Laser spine surgery

Hello Dijohn,

WELCOME to this forum and especially to this thread. I commend your efforts in reading through this "book". A lot of info is shared to say the least.

As soon as I read that you live in the Boston area I immediately knew you needed to contact Fran. She has a SUPERB spinal surgeon. I'd see the fellow myself, but as you so properly decided, it is best to go to the very best spinal surgeon in ones own area.

Permit me to make a small correction in your No. 2 - I do not know of a single surgery where there is not the development of scar tissue. The only question is was the surgery done in a manner that minimizes the formation of scar tissue.

SOOO Djohn, I'll let you and Fran have a good discussion.

Hope all goes well for you.

RichT

John, If you are open to one more surgical opinion, Fran is up in your neck of the woods. She might be willing to help you get that one more surgical spinal opinion to your questions and give you more options.
She also can tell you more about the hospitals around that area.

I had Lamenectomies at L4 L5. To get to and remove the cause of my stenosis my spinal surgeon had to remove the entire Lamina..."they called it "taking the roof off" the vertebrae. This part of the procedure decompressed a buldging disc and its accompanied buckled and over grown ligamentum flavum that was pressing on the Cauda Equina. I also had Medial Facetemies. I had a lot of bone spurs present that needed to be addressed. This resulted in my having to have Fusion. I did not have rods and screws etc for the Fusion. My surgeon used the bone from the removed lamina as the grafts for fusing L4 and L5. The process was called Fusion In-Situ.

My surgeon did do Foraminotomies to give my exiting nerves more room. I did have at S1, a herniated disc that was sitting on the nerve seat. The foraminotomy took care of the exiting nerve by giving it more space. The nerve was not impinged. I did have a small impingement at the L4 on the right side of the vertebrae. The Foraminotomy relived the impingement and the nerve recovered nicely.

After 8 months I am doing absolutely fine. No pain at all and all the concern about limited motion at this point in time is gone. I am amazed at how much movement I have in my back. I can bend forward although I am careful not to push it too much.

Good Luck with your decision and if you can handle the pain, make sure you get as much information as possible to the surgical approach to your spinal surgery. Know what you are getting into ahead of time. If you find your doctor does not answer questions nor give you as much time as you need for you to make a decision, there is always another person to go to.
If you need this, Fran I'm sure will help with a name and a place.

Marie B.

RichT...thank you for the welcome to the forum. There is a lot of great information here! And thanks for the correction on the scar tissue.

Marie...it looks like your surgery has been very successful. You mentioned that you had an overgrown ligamentum flavum, which is a major ligament in the spine. The thickening of the ligamentum flavum seems to be a fairly common spine issue as people age. How is this decompressed ? Does the surgeon actually trim part of this ligament ?

Looking forward to Fran's input on her experiences with spine surgeons in Boston.

Thanks!!

I'm here, and wow, really. Thank you Rich and Marie for such sincere compliments on my knowledge and experience.
Believe me, I wish that I didn't have the experience, but glad to be able to help.

So Djohn, first off please remember that all that I say is either my own personal opinion, personal experience and some medical experience that I have had.
I AM NOT A DOCTOR, NURSE, OR ANY OTHER KIND OF MEDICAL PROFESSIONAL.

I've just had far to much experience in dealing with orthopedic problems since I was a kid. Between myself, my brother the accident prone kid, my sister and 2 varsity athletes for kids who played sports since they where 5, one is now 30 and the other 25, I have learned to read x-rays and some ability to read MRIs especially spinal ones.

I too am in the Boston area, actually northwest of Boston by about 25 miles and quite familiar with New England Baptist Hospital in Boston, all to familiar in more ways than one, which I will go into in a bit.

I grew up in Brookline, a first suburb out of Boston. I am now 57, and when I was growing up and until a few years ago, New England Baptist Hospital was considered the premier orthopedic hospital in the state, in the area, in New England, in the country and in the world.
They specialize in spinal surgery and do about 20,000 spinal surgeries a year.
And yes, they are the selected hospital of the Boston Celtics basketball team.

Now having said all of that, I will take an excellent guess that in the past few weeks, patients are running away from the New England Baptist Hospital faster than a "cat has kittens", as fast as rabbits multiply and any other saying you want to use.
That is based on a front page article that appeared in the Boston Globe about 3 weeks ago that stated over the past 2 1/2 years ago, New England Baptist Hospital and Lahey Clinic, both in MA accounted for 50% of the spinal surgery errors, and we are talking about serious spinal surgery errors. Things like fusing the wrong vertebrae during surgery, not finding out till after it was done.

This was serious enough that when the information was reported to the state by the Globe, the state ordered New England Baptist Hospital to hire an outside consultant to review the errors and their "blueprint for reducing errors"

Believe me, I was amazed to read this article and to think that I was there in 2006 and saw 2 different spine surgeons for other opinions before having my first spine surgery elsewhere.
I was even more amazed to read that this was going on in 2006 while at the same time New England Baptist Hospital was doing a massive blitz of advertising on every radio station in the state, every newspaper in the state and all over the local TV networks, about their expertise in spinal surgery, innovative procedures and the best in the world.

Before I go on, Djohn, i want to post this and then a link to the globe article

Fran

I have some comments I'd like to make about the article that I posted from the Boston Globe, but I'm going to bed, it's 1:30AM. Will post them later today.

Fran

I agree with the walking. Walking really helps the body and mind after an operation if you are able to do it. An excellent way to feel better and even if you have any leftover pain, walking eliviates its. Highly recomnd it. Even if you have to push yourself, you will be glad you did it.

Fran,

Wow....thanks very much for taking the time to provide all that information. I had not seen that Boston Globe article, but I'm definitely having second thoughts about NEBH. The surgeon there was looking to do endoscopic surgery, so that may have been why he was saying 2 - 3 weeks to go back to work. I understand that the recovery time is a bit shorter with the endoscopic approach.

I recently went through a physical therapy program for about 6 weeks..doing stretches and strengthening exercises for lower back and core. I have continued these exercises and stretches and do them daily on my own. There are also a number of exercises that I learned through the therapy, that I do at my gym several times per week. The exercises are great for strengthening muscle to support the spine and should provide long term benefits, but have little or no impact on relieving pain from compressed spinal nerves. And since the epidurals are losing effectiveness, I'm now looking at the surgery option.

I will PM you to get the name of your surgeon. I'll also check out Newton-Wellesley.

Thanks!

See! John. Rich and I arm ourselves with Fran's information and when she doesn't know the information she has sources where she gets direct information.

From the New Balance Shoes to Grabbers, to long shower brushes, to almost anything, Fran is our Encyclopedia for spinal needs. A lot of people don't like to read all of that information that she provides. Heaven only knows why. Too many men and women go to surgical spinal doctors unarmed or like I tend to say "a lamb to slaughter"

You are a wise man, John, to be willing to get that one more spinal surgical opinion.
Once you do that, please keep us aware of what is happening to you, your thoughts and opinions as you proceed into this getting rid of spinal pain. Our hope is to help all people who read the postings here and to emphasize the need for a thorough search for a good spinal surgeon.

Marie B.

Hello Marie,

YES, John is a wise man. I too will look forward to his sharing his "process" in selecting the BEST spinal surgeon and hospital.

"a lamb to slaughter". I know what you mean. People blow my mind when they just bury their head in the sand and blindly have surgery by the first doc they meet on the street so to speak.

I'll tell you another one - A member of our church had a cochlear ear implant by a doctor at a university. I asked his wife how they selected the surgeon. Her response "we just went on blind faith". That about sent me through the roof!!!!! The good Lord expects more of us than that in my opinion. And sorry to say, less than a year later she died from a brain tumor. A very nice wonderful lady. I often wonder if she would still be alive today if she went to the best doctors she could find rather than "going on blind faith".

Take care.

RichT

Just got official word in writing from my HMO .......no more money they will not pay anymore than the $800 they sent. They said that on the phone, but they had to follow up in writing. As to trying to get ss disability, after seeing the Social Security Dr awhile back, I got a letter from SS saying although they aknowledge I have Arthritis problems based on all the info and their Dr's tests and so on, as long as a person can grasp something in their hand, they can find work. They then wished me the very best and I can anytime re-apply again for Disability. Heck at least they aknowledged my "problems". When you apply for Disability, you have to show them everything, all Xrays, MRI's and the whole works and as mentioned you have to then see their Back Dr. Don't get me wrong ethier Dr did say I had problems based on the MRI and other stuff, and he was a real nice guy, but no SS Disability was end result. He also wished me luck down the road......kinda makes me sweat when all the various Dr's keep saying that. Sounds like they are implying something. GULP!!

Ratter, SS Disability is for people who really can't work. If you can hold things and move and do things, then you may have to change jobs, but you still can work. It's that simple.
They make it extremely difficult to obtain SS disability, more than they really should, but on the other hand they are trying to keep people form obtaining benefits that really don't deserve it.

As for your HMO not paying any more for you LSI bills, you should be grateful that they paid anything. Usually HMO's do not pay anything for out of network surgery or doctors unless it is a life or death situation.

As for doctors wishing you luck down the road. That can just be a courtesy comment and polite without any meaning. On the other hand, it could be an indication that you could or will have some further problems with your spine, arthritis etc. in their opinion.

No one can predict the future, not even the best spine surgeons or any doctors in the world, they can only give an estimated guess based on statistics. They can only deal with what is present in front of them.

How you deal with your present situation and/or medical situations is up to you and how you decide to treat them and with what kind of doctors is also up to you.

I only know that ignoring existing medical problems will not make them go away and pretending they don't exist won't do it either.

Fran

I hear you Fran. I did see the Dr about my hand and he wanted to give me one perscription and 3 types of B12 and I forget the other two B vitamins. The perscription pills were suppose to do something to allow the blood to flow easier or something like that and stop the hand and fingers from cramping up. He said the pain people get when this happens is the blood being cut off causing the intense pain and then when the fingers or hand get stretched, that allows the blood to flow again stopping immediatly the pain. He said it was definatly Arthritis. If he is giving vitamin pills than I figure it couldn't be too bad so I tossed the perscription into the waste basket and its gone now. Dr also said I had to keep taking the perscription pills once started. I am soon to be 55 Sept 3rd and feel to young to take a plateful of pills but might have to soon. My father soon to be 85 says he has had lots of pain in his life (and he definatly has), says if you keep thinking about it, it hurts more, if you ignore it, it will go away. He also says that even if someone has constant pain, that the mind by itself will lessen the pain in time. I think he may mean you get use to it. I said to him how can anyone stop thinking about it when it keeps happening? He thinks it will go away by itself in 6 months to a year that the body has a way to heal itself. He said he doesn't hate Dr's and they are needed, but he definatly does not trust Dr's at all unless its like a broken bone and something obvious. I'm not saying he is totaly correct but he does have some points. Next time I go to Dr I will ask him for another perscription just to be sure. All this crap started after I hit 51. Again will get the Dr perscription again soon and start taking the pills. My HMO insurance pays for it anyway so it don't cost anything, nothing to lose. Hope you are feeling better with your surgery and I think you said you are in previous posts. Your in a lot worse shape than I am, good luck.
PS one other note...not to keep crying about myself, but my job is cleaning gutters on houses and most of the jobs are high 2 story 2.5 story and have various pitched roofs some I can get on and some I cannot and some I take a hell of a chance so I can get done faster than moving the ladder evrery few feet and climbing back up and down again and again. The job pays well but is highly dangerous but in 28 years in business no falls as of yet. I believe this was the cause or a contribution to my Arthritis big time. EVERY Dr I see now tell me I am nuts to continue cleaning gutters and strongly suggest I something else including LSI. Have been getting a couple very slight momentary dizzy spells but they clear right up. I have a big following of customers who count on me and only want me and no one else. But point being the job caused my Arthritis I think or the lifting of heavy ladders etc. Finally done.

Hello again, looks like once I start to post I just don't stop. but I did post early this morning that I wanted to make some comments on the article that I posted and linked to that was on the front page of the Boston Globe on July 30, 2008.

So here they are.

First of all, to be fair, there will always be mistakes made with all kinds of surgery. It's the "nature of the beast" as we are all human and that includes surgeons of all kinds. Human beings make mistakes and there really is no way around that.

On the other hand, everything possible needs to be done to try and prevent as many surgical mistakes as possible, no matter what kind of surgery is being done.
Excuses are not good enough, nor are they acceptable.

What is acceptable, is doing everything humanly possible to prevent as many surgical errors as humanly possible.

Every type of surgical procedure has its own set of risks and difficulties, so that in my opinion, there needs to be many areas to deal with in preventing surgical errors and each of them need to be tailored to the specific type of surgery as well as surgery in general.

When it comes to spinal surgery, like any other surgery, it has it's own unique set of problems and they need to be dealt with.
Working on bones that encase the nerves of the spinal cord is very complicated and those bones, as stated in the article, are only about an inch in size. Some may be a little larger and if you are unique in height as Marie and I are, under 5 feet or a child, then you are and can be dealing with vertebrae that are even smaller than that.

It is also true that various problems in the spine including osteoperosis can make even a simple xray more difficult to read as well as an MRI and visualizing the vertebrae when the spine is seen with an open incision in the OR.

Having said that, I don't believe that any of that is an excuse for a doctor to make an error in what vertebrae are or are not fused or anything else that is done on the vertebrae.
That is what I believe the New England Baptist Hospital was trying to use and say as the reason for their high botched error in spine surgeries and to me, personally, it is not an excuse.

On the other hand, I can understand how confusion and errors happen with complicated spines and spines that do not present as the typical normal. I have one of those myself.

Yup, I got one of those so called "complicated spines" that can have the vertebrae counted differently depending on who the radiologist is that reads the x-ray, CT or MRI or all 3.

I'm just lucky enough to have a spine surgeon that doesn't go with just the radiologist's reading, but rather actually reads the MRI himself. Most times he does agree with the radiologist and with 3 MRI's I had he agreed, but the last one I had prior to my last surgery, he did not agree. The radiologist didn't count the vertebrae the same way as the prior ones had done.
He immediately contacted the radiologist and they went over the MRI report again and the radiologist then agreed with my spine surgeon that he just counted differently and it was impossible for my L4/L5 vertebrae to be the problem.

To be specific, my S1 is fused to my sacrum. I was born that way and so are many people. It doesn't create any problem for anyone unless you are counting the vertebrae. If the radiologist starts to count in one way, he uses that fusion as the S1 as he should and then counts up and everything is in the right numbered order. If the radiologist ignores that fused area, then the L4/L5 is counted as S1 and the numbers are all off in the count.
That is what the last radiologist did with the last MRI I had done.
So his interpretation had my L3/L4 counted as L4/L5 and that is where all the problem was in my spine this time.

Now, in reality, my spine surgeon couldn't make the mistake of doing the wrong vertebrae for this reason. He already knew that he had done a laminotomy on one side of the L4/L5 vertebrae 2 years ago and it would be impossible to do a bilateral one on the same vertebrae and it was quite clear that it was the vertebrae above that he was going to work on.
That made the surgery easy, but this radiologist would be available for consultation in the OR if needed and he needed to make sure that they where counting things the same way.

BUT,, and here's where it get's sticky. The MRI report had already gone into the insurance company as L4/L5 and if either the doctor sent in to approve the surgery with L3/L4, it would have been denied and he would have to go through that stupid appeals process and it would delay my surgery by about 6 weeks.
I was getting worse by the day and he didn't want to do that. They had approved the surgery, so he went with the approval and knew what he was going to do in the OR. He also knew that when the bills went in for the surgery, he would be delayed in getting paid till the info was straightened out.
He just got paid this week, for surgery done on June 27th, because the numbering had to be straightened out on his end with the insurance company.

Now there is an example of complicated spines, in my case not a real serious one, but if I had not had surgery before, I could have ended up with surgery on the wrong level.

There are far worse spine complications to deal with and that means that there needs to be a real serious effort around the world to be very careful how vertebrae are counted. There should be an automatic standard and a check for a simple fused like I have and I'm told about 30-40% of the population have. That's a lot of people that have the same thing.

Everything should be all figured out as carefully as possible long before the patient is in the OR, not after the fact as it appears to have been done at the Baptist and I would assume, many other hospitals as well.

There should be state of the art x-ray machines in the OR set up for spine surgeries and they should be ones that are digital so that they are the clearest possible, not the old film versions.
And there should be radiologist available at all times for an immediate consultation during that surgery and before any work is done on any vertebrae.

That just astounds me, that a hospital that specializes in spine surgery didn't have that until after the fact.

Once the patient's spine is opened up, xrays should be taken to be sure that things match what the ones did that went into the OR with the doctor.
Yes they do go into the OR with the doctor, all the MRI, CT and any x-rays that where taken prior to the surgery and they are all lined up for the doctor to see before surgery actually starts and during the surgery as well as well as all the ones that are and should be taken during the surgery and before the incision is closed.

How do I know this? Because of what I saw with my own eyes before both of my spine surgeries.

In the OR, before the "lights out time", my surgeon was in the OR looking at all the films of my spine and there was a weird looking machine in the OR and someone I hadn't met yet.
Being the "queen of nosey" as my kids call me to this day, I asked the doctor what he was doing, what the machine was, and who was this new person and hadn't met yet doing in the OR with us.

My surgeon just said to the effect of, "I keep telling you I'm not perfect, but I try to be as close to perfect as I can be. I'm doing a last minute review of that nasty looking vertebrae I've got to fix. I have this thing about liking to be sure I'm dicing up the right vertebrae. that's an x-ray machine, one of those new digital ones, and this is Dr. ##. He's going to help me be sure I don't screw up, so if I do, it's all his fault not mine, and here's your favorite xray tech from the office. She's going to make you glow in the dark while she takes x-rays of that nasty vertebrae and spine of yours before I dice, during the dicing and after, and the doc and I are going to make sure I'm doing the right one. Now, can you please SHUT UP long enough for me to look at these pics please. Hey Joe, turn on the switch and shut up Mrs. nosey."

next thing I knew I was waking up in the recovery room and crying because all my pain was gone and I couldn't believe it.

That's the perfect set up to do everything humanly possible to not make a mistake in surgery. It won't guarantee it won't happen, but it sure will make it far more difficult. And by the way, this was not going on in a major Boston hospital or any huge well known big hospital, but rather in a small community hospital.
So obviously it can be done anywhere and should be.

Personally, I have to say that I never thought about the wrong vertebrae being operated on, fused or anything, until my first surgery and my doctor told me what he did in the OR.
but I sure didn't expect to read about it at one of the leading spine surgery hospitals in the country, let alone in my back yard.

As for Lahey Clinic, well their refusal to talk to reporters or anything doesn't surprise me. I wouldn't take my cat to Lahey Clinic for any orthopedic surgery or treatment before I read this article and I do consider spinal surgery as both orthopedic and neurosurgical.

An interesting side note to Lahey clinic and New England Baptist Hospital.
In terms of the top to hospitals with the most botched spinal surgeries.
All of the spinal surgeons at New England Baptist are orthopedic spinal surgeons. All of the spine surgeons and Lahey Clinic are neurosurgeons.
So we can't say that one kind is better than the other.
It still comes down to the skills of the surgeons and the hospitals that they do their surgeries in.

OK, I've talked enough here, time for someone else to speak up.

Fran

Fran,

Thanks for the great information and details from your experiences. Spinal surgery is quite an adventure! I think one of my biggest fears is coming out of the surgery worse off than what I am now. I don't really have any muscle restriction, but the nerve pain down the left leg can get pretty bad at times. I find that the nerve pain seems to be pretty draining on the entire body in terms of energy levels. Sometimes the day after I work out at the gym, my body feels like I've been run over by a truck!

I'm a big golfer and I can get through a round okay with some motrin, so my fear is coming out of surgery and never being able to play again!

But with the epidurals not working effectively any longer, I think the surgery is the best option I have. Just need to find the right surgeon.

Thanks for the referral with your surgeon. I'll schedule a consultation and keep everyone posted on how things go.

John, with my first surgery, I didn't think I had any muscle restriction either. Post op I felt pretty good and when I finally was able to start PT, 3 weeks post op I thought it was kind of a waste of my time and money, but, if the doctor said I needed to go, fine, he knew more than me.

Oh did I get a shock, when I went in for my PT evaluation. Everything seemed fine until the PT asked me to stand on my right leg only. That was the side that was affected. Oops, I almost fell over. Then I was asked to stand on my left leg and moe my right leg out to the side. Oops, leg didn't go very far and it felt like lead, dead weight and I was just bowled over with shock.

That's called muscle weakness and if it is not worked on post op, you will stay that way for ever. Last time I ever thought I didn't need PT when the doctor said I did, and the last time I ever questioned how great I felt.

My biggest fear was the post op and what would go wrong too, John. On the other hand, I couldn't go on the way I was either and I wanted my life back. My choices where living in hell with the pain or trying to get my life back to at least some level of normal.

I was a sudden onset of symptoms the beginning of Feb. 2006 and by June I could barely move. The ESI didn't help me at all and I had so little ability to move my right leg because of the pain, that PT wouldn't help either.

In the scheme of spinal surgeries, laminotomies are on the low level of severity and complications, but that is not to say that it isn't major spinal surgery and there are risks involved.

But in the end, I made the decision to get this over with and get moving on to the next chapter of my life without the pain or as little of it as possible. I decided to refuse to think about the negatives that could happen and only think about the positive.

Before I was wheeled into the the OR itself from the pre-OR room, I told my spine surgeon "to hurry up and get the show on the road, time's a wasting and I've got a lot of living to do without pain." He looked at me like I was nuts and said "you heard the lady, lets get a move on it, NOW."

Fran

Low back pain is a common musculoskeletal disorder causing back pain in the lumbar vertebrae. It can be either acute, subacute or chronic in its clinical presentation. Typically, the symptoms of low back pain do show significant improvement within two to three months from its onset.
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Valrossie,

I'm not sure what the purpose of your post is, but those of us who are and have posted on this thread are not suffering from a simple strained back that would be caused from simple over use or poor body mechanics. Nor will we show any kind of significant improvement within a short period of time.

If you had bothered to read any of the many, many posts over the 63 pages of this thread, you would have seen and read that we have been diagnosed with serious spinal disorders that require serious, big time medical and/or surgical treatment.

Posting what you did was an waste of our time to read, and is extremely misleading information.

I would advise anyone reading your post to fully ignore it and seek immediate medical attention for any kind of low back pain and not ignore it and wait a period of 1-3 months to see if it improves.
Delaying seeking medical attention and waiting can cause serious complications to spinal issues that should be addressed when they occur.

Fran