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Laser Spine Surgery

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littleonefb

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Re: New to forum, old to pain
Posted: 04-22-08 00:05am

SciaticAl wrote:

Hi all,

Read the first 7 pages, skipped to pg 52 due to time constraints. I am Alan, and I guess I am a Spiney. 11 years ago, herniated L4-L5. Pain at first, but it subsided. Doc said try your best to live with it. Well, I have led a fairly normal life. Work, kids, all the good and bad this world provides. Then... for some reason, 3 months ago.... OUCH!. Now I struggle getting out of bed. Standing in the shower. Sitting for long periods. Chiropractor did his best, sent me for an MRI. L4-L5 herniated to the left, with a fragment. That would explain the stabbing pain in my calf, the invisible vise around my left ankle, and the tingling in my toes. L5-S1 also herniated to center, causing slight issues with bowel movements. Pain issues, that is.

I am 43, used to be strong as a bull, now I tear up when I feel a sneeze coming on. My three jobs keep me moving. I thank the Good Lord I can still climb ladders, albeit through clenched teeth and a painted on smile. The stretching and exertion seems to help. My second job involves a lot of walking, which seems also to help. My third job is a bit more sedentary, must take frequent breaks.

I am trying to get a neuro appt, could take two months. Until then, there's laughter, a supportive family, and pain meds.

Thanks for all the great info here. You all have been through a lot, and are a collective inspiration.

Alan

Hello Alan and welcome to this forum.

Having read your post, I see that you say Neuro appt. I hope you mean a neurosurgeon that specializes is spines and not a neurologist, as a neurologist is not the type of doctor you need to see.

You could also use an orthopedic surgeon that specializes in spines.

It's not surprising that your prior herniated disc subsided on it's own. Most do with some time and physical therapy. Sometimes an epidural injection can also help relieve the pain and allow you to to do physical therapy and give you the time for the disc to heal on it's own.

I, personally, would not go with the diagnosis from a chiropractor but wait until my MRI had been seen and read by an MD that specializes in spines. I know too many people who have had MRI's done my order of a chiropractor and diagnosed by them and then gone to a spine specialist to have a totally different and correct diagnosis made.

That being said, once you have a diagnosis from a spine specialist, you will have a better idea of what your situation is and what the doctor suggests for treatment.

One suggestion I do have, though, is that if surgery is recommended by the doctor, that you get several other opinions before going ahead with surgery. I would suggest a minimum of 1 more but I would get several, before I made any decision on surgery.

I would also be very, very careful about a trip to one of the laser facilities for treatment as well. Upfront outlay of money that they require is a huge investment in a medical treatment that is still very much in question with the medical community.

First get your diagnosis from a spine specialist and then you will have an idea of where you are headed.

Good luck and let us know what the doctor says.

Fran

littleonefb

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Re: L4-5 DDD
Posted: 04-22-08 00:14am

Mel11 wrote:

Hello everyone;
I am impressed with Fran’s knowledge of various spiny’s medical issues, I bet she know more than some doctors. Before seeing my Neuro last Wednesday I had focused my attention on Bonati and Microspine. I talked to United Health, my insurance; they said Microspine is in-network Bonati is not. Microspine and Bonati are about 10 hrs drive from Greenville, SC. To my amazement I found about Foothills Pain Management Center which is 1 hr from me in Seneca, SC. According to Foothills, they are not in-network with UHC and their fees are not very different from Bonati or LSI. They started their practice in July 2007 and their Dr. McMillan do about 3 laser procedures on average every week. Microspine advised that you come in for four days, three days for tests and the surgery is on the fourth day.
When I met my Neuro last Wednesday I was surprised twice. One: he did not know about Bonati, LSI, or Microspine. Two: He heard of Foothills and Dr. McMillan and he said their laser procedure is an option. I was shocked; I thought he would say these guys are snake oil salesmen. He also said since PM clinic could not diagnose the source of pain and since my pain is only in my lower back it will hard to pin down what to do. I will do a new MRI on Monday, he will ask for discogram after seeing the MRI. He said, there are discograms now where they inject and the patient would stand to feel the pain, if any.
Mel

Hi Mel,

Thank you very much for your compliment on my knowledge of spinal iissues.

I have spent most of my life working in hospitals, mostly with children, but I do have contacts that I can talk with when needed.
Surprisingly though, that was not much of a help to me overall, and my knowledge comes from experience, common sense and studying of anatomy and physiology in college.

I will agree, though, that in my travels with "second opinions" I did know more than some of the spine surgeons that I did see in consult. On the other hand, my husband with no medical training or knowledge also knew more than they did; and some of these doctors where supposed to be some of the best in the country and where from some of the most prestigious hospitals in Boston MA.

I don't know anything about the particular spine center that you mentioned in your post, but have seen them mentioned in some other spine sites. nothing bad, nothing really good, just mentioned.

Good luck with your discogram

Fran

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Mare Posted: 04-22-08 00:50am


Mare, I don't know where to begin to respond to your post to me. I just baffled by what you said and just really don't understand, what you said just doesn't make any sense to me at all and I can't' understand how you can think they way you do about LSI. I don't understand how you can still praise the facility after your experience. First they said that you where a candidate for their surgery, yet there is no way they could do a laminotomy or anything else on you. there isn't any vertebrae left to do that on and they where aware of that before you got there from your MRI's. Yet they still had you come down to their facility. Then they turn around and give you these tests that made you worse and told you that they couldn't do the surgery on you, it was too risky to you spine. Then you contact them that you are worse and they want you to come in at further expense to do more tests, and schedule you for the same surgery that the doctor had already told you they couldn't do a few months earlier. Then you where in more pain and told for a second time that you couldn't have surgery done and they offered you a spinal ESI, which you could have gotten back in Canada. And all of that doesn't include the other problems you had when you first got to LSI and they wanted to pawn you off to some other doctor, if they could find one that would agree to it and do the nerve block. at further cost to you outside LSI. When you sort of held off on it, they turned around and told you that they had a doctor coming in the next day that could do it. Talk about 1. one hand not knowing what the other is doing from the moment you arrived at LSI and all the way through the entire winter. 2. Sounds like they where far more interested in just getting money out of you even though it was obvious that you where not a candidate for further surgery with them. You state the following "I might add, if they had been able to do the surgery, they were not going to charge me anything additional." May I ask what additional means? and why do you think this would have been a good deal? They wasted your time and money already, got your hopes up and caused you further physical pain more than once and for what? They knew you had a 3 level laminectomy and there is no way they could have done any further surgery on that. Yet you still are praising them for the fact they wouldn't charge you any further amount of money and also that they refunded you $1,000 for your trip. I'm sorry if I sound harsh, Mare, but that isn't anything to praise LSI for. This whole experience must have cost you at least $15-20,000. One huge chunk of money and well over priced for what you had done, but many thousands of dollars. You may have seen lots and lots of people that where quite pleased with their surgeries, how long that lasts we don't know, but I'll bet money on it that it won't be long, but that has nothing to do with you. In my eyes, LSI treated you horribly and if it where me, I would be all over them about it and really going after them for all of my money refunded to me. The way I see it they outright lied to you about being a candidate for surgery, and they did that first to get you there, and then to get you back a second time after they caused further pain. I for one would not be letting them get away with the way you where treated and I would be screaming about it to both LSI and on the Net. Unfortunately you are far from the only one that has had this kind of treatment. As for nothing else able to be done for you. that is what one surgeon said to you and if it where me, i would be getting more opinions and doing everything I could to find a way to relieve my pain. If that meant more than one operation to do it, that is what I would do. I wish you the best, and hope that you can find some relief from your pain. Fran

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Thanks again Algosdoc Posted: 04-22-08 08:20am


Thanks for the clarity of your explanations of surgical procedures and methods of approach. Marie B.

Marie B.

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Don't Be Offended Posted: 04-22-08 08:39am


Don't be offended by anyone's words, Mare, but I don't understand your defense of LSI either. LSI is a business. That's very clear. They have advertisements on every health and spinal website. That must cost a pretty penny. It also might be where a lot of money must go to encourage patients to view their magnificent looking facility and website. If someone goes there and has successful surgery, meaning if they come home and never have pain, that is great. If the situation you find yourself in now is not that great, at least you have put it out there for people to know and read about for thrm to recognize the inability of LSI to free you from your pain. It also helps give balance to the picture of Laser Surgery. The decision others have to make in regard to "where should they have surgery done, if surgery is required", needs that balance of reporting. Thanks Mare for sharing your experiences with us. I do hope there is light for you in the future to help your pain. Marie B.

RichT

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Posted: 04-23-08 20:08pm


Hello Everyone, Sorry to have been "absent". Gardening and trying to deal with contractors GRRRRRRrrrr, have been taking up my time. Thanks everyone for keeping this thread on a roll. Mare, I too want to thank you for sharing your experiences at LSI and also the "background" info regarding your back situation and the advice you received from "traditional" spine surgeons. You have provided much "food for thought" for all of us spineys on this thread, and also for all who just "listen in". We continually learn from each other on this forum on the many threads regarding back issues. My PM doc has done it again with my last epidural injection. He is amazing in being able to reduce my pain so I can keep on rolling. Take care all. I hope that in a few weeks I can be somewhat more active here. RichT

jimare

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Offended Posted: 04-29-08 21:57pm


Marie and Fran I am not offended...I guess I am not the "fighter" that Fran apparently is. I think I already related that I went to 3 specialists within a 2-1/2 hour drive of where we live and I got three different opinions of what should be done...then ended up driving 8 hours each way to see the Dr. in Toronto who came recommended as being one of the best in Ontario. Ended up with the hip surgery that he was positive would fix the problem, and turned out not to be the case(another unnecessary surgery) and after going back and forth over a period of 4 years I ended up having the 2nd back surgery. Another failure. To see a specialist here in Canada takes 1/2 a year with another 1/2 year at least until the surgery takes place. I've seen people wait 2 to 3 years for surgery while suffering terrible. It is not as simple as Fran thinks to keep getting other opinions. Four referrals by my GP is probably my limit. She has gone along with all my suggestions including LSI, but I doubt she would agree to any more. She is most sympathetic, but she has noted that each time I have had surgery I have become worse so I think there comes a time when we have to say "enough". As far as Epidural Injections...there again...I would have to travel 16 hours to have it and it didn't do all that much to change my situation. Slightly, but not much. Fran you seem to have a real hate on for LSI...dismissing all the opinions of people who said they would willingly pay twice the price for the relief they rec'd. Granted, there are some like myself who paid a high price for an unhappy ending..and perhaps if I lived in the U.S. I would "be all over them"; maybe even resorting to "Calling Lee Free" to fight them on it. I can only speak for those I know...like my sister who would gladly pay the price again. Just to be able to walk and stand without pain and to garden...she couldn't be happier, and she paid a good deal of the charges by LSI for me because she was so thrilled with her results. What can I say?

RichT

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Posted: 04-30-08 00:58am


Hello Mare, You have spoken well Mare and you have done so in a polite proper manner. I commend you for helping us all to better understand what you have all been through. I was most saddened when your surgery at LSI did not reduce your pain for we all know many have been helped at LSI. Your unfortunate experiences with "traditional" spine surgery reminds us that that approach also has its failings, many failings. I hope and pray that somewhere there is a doctor who is able to help reduce your pain, and I don't mean by pain medication for that only dulls the mind into thinking things are better. MANY gentle HUGS!!!! RichT

jimare

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Hugs Posted: 04-30-08 21:27pm


RichT Thanks for your kind words...you are a good moderator...encouraging all of us as we share our experiences...be they positive or disappointing. I really shouldn't complain because I have a great supportive husband, and many good friends who are riding the same train as I am. We enjoy a lot of laughter and a lot of fun in spite of our various "infirmities"! These Golden Years eh? Hugs are always welcome; never have too many of those. Mare

ratter

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LSI Posted: 05-13-08 16:44pm


I had all pain removed by LSI and its been almost 2 years in July. C6 C7 lamin. and form. and Ablation. Words are hard to say let alone spell. It was a success for me so far. Operation was done by Dr St Louis and re-hab by Dr Kellog. I am back to work. Left arm is weak but it was weak before the operation. The left side of my left hand (pinky area) is numb and will stay that way but feeling returned to my other fingers (ring and middle). As to numbness....who cares so long as the pain is gone. The place was packed with people believe it or not. I give the place a huge thumbs up. It was $30,000 but if you hurt bad enough you will sell your house to get relief. I took the atitude of either it will work or it won't but at least I tried. It worked. Insurance sent me $800 back (HMO) The HMO Dr told me to live with the pain its gonna get worse so thats when I found LSI and did it. After the surgery at LSI, I ran into the HMO Orth. Dr because my son hurt his finger at school and he said "Oh, how did the surgey go?" and I said great all the pain is gone and he replied....your not out of the woods yet...your gonna be hurting down the road......my reply was yeah, but at least I know LSI might be able to fix it. I then saw same Dr a few weeks later when he checked my sons finger and this time he was a lot nicer. My opinion on LSI is if they cannot remove all the pain, they can remove most of it, in talking to people whe went there. I think in a worse case scenario, they can kill the nerve causing the pain but I am no Dr, and only guessing that. If you go on their referral list, you will get constant calls every week so you might want to think twice about that referral list.

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Posted: 05-13-08 19:10pm


Hello Ratter, WELCOME to this forum and especially to this thread!!! THANKS MUCH for sharing your wonderful very positive experience at LSI. FANTASTIC that your pain is now gone. I hope that with time the numbness you feel will also be gone. It takes a LONG time for nerves to "reconnect". Your recent experience at your ortho doc is typical of the "traditional" doctors. Thanks also for sharing those two experiences. Ratter, you have added greatly to this thread. Each experience whether by laser spine surgery or by traditional means helps each of us spineys. Have a GREAT Day!!!! RichT

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Posted: 05-13-08 19:26pm


Hello Mare, Thank you very much for your kind words to me. You are most blessed to have a husband and good friends who support you AND bring out the laugther that you share together. I had to chuckle regarding the "Golden Years". Now that I am about there, makes me wonder about the person who coined the phrasel. lol Oh yes, I sure the heck ain't 25 any more, however, I still cherish the good days and times. Mare, do read Ratter's post and experience at LSI. Though the results of the surgery there for you was disappointing you can at least rest assured that others have been helped at LSI. Me - I'm back out gardening today after the past several very rainy days. Though I sometimes "push" the ole body a bit, some rest in my recliner with the heating pad and a glass of wine makes everything better. Stay in touch as I hope Ratter will too. RichT

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Re LSI Posted: 05-14-08 15:45pm


Ratter I am very glad to hear your positive post. I am sure if I hadn't had so much bone removed during my traditional surgery I would have been helped by LSI...under the circumstances they could remove no further bone to decompress the discs that were causing my back and leg problems. My complaint was that Dr. Perry should not have said "after viewing your MRI we are convinced we can remove your pain with a laminotomy/foraminotomy. Right from the get-go they could see that I had several vertebrae taken out and the spine would be comprimised. Anyhow I still would recommend LSI over open back surgery any day, for those without a lot of complications in their spine. My sister had great success in her surgery in Jan. 07 (no previous surgery), and a good friend had her lam/foram done in Mar this year and is ecstatic...Those I have kept in touch with generally have done very well, EXCEPT those who have had a lot of previous surgery. There must be something there. I feel they did the thermal ablation on me knowing full well it would do nothing for my compressed discs which is where my pain was. I have stenosis and DDD in 7 discs...a lot of problems. My last surgery was in 2006 and I was only made worse, which is what happened to me from the thermal ablation on my facets. I have written them a letter explaining my feelings...not rudely, and I ended it by saying I feel they owe me a partial refund, if not a whole refund because of what I went through there. Paying all that money to end up in worse circumstances is quite galling. Anyhow, I had nothing to lose. Mare

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LSI Posted: 05-14-08 19:18pm


Hi, I would be mad too if I shelled out 30,000 and it didn't help. But at least you tried. You should stay in contact with them in case they have future breakthroughs. My post was directed not at you but someone else. I have talked to many many folks and 99 percent had positive response and a couple did say it was of no help unfortunatly. I ask the people who call me for a referal if they talked to anyone else and most say they have asked others and got positive results. So far so good for me. My shoulder or back (whatever you want to call it) does get stiff once in awhile but any kind of exercise immediatly loosens it up. I don't ever want to go through it again but at least the place is there just in case. I have a new unrelated problem in that my left hand and fingers cramp up and start to hurt but when I free them up the minor pain goes away instantly and hand and fingers are free again. I am 54 years old and a Dr up here said it almost certainly is arthritis unrelated to my operation. I asked LSI also first and they said it was unrelated but urged me to see a Dr which I have not other than telling him what I said. IThis getting old sucks.

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LSI Posted: 05-14-08 21:25pm


Yes..getting old is not for sissies. I am 69 (don't know how that happened) and was in great health 'till I hit 60, and since then I guess I fell apart and have had about 6 surgeries...yikes! If I ever see the inside of a hospital again it will be too soon. Before leaving FL, LSI asked me to come in and try a steroid epidural shot in the L3/4 which was the worst area and I am getting back to where I was before having any surgery which I am thankful for because I spent the whole time I was in FL absolutely sick from pain and misery. Now I am able to make meals again (sitting down every so often) and go outside and use my weeder in the flower garden, and walk down to the lake out front and sit and watch the sunsets. For a while there I couldn't even sit comfortably...so I am thankful for small mercies. It is a far cry from where I was but compared to a lot of others I am well off. Oh yes..I'd better set the record straight...when they decided not to do the lam/foram, and did the facets instead, I was refunded $10,000. Mare

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Posted: 05-15-08 22:13pm


Results from a single spine center, whether it be LSI, Microspine, Bonati, etc are not released to the public since these centers 1. do not track their outcomes over time 2. give patients a referral list of those known to have positive outcomes, thereby invoking a very uneven playing field 3. do not use standard measurements of functional assessment before and after surgery. How many that have had surgery from these centers have had an Oswestry or Roland Morris test before and after? How many have had a SF36 pain assessment instead of a simple "think of a number between one and ten"? How many have had the modified MacNab outcome assessment? My point is, the lack of data available is not equivalent to a center having good outcomes. Talking to a few people about their outcomes is effectively meaningless. Talking to those on a referral list is even more ludicrous. If you elect to go to an unorthodox spine center, then ask the appropriate questions: 1. In what peer reviewed medical journal are your outcomes published? 2. What standard testing before and after, are used to assess outcomes? Failure to acquire this information is permitting centers to engage in experimentation on you while you mortgage your house for them to do so. Be a smart patient in your pursuit of health care, and go into surgery armed with published outcome information about the techniques of non-standard surgeries. If you do not have this information, you might as well take your $30,000 and go to Vegas. At least in Vegas, your outcome odds are statistically known.

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orthodox vs. unorthodox Posted: 05-16-08 16:38pm


Algosdoc You would know a lot more about this than I, but should this rational not also apply to hospitals or centers where the "accepted" methods of spine surgery are performed? Are there medical journals that list the outcomes of their surgeries. I have had two open back surgeries, plus a lump removed from my back, and nobody ever checked to see what my outcome was. I never thought to ask for statistics on the outcomes of their standard open-back methods when I signed my name on the dotted line in hopes that the outcome would free me from the tortuous life I was enduring. As it was...my laminectomy was done under emergency conditions and I would have gladly agreed to have my leg amputed on the spot to get rid of the pain. I just assumed the surgeon knew what he was doing. Would I have changed my mind about surgery if I'd had the data on successful outcomes from open-back spine surgery? Not likely under those circumstances...On any studies I have seen comparing laser spine surgery to open back surgery...the results were not even close. Also, the risks were way higher with open back. Those tests you mentioned..Oswestry, Roland Morris. SF36...I never heard the terms, and would have most assuredly appreciated something more effective than the number between one and ten. Mare

algosdoc

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Posted: 05-16-08 18:59pm


The risks between open and endoscopic or laser surgery depend on the technique being employed. For instance, laser disc decompression via a fiber through a needle has the risk of penetration of anterior wall of the disc and the iliac arteries, causing an instantaneous life threatening bleed. However, the laser is typically not brought into the epidural space, so the risk of peridural fibrosis (scar tissue) in the spinal canal is very small. Endoscopic techniques use a larger scope, usually between 4 and 8mm diameter. These can do some damage. Also, the use of a laser in the neuroforamen to open up foraminal stenosis can cause nerve damage due to the compression waves from the laser reverberating off the bony wall and onto the nerve. Using a reamer or other mechanical device through the endoscope is no less risky than doing the same via open surgical techniques. So just as SI Hiakawa once said: "Cow one does not equal cow two does not equal cow three". Hospitals typically do not permit laser surgery or endoscopic surgery so they do not have to report on cowboy or investigational techniques. There are large surveys (usually not reported to the public but by which spine surgeons gauge themselves) that keep the surgeons in line. Also peer review is a process that dings surgeons whose practices are outliers.... This is not true when the surgeon owns the surgery center.

jimare

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new option to treat chronic back problems Posted: 05-16-08 23:22pm


Algosdoc Wouldn't mind hearing your thoughts on the following: The Total Facet Arthroplasty System™ (TFAS™) is a non-fusion spinal implant indicated for treatment of patients with moderate to severe spinal stenosis. TFAS™ replaces the diseased facets (and lamina, if necessary, to attain adequate decompression) following surgical removal. TFAS™ offers the surgeon new options for treating spinal stenosis, enabling a more comprehensive decompression via complete removal of the facets. TFAS™ also offers an alternative to rigid spinal fusion fixation enabling intervertebral motion and restoration of stability and sagittal balance to the spine. TFAS™ eliminates the need for painful bone graft harvest from the patient's hip, typically required with fusion procedures. I think it is still in the experimental stage, but appears to be showing positive results.

algosdoc

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Posted: 05-17-08 06:34am


This system has been in development for many years and does indeed represent a major advance in posterior column disease. I anxiously await the clinical trials as this system may solve some of the many problems that occur due to facet arthritis.