Laser Spine Surgery

I guess I'm going to be a posting hog after all . . .

Here was DMB's message:

I sent a hard copy of the MRI report to LSI, an MRI disk to Bonati. Both institutes used this information to decide if I was a candidate for their surgery techniques . . . and I was cleared. I didn not have any xray film to send, nor did they want this. From what I understand, you can see slippage better on film? One of my doctors in TX said there was some instability . . . which everyone has a degree of . . . no one mentioned spondy and I didn't know of the term then. By researching, reading etc. I'm thinking it is one and the same, but I haven't seen a doctor other than my pain mgt. and he has only seen MRI info. Pls. help me understand, what I'm missing in asking my pain mgt. doctor. Thanks.
You've been a good source of info. for us! I think you are my back pain twin!!! Gotta go, keeping my fingers crossed this will go through . . .
C

Rich T:

Congratulations on not needing the surgery . . . now . . . you should cough up some of those retirement bucks, spluge and buy yourself a laptop, so you can enjoy your garden and keep us posted all at the same time!!!!

C

O.k. this is getting crazy . . . I'd much rather reply once and be done with it, but . . .

MJ57
I loved the Clark Gable picture!!!! too cute!

Don . . . hang in there . . . you're doing the right thing for yourself under your circumstances . . . that's all that counts.
C

Hello Carol,

Yes, I've had the same problem. AND I have not contacted the Admin. as I said I would to get this problem resolved. My apology to all. As a quick "fix", save your post to MS Word or Notebook before you try to send a lengthy post.

With my computer issues, I hope you and others will send an E-mail to the Admin. land kindly voice your frustrations with this issue.

Take care.

RichT

Hello Everyone,

Okay, what causes a situation where you need to have emergency surgery on your spine? I just want to get myself informed so that I understand (at least somewhat) the risks of delaying surgery.

Have a GREAT Weekend.

RichT

Hello Carol,

Carol, you are an important member of this family, so glad to see you are continuing to post.

Thanks for hanging in there regarding the frustration in posting on EHealth. I too take some time to write a post and then try and proof it.

RichT

Hello Carol.
So gald to see at least one post from you.
With Rich T's computer down and your difficulties with posting on this website, and now that Joebob is up, running and feeling good, I feel I am missing valuable contacts who were so very informative and helpful in the past.

RichT I do try to push these appointments closer together, but there is a cadre of office people to go through. I can't begin to tell of some of the scenarios that I have had to deal with. BTW, I too, have stenosis in the thoracic region and that's why I am so resistant to fusion. I don't want them to cause me more trouble in my thoracic region in the future.

As I have mentioned before, I live in the cornfields of Ohio, and civilization is an hour away no matter which direction I turn.

I still don't know if I am a candidate for minimal invasive spine surgery and I have not even brought up the subject of laser yet.
I would like to just to fax my info to Bonnati and get at least an honest answer about my being a candidate.
I'll worry about the money later.

The pain diary that I started as I tried to see what medicines and dosage would be helpful, reads like Day one....pain....Day two...pain....Day three...pain. etc. I don't think meds are going to work. I've been doing them already for a year and just trying different ones is beginning to look like a waste of money.

When I hear people, like Fran, who said she is glad she had the surgery done, makes me think I am just fooling myself to believe I'm not going to have to face the surgery. I'm getting that "Please take away the pain, look."
D.MarieB

First of all, I just sent an e-mail under technical problem about the difficulty we have been having posting and posting with lengthy posts. I hope something will be done to correct the problem very quickly. I had it yesterday trying to post 5 different times and finally just gave up till now.

Now, what I am going to do, is post several times, one right after the other about my spine problems, how it became emergency, when it began and some info on the laser guys in Florida as I did have contact with them as well and why I didn't use them.

First off, the question of what makes spinal surgery an emergency. From what I know, it is the loss or beginning to loose bowel and/or bladder control. If that begins to happen, from what my doc told me, the damage to the nerves involved become permenently damaged very quickly and there is very little time, about 48 hours to relieve the compressed nerves, before the damage won't reverse.
My doc told me that if any of that begann to happen, I was to call him immedietly any time of day or night, any day of the week. Well, about 9PM the night before my scheduled surgery, I started loosing bladder control out of no where. I called the doc and he said we had time as I was scheduled for surgery at 8:30Am the next morning. Had I not been scheduled till later in the day, he would have moved patients around to get me in the OR first thing in the morning.
By the next morning, when I arrived at the hospital at 7AM, less than 12 hours after I had noticed the urine dribbling from me, I had no bladder control at all and was all but soaking through 3 depends on at one time in a 30 minute drive to the hospital.
Upon waking in recovery, I found that I had full bladder control again and have never had a problem since.

Will continue in the next post

So to continue, my spinal problems first became apparent the first week in February 2006.
Prior to that, I had had various things going on since 1978, that may or may not have been started with an epidural while in labor with my son, who is 29 now. I was just shy of a month over 27 when my son was born and he was my first baby, though I had had 2 miscarriages prior to him.

Anyway, my spinal doc can't be sure if that attempted epidural had anything to do with the resulting lumbar spinal problems, but he could still see evidence of the disaster that occured when an incompetent resident attempted to do an epidural before my son was delivered my caesarean section.


essentially what the fool did was take that huge needle full of lidocaine to numb the area and smash it directly into my vertebrae and hit a nerve. Needless to say, I screamed like you wouldn't believe in agony and he pulled the needle out. that shot my blood pressure sky high and my son's heart rate dropped dramaticaly. I wouldn't allow him to try again and was told there was no one else. ya right folks in a major teaching hospital in boston at the time and no other doc to do one. Sure, the hospital that delivered more babies than any other at the time.

Then there was a problem with the baby's heart rate, and it was off to the OR and general anesthesia.

The vertebrae was severely bruised and I had spinal pain from that needle for a little over 2 years. and the bruise from it went all the way down from where the needle went in and covered over half my butt.

My doc thinks that it may have contributed to the spinal stenosis, but he can't be sure.

By the time the pain seemed to go a way, we where trying to have another baby, which took time and my daughter was born in 1983. During that pregnancy it seemed that the same kind of pain came back from the second trimester on and it never seemed to go away.

The pain would be worse some months than others and always worse when I had my period.
My gyn said it was because I had a tipped uterus and some months it tipped more than others and pressed on my spine. I also developed a fibroid and that supposedly made it worse. If I had a hysterectomy that would solve the problem, otherwise it would be fine after menepause.

Well who was I to think differently and that the doc was wrong.

Well, didn't have the hysterectomy and after memepause the pain and discomfort seemed to be all but gone for years.

Then for some reason, on occasion, I would feel that discomfort.

see you on the next post

OK, so the story continues.

Over the prior 5 years before I had any acute spinal stenosis symptoms I had some very vague, ortho type problems that kind of said, "well girl, the bod is getting older, you're in your early 50's. what do you expect."

Little things like, occassionally my right knee would hurt. Mind said, well you where warned that you would get osteo in that knee after breaking it a couple of times in high school when hit with a line drive of a soft ball while pitching a game.

Occassionally that pain would come back in my spine, just to the right of the vertebrae and occassionally I'd feel like my right leg seemed to feel heavy and I'd have a bit of difficulty lifting it up over a very high threshhold.

I let the arm go until April 2003, when it got so bad it was time for a trip to the PCP to find out what was wrong. DX tennis elbow, common from shoveling snow, but most common in tennis players. I needed to see an orthopedic doc and he sent me to one, but had to wait several weeks to get the apt.

My primary now wondered if there was more going on with me ortho wise and wondered about my spine, because this was not normal for me and if I wasn't standing correctly, then I could damage my arms, especially my right one because I am right handed.

I thought he was nuts, but darn, he was right and the ortho for my arm said we where both nuts. On the other hand the ortho doc is an incompetinet fool.

Will continue

I'd mention these things to my PCP and of course he never had the priveledge of seeing any problem as it was so infrequent. None of them interferred with my ability to function and do anything. I was still walking 4 miles a day 5 days a week, running around after kids on sports fields, coaching soccer, with practices every day and games every weekend, gardened for 6 hours at a time. So I never thought anything about it.

Then in the winter of 2002-2003, in February, we had a big snowstorm that left 3 feet of that real light powdery snow. Somewhere during the shoveling process and started having pain in my right arm. Figured, hey it's a lot of snow, what would one expect. first big snow storm and all.
and my back was sore, but so where all my muscles and everyone elses that where out there shoveling.

The arm got better, then of course it was the winter of never ending snow storms. So the arm got a break and it started to feel better, then presto, it was hurting all over again and so was my back. Neither of which was a normal thing for me to have after the first few times of shoveling.

Ok the rest of the post didn't make it onto the prior one so adding it here.

In april 2003, the arm got so bad it was time to see the PCP to find out what was wrong. DX: tennis elbow, common from shoveling and most common in tennis players, hence the name tennis elbow.

He was quite suprised to see this in me as it's not common for me to have this kind of problem and he wondered what was going on. Also wondered if there was "a spinal issue" going on. If I'm not standing correctly, then I would or could injure my arm like I did. So he sent me off to an ortho doc who happened to be the head of the hand and arm ortho part of a major hosp and a well renowned hosp in the are.

I thought he was nuts, but little did I know, my PCP was right. The ortho doc thought we where both nuts and the arm had nothing to do with any spine problems and the idea was crazy.

Well, the truth is they where related and the ortho doc not only is an fool but an incompetent doc who did more damage to my arm than one could believe and resulted in permenent loss of some function in both of my arms, needless surgery that made things worse, incorrect diagnosis and furthermore, missed a key problem as the real cause of why I developed the tennis elbow.

After he messed up my arm so badly and I had lost most of the use of my right arm and was loosing function and having pain in my left from over use, I got another opinion in Jan. 2004 and was correctly diagnosed with tennis elbow, not what the other doc said, "torn flexor pronator tendon" that need surgery to reattach."

It took me 2 years to regain most of the use of my right and left arm and a doc that wanted me to have my spine checked as well, just to be safe and it was the first Iheard of the possibility of spinal problems involved with this from anyone other than my PCP.
I was planning to make some arrangements to see the spinal doc in my ortho arm docs office, but hadn't gotten around to it when I was hit with the spinal problem

hopefully this all goes through

second time trying to post this part.

I never got the chance to make those arrangments as the spine decided to beat me to the punch.

The first week in Feb. 2006. I woke up and had trouble getting out of bed.
I had this terrible pain on the right side of my butt, just below my waist. It almost felt like a sore muscle and I figured it it's really time to replace that 20 year old mattress with a new one.
I had trouble moving, couldn't bend or reach even to pull my undewear up after using the toilet.
I hobbled downstairs and poured a cup of coffe and just sat down. After about 20 minutes I was fine for the rest of the day. this went on for 4 days and then it was gone.

The following monday the same thing happened only it was more pain and down my thigh. I put moist heat on it and it seemed OK. But on tuesday this had become full blown, burning nerve pain up and down my right leg into my foot, couldn't stand up straight and was in agony.

Called the PCP and of course he's away on vacation so saw one of his associates right away. he had spinal xrays done right there in the office and then told me that I needed to see a neurosurgeon as this was nerve involvement from something in the spine. The quickest appt. he could get me at that wonderful hosp was 8 weeks. He told them it was an ASAP appt and he finally got it down to 6 weeks. I wasn't waiting that long and told him I was going to call the ortho place that fixed up my arms. Took my xrays and went home to call.

They gave me an appt for Thursday of that week to see the spinal sports medicine orthopedic doc as Wed he was in the OR all day.

The covering doc for my PCP called on WEd morning to tell me when my appt was for neurosurgery, 6 weeks and 5 days from that day and that the radiology reading on my xrays was normal. Told him where i was going and he was pleased. My hubby picked up the copy ofthe radiology reading on his way home form work to take with us tho the ortho.

to be continued

OK, this is crazy, the 3rd time I'm typing this to post.

First let me describe this sports medicine orthopedic practice, because this, in my opinion, is the way all orthopedic practices should be run and be like.

The office is a one stop shopping for all orthopedic needs, regardless of how simple or complicated they are. Docs specialize in specific areas of orthopedics, but also work together. there is also a pain managment doc and an EMG doc that does all the nerve testing all in one office, which is huge. They also have specially trained sports medicine orthopedic PA's that work with them and are wonderful for support etc.

Unlike what I've read about LSI not being handicapped friendly, at least I think I read it was LSI, this place couldn't be anymore handicapped friendly if they tried.

You are asked when you make an apt. if you will need help getting from the car, need a wheel chair, etc. If you say yes, then someone from the office will be downstairs in the parking lot waiting to assist you. They have wheelchairs in the lobby, those doors that you push a button to open and a huge lobby with chairs etc to sit in.

When you get out of the elevator to the office itself, if they see you are having trouble walking, someone is right there to assist you.

They have their own xray facilities right there within the office and technitions that do the xrays and the docs read them themselves.

The docs own the bulding that the offices are in and have OR facilities on the first floor for less complicated and minor surgeries as well as have all the spinal epidurals done there as well. They can get surgery done more quickly this way with several surgical suites as well as spinal injections done more quickly.

On the basement floor is an MRI facility that rents the space. They are not owned by the docs. They have 5 state of the art MRI machines and always leave 2 available for emergencies. The ortho office usses them for their MRI's but any outside doc can use them as well.

There is also an PT, OT facility that rents space there as well and any docs can send their patients there.

The pain managment doc and the EMG doc all work together with the ortho docs.
How's that for service and speed in treatment? Works like a charm.

Hubby and I met with the doc, who only wanted the xrays not the report to look at. He looked at them with the 2 other spinal docs and then came in to examine me. He tried to be gentle but, believe me, it didn't work.

Then he told me that my xrays where not normal and showed spinal stenosis in the L4, L5, S1 vertebrae. He showed me what he meant on the xrays and what a normal one would look like. He told me that I needed to have an MRI done to determine the specific type of stenosis, what was involved and then we would talk treatment. He starts with conservative measures and then goes from there.

He arranged for me to have an immediate MRI downstairs and I was to return to the office to see him 1 hour after I had the MRI done.

Nice service and the doc sure seemed to know what he was talking about.

Back to the doc and he goes over the MRI pics with me and he has a huge book of MRI pics of every kind of spinal problem in them to compare to mine so we can see exactly what he is talking about.

The diagnosis is Lateral recess stenosis of the L4.L5.S1 vertebrae and he couldn't see anything else on the MRI of any problem. He told us that didn't mean that in the future there wouldn't be, just that at this time, this was the only thing going on. nothing else.

So he showed us what a normal MRI of the spine would look like compared to mine. The showed us pics of different types of spinal stenosis, and none of the matched my MRI pics. Then he showed the pic of lateral recess stenosis and that was a perfect match.

What he wanted to do was have me try the spinal injections and had the pain doc come in to meet with us. He explained all about them, what the risks are, and I told him about my disaster in labor. He told me no way does that happen with him and no excuse that it ever hapened to me. He actually apologized to me for it happeneing and he wasn't the one who did it.
He uses sedation and it's done downstairs in the surgical suites. I'm out cold and won't feel a thing, he uses floroscope to be sure it's going into the right place and hopefully it will help. nothing promised but got nothing to lose by trying.

Following Monday I have the first epidural injection. and it was great for 48 hours and then the pain returns. get 2 more and the second did nothing, the 3rd made everything worse.

In the mean time I was dying in pain. took over an hour to get out of bed with the help of my hubby as I'm screaming in pain. Pain meds wouldn't help as I'm so sensitive to them that all they would do is put me to sleep and I needed them to just be able to get out of bed. I couldn't be left alone while taking them as I get so dizzy and unsteady on my feet that someone has tohold me up to move, so I suffered in this agony from Feb till I had surgery in June.

OK, after the 3rd injection and it made things worse, I was ready for suicide as I couldn't live like this with the pain. The doc started me on neurontin to see if it would help the nerve pain and he told me the choice now was either live like this or surgery.

The one who told the doc, "no way in hell is anyone putting a knife to my back" is now ready for surgery.

The neurontin did help quite a bit. Hard to get used to and a very slow increase for me but it helped.

I met with the doc to discuss surgery. With me was hubby, and my best friend who is a nurse.

he told us all the info, spent almost 2 hours telling us everything and answering all the questions.
I was not a happy camper, let me tell you. He said not to local, no to endoscopic, but it was minimally invasive. I one inch incision and only a partial laminotomy.
He told us the facts about surgery. he could make no promises about anything, but he will decompres the nerves and that will stop the horrible pain I was having. The muscle pain would not be cured with surgery, it was from atrophy and lack of use. That should subside with physical therapy, but how much of it will come back only time will tell. He told us the risks and held nothing back. I would return to most of what I did before all this, but would have some limitations in terms of length of time I was able to do things etc. and it would be 10 weeks of PT starting 3 weeks after surgery and exercises for the rest of my life.
The he dropped, what hubby and friend called, "the bomb". The cause of my developing the tennis elbow was the spinal stenosis and the supposed pain from a tipped uterus that I had had for so many years was also the spinal stenosis. the pain local was not correct for a tipped uterus. and the heaviness and knee pain that I felt occassionally was not arthritis but rather spinal stenosis as well and the damn ortho doc that screwed up my arm should have known that right from the beginning.

Then he dropped an ever bigger bomb. Because, at this point in time, my surgery was not an emergency but what ins. calls elective, he required a second opinion before I went ahead with surgery. He wanted no doupts in my mind or hubby's or friend's that I wanted him to do the surgery and the way he did it. He also would not give me names of docs for a second opinion as that then interferes with the second opinion process. When I had had another opinion, please call him and if I want him to do the surgery, they will get me on the schedule ASAP. If the following occurs, then call ASAP, as that changes the picture and I need to have surgery right away and he told me about the bowel, bladder issues.
He gave me the MRIs to go with me for the other opinion/opinions and we where on our way.

Oh before we left, I did ask him about laser surgery, Bonati, LSI etc.

He really couldn't provide much information, even though he would like to.
The info is kept secret except for their web sites. It angered him as whe would like to know more info about it. If they really have a new and better way of doing spinal surgery and they don't let it get peer reviewed and provide the details to other docs, to him it was a crime and violated the hypocratic oath that specifically says "do no harm", because,by not providing this kind of info to other docs they are potentially doing harm to patients. he also told me that he and his 2 associates had had a couple of patients that had had laser at both places and several years after they had to redo some of the surgery and do more. he could not say that either place was at fault or not. He didn't have records and the places wouldn't provide the info. He also couldn't tell if this was a reoccurance of the original problems, wasn't done correctly, or just newly developed problems.
He also told us that he had tried several times to communicate directly with the docs at LSI and Bonati to find out more info and they would never talk with him or provide detailed info, just told him to read their websites.

That bothered us a great deal, that other docs would be treated this way.

Anyway, he was honest and did not dismiss them or think they where not good places, just gave us the honest info that he could. So it was off for another opinion.

Holy crap, what a chore that was and our heads where spinning faster than a little kids spinning top. To make matters worse the DX where never the same as the original and none of them where the same with each other.

Pick the prestigious hospital in Boston that exists and I was there for a another opinion, and did a couple outside of the boston area and I did send info to Bonati and LSI.

Other opinion DX

1. No spinal stenosis, but a herniated disc and 3 bulging discs. would want to do a 3 level fusion ASAP. from a neurosurgeon.

2. herniated disc and bulging disc. need open microdisectomy right away.
again from a neurosurgeon.

3. very mild central canal stenosis. would do more injections and wait till it got worse, bad enough that you need a wheelchair

4. nothing with the spine. you have a serioius circulation problem that needs ASAP treatment. from a apinal ortho doc

5. Bonati and LSI, both said the same thing. facet joints, stenosis in the L4.L5.S1, arthritis mild, and some bulging discs that need work. will require 2-3 surgeries.

My ins will not pay for anything at either place and the full charge of 30 grand was more than I could afford or borrow and we had no place to stay other than what they provide on a list to rent or pay for.
I was very concerned about any kind of complications as well and how much extra time we could end up staying.
I didn't like what my doctor had to say as to how he was treated as a professional, and I kept hearing that old "if it sounds to good to be true, it probably is."

Now mind you, when I went for all these other opinions I was seen in person except for bonati and LSI. I looked like I was recovering from a stroke. I could barely walk now, dragged my right leg as it wouldn't bend at the knee any longer and one of them was telling me to wait till I was in a wheelchair and the stenosis was worse.

So called my original spinal doc and first told him about the circulation bit. The doc said I barely had a pedal pulse in my right foot, but my friend checked it when the doc was done, and told him he was crazy the pulse was normal and identical to the left foot.

But now he said I had to have cirulation tests done to be safe first, but he didn't believe there was a problem with it all.

Of course those tests came back negative and I made arrangements to meet wit the doc to go over all these results.

One by one we went over them with my doc and his famous book. he showed us what MRI pics would look like for each thing that these other docs said was wrong and nothing matched my MRI, including what Bonati and LSI said.

it was OK doc, lets get this done cause I want to start living again. That was on a friday and my surgery was scheduled for the following Tuesday, June 13th, 2006

Ok will post the surgery and after tomorrow, my power is going to go in a thunderstorm anyminute. it's flickering now. hope this goies through before.

Fran

As I said before, my surgery essentially ended up an emergency because of the loss of bladder control.

Surgery was a success per the real definition of spinal surgery success. I do have my life back but as the doc said with some limitations and I keep having set backs that are not uncommon for spinal surgery.

Surgery was done under general anesthesia and took about 2 1/2 hours.

I had what was called a partial laminotomy of the L4,L5,S1 and a procedure that my doc is teaching along the east coast called an "outside in". Where he removes a bit of the lamina and then reaches in and does the shaving of the lateral recess of the vertebrae, where the nerves where being compressed. If he can release the nerves with full movement and no problems that is all that he does and there is no further bone removal done. It works in about 90% of the cases he does.
my incisision is exactly 1 inch and I had one suture on the outside.

What I didn't know about was how much bruising I would have after the surgery from those damn horse things they put you on to arch your spine for surgery. Anyway, I was bruised just below my breasts, and just above my waist in the front and my entire butt was black a blue for over a week. I also didn't know about the swelling in the butt. Even my underwear didn't fit and my daughter had to buy me a bunch 1 size larger than normal to wear for about a month.

In recovery, the first thing I noticed was all the pain gone in my leg, I could feel it again and at first thought I was paralyzed because i couldn't feel the pain. The doc thought that was funny and laughed at me cause he told me in 15 years he'd never had that happen.

So my next words where great, I'm going home tonight. We then argued that I was staying till the morning and I told him no way, home in my own bed tonight thank you. I did agree to follow the requirements to go home.

Bach in a room, I felt great, just tired and loopy from the pain meds in my IV. They kept checking the incision and with no nausea I could have water, then the blessed coffee. Then I could eat some solid food. I kept saying I wanted to go home, and the doc came in and said "shut up all ready, prove to me you are capable of going home first."

In came the PT and I was sitting up at the edge of the bed. Oops, dizzy a little. Then, like gravity working I had to go to the bathroom and I was in tears about it. I had to go and was holding my bladder, no urine pouring out on it's own. So she helped me to the bathrrom and I sat there for what seemed an hour going, and no pain, no help needed. first time in months.
Next I had to stand up and slowly walk up and down the hall. So out I went and I'm looking at my right leg and realizing that it works again. OMG, the leg bent at the knee and I walked like a normal person again, not like I had a stroke. so slowly, up and down the hall I went and they couldn't get me to stop. It was llike I was a kid again and it was "look at me mommy, I can walk all by myself." Then it was the PT stairs. Up and down I went, like I never had a problem.
So PT says, what did they need me for, she passed the test an hour ago, she can go home and called the doc. He didn't believe it and came up to see for himself. I'm still walking up and down the hall, up and down the stairs and wouldn't stop. Doc couldn't believe his eyes. He'd never had anyone ready to go home so quickly. Just looked at him and said "I told you so, I'm going home tonight".

So arrived at hospital at 7AM and was discharged at 6Pm the same night.

Not saying I didn't have any pain from the surgery, but compared to before surgery, the pain was nothing, a piece of cake. I did use some percocet but only for a couple of days.

Restrictions, where no bending, turning, twisting, stooping for 3 weeks, lots of short walking in the house for the first 24-36 hours and then at least 15 minutes of walking every 3-4 hours on very flat surface outside every day.

And was told by the doc. "enjoy the beginning of your new life without all the massive pain.

Fran