow will give me a better idea if my PM doc is still doing his "magic". RichT

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Severing Pain Nerves Posted: 04-03-08 16:27pm


Hello Matt, I hope your recovery is going well. Do stay in touch and give us an update now and then. I would like to go back to one of the points you listed in your post. "2. I may not have had the nerves burned off in my facet joints" Matt, I'm glad you brought up the subject. The severing of the pain nerves by whatever means has concerned me. It is not just the laser institutes that do this procedure, but also traditional spine doctors. Even my PM doc has told me he does it. What concerns me about severing the pain nerves, is that then you do not know when something is wrong. Ones brain does not get what to me is an important signal. Yes, I understand that for those in sever pain, and where every other option including surgery has been attempted and failed, then it would seem to be the only option left. However Matt, it seems to be a procedure that for some doctors is almost a routine part of spine surgery. It is a way for the surgery to be a "success" because now the patient feels no pain. Far better in my opinion to NOT sever the pain nerves until one finds out if the cause of the pain has been addressed successfully during surgery ore by some other means. Those are my thoughts on the subject. I'd be interested in knowing the thoughts of everyone. Hope you are having a GREAT Day!!! RichT

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Re: Severing Pain Nerves
Posted: 04-03-08 17:06pm

RichT wrote:

Hello Matt,

I hope your recovery is going well. Do stay in touch and give us an update now and then.

I would like to go back to one of the points you listed in your post.

"2. I may not have had the nerves burned off in my facet joints"

Matt, I'm glad you brought up the subject.

The severing of the pain nerves by whatever means has concerned me. It is not just the laser institutes that do this procedure, but also traditional spine doctors. Even my PM doc has told me he does it.

What concerns me about severing the pain nerves, is that then you do not know when something is wrong. Ones brain does not get what to me is an important signal. Yes, I understand that for those in sever pain, and where every other option including surgery has been attempted and failed, then it would seem to be the only option left.

However Matt, it seems to be a procedure that for some doctors is almost a routine part of spine surgery. It is a way for the surgery to be a "success" because now the patient feels no pain. Far better in my opinion to NOT sever the pain nerves until one finds out if the cause of the pain has been addressed successfully during surgery ore by some other means.

Those are my thoughts on the subject. I'd be interested in knowing the thoughts of everyone.

Hope you are having a GREAT Day!!!

RichT

Hi Rich

There always seems to be a misconception about "burning nerves".

I know I've posted about it before, but too many posts to go back and check for it so will repost the information that I have been consistently told by several spine surgeons and pain management docs, including my own.

The nerves that are involved in ablation or rhizotomy, which is what this is called are "minor nerves". They come from the facet area and can be the cause of a lot of pain, especially sciatica.

The nerves are not really "burned off" but are severed so that there is a space between 2 ends in the nerves.

It can provide varying amounts of pain relief, from mild to moderate to total pain relief.
What usually isn't understood is this is only a temporary fix. These minor nerves regenerate, and the pain will return.
The pain relief can last anywhere from a couple of weeks all the way to about 18 months before it returns.

The laser facilities seem to be the only ones that do it as "part of surgery".
What I will call "traditional spine surgeons" do not do nerve ablation/rhizotomy.
Pain management doctors are the ones that do the nerve ablation/rhizotomy and they use radio frequency to do it and it's called radio frequency nerve ablation or rhizotomy.

The usual method to determine if the ablation will be successful is to do what is called lidocaine injections to the facet joints, one facet at a time. Instead of steroid injections ie ESI, lidocaine is injected into specific facet joints that is suspected of causing the pain.
Over a 10 hour time span, the patient records the amount of pain relief that they have in very great detail.

The results of those lidocaine injections and the amount of pain relief determine whether nerve ablation will help decrease and/or eliminate the pain that the patient is having.

Traditional doctors turn the possibility of nerve ablation over to a pain management doctor for evaluation and to be done, long after the patient has exhibited continued pain after fully recovering from whatever spinal surgery they have had done.

Never ablation can be repeated over and over again if the patient wants to have it done, but they have to remember it is only a temporary fix and the nerves will regenerate.

There is quite a bit of information on radio frequency nerve ablation/rhizotomy on the web. Just google either words or both and you will find quite a bit of information.

Fran