Laser Spine Surgery

Hello Algosdoc,

Thank you for your very thoughtful informative post. For once again sharing your wisdom with us.

It is good to know the downside of multiple surgeries. Your thoughts regarding the "placebo response" and its effect on "perceived results" is something we must all keep in mind. It is because of placebo effects that researchers must use double blind testing in their studies to determine whether a material actually does have a positive effect on the body. What our minds perceive (or want to believe) is not always reality.

"Surgery, whether laser or not, should be viewed as a last option." Thank you Algosdoc. Each time I hear those words from a medical professional I know I have made the right decision to not have back surgery until no other option is available. Even on a "bad weather" day like today when my back pain is worse those words keep me on the right path.

"One should never ever place all their faith in one surgeon" - YES!!!, and that is the reason I have sought out the medical opinions from six spinal surgeons. And I have an appointment for next Tuesday with a recommended neurologist. Each doctor adds to my understanding of the situation with my back and what to do or not do. There are differences of opinions of course, however they all contribute to a "clearer picture" for me. If I had gone with "blind faith" and had extensive back surgery last fall as my first spinal surgeon recommended I doubt that I would be looking forward to (or able to) planting four 6 ft trees. My pain management doc has been amazing in enabling me to do many of the things I could not do last spring.

Thanks again for your thoughts and wisdom.

RichT

Hello Jerseyboy,

Your sharing of your experiences at Bonati Institute have not given a "wrong impression", rather the details of your experiences help to add to the information in our mind's "database" so that we can make the best decision for ourselves.

The post by Algosdoc has verified your concerns of the multiple surgeries recommended by Bonati.

"At least I was able to walk away from Bonati. I gave it my best shot and I will keep looking for an answer to helping with this miserable pain." JB, I hold you in high regard. You did give it your best shot, and you (and your wife) were wise to walk away given the situation.

A question if I may - In the surgery recommended by Bonati was he planning on performing a "facet thermal ablation"? In other words to use the laser to "zap" the nerves which carry pain signals to the brain?

I hope and pray that in the days ahead you will find the RIGHT answer for your miserable pain.

Take care.

RichT

Hello Rich T.
To answer your question about my procedures at Bonati. No it was not going to be facet thermal ablation, I wish that it was , but I'm not that lucky. That procedure was explained to me when I was there, it really is one of the relatively simple procedures they due. They seem to be very successful at it. As I said in an earlier post I spoke to three people who had it done. Two or them showed me the scars, they were 1/2 ". One woman had three levels done, both sides, she was back to work in 3 days and felt great. What Dr. Bonati was going to due to me wasn't quite so simple. He was as he put it (clean out ) the stenosis on the left side starting with L2/L3 working down , L3/L4, L4/L5. He said he would due the right side in one year because the pain would be as bad as it is on the left now. This is another thing that bothers me, they can due both sides at the same time. Why not due both now ? No explanation. Maybe so I can pay for 3 more surgeries next year and be in pain in the meantime? Like I said before, I think it really bothered him that he was totally wrong with my pain location. I hope that I am totally wrong about this, but I can't seem to find another explanation. I hope this answers your original question. Sorry that I got so carried away.

Jerseyboy

Hello Jerseyboy,

Thanks for your answer to my question. To my knowledge you are the first one who posts here and has been to Bonati or LSI in which they did not have the thermal ablation done/recommended. I was beginning to think it was a "standard" procedure they did.

My view on "thermal ablation" or similar technique in which the nerve sending pain signals to the brain is severed - To me it would be THE LAST procedure option in the case where I had SEVERE PAIN and AFTER spinal surgery did not work OR IF spinal surgery was not an option. For me at least at this time I want those pain nerves intact so that those pain signals will be able to tell my brain that something is wrong and I need to see a doctor.

I know my PM doc told me that he does the procedure. I'm not sure if he does the procedure at the institute or as an outpatient in a hospital.

"Maybe so I can pay for 3 more surgeries next year and be in pain in the meantime?" Honestly JB, that is something I have suspected for some time - that in part at least it is a way to add to their coffers. Whether true or not I do not know.

"He said he would due the right side in one year because the pain would be as bad as it is on the left now."I n my opinion you don't plan for a second surgery for something that doesn't even bother you at this time. Doesn't add up to me. Algosdoc your thoughts.

May you find the spinal doctor who has the RIGHT answer for your pain, AND that you feel is the right doctor for you.

RichT

Rich, I was always uncertain of the procedure Facet Thermal Ablation as you well know because we have discussed it before.


My MRI had shown Facet degeneration L4 &L5 S1. There was also nerve impingement. My PM was convinced my pain was being caused by this Facet degeneration....hence the steroid injections. When I had no relief from these injections, I asked him about identifying the nerve and lasering it. He said that he would not do that because the nerve was too big to do any severing. Nothing more that he said to me made sense as to why he would not do the procedure. But now I am glad he took that position.

It was not until post op that I learned although I had Facet degeneration, my pain was from the buckled ligamentum flavum pushing on the cauda equina that was causing my severe pain. The buldging disc must have caused the ligamentum flavum to buckle but no confirmation on that. My surgeon, leaving the buldging disc alone, removed a large amount of l. f. did do all of the Laminectomies necessary, Foraminotomies around the L4 L5 & S1 and and the cleaning up of the Facet joints. I have to make the assumption that even though the nerves exiting the Facet areas were impinged, it was not necessary for them to be destroyed in anyway after the Foraminotomies and Facet areas were debreded because there was no longer any impingement. In fact the word debreded was not used in regard to the Facet areas. The word used in the surgical report was "decourtment". I looked everywhere and couldn't find that word to identify if it was the same as debredement.

I don't know how a doctor decides to go for Facet Thermal Ablation even if the MRI shows Nerve impingement. Now my question would be , why kill the nerve if all that would be needed is to make the opening around the nerve wider so it would no longer be impinged? In my readings, they tell you what Facet Thermal Ablation is and they describe the procedure but I haven't found the reasons for why choosing that method....maybe it is to avoid having spinal surgery. I think I would rather have the surgery rather then kill the nerve. I need that nerve for its proper functioning and signals to my brain. Besides, there are reports that those nerves can regenerate and you might be right back to where you started from.....pain.



I think Jerseyboy made a good decision waiting and continue his search.

Marie B.

Hello Marie,

Thanks for the info on your surgery/experience, and for your thoughts on thermal ablation.

Me thinks you and I are on the same wavelength.

RichT

Marie and Rich,

A comment on Thermal Ablation,

A while back, I discussed thermal ablation with both my spine surgeon and pain doc.
The subject came up in reference to possible use for some continuing discomfort and some degree of pain on my right side from arthritis in my spine.

The discussion was in depth and informative in that the use of this procedure has limited use within the spinal community and only used for possible treatment for chronic pain patients for temporary relief and is only 50% effective.

Temporary relief and only 50% effective where words that really brought out my questions. A ton of them to be honest.

What i was told is the following info.

Only the laser spine facilities use thermal ablation to treat everything to relieve pain.

It's accepted use and paid for by insurance co. is for chronic pain patients that have no other issues causing the pain other than arthritis type problems.

It's only real use and success rate is for the above reasons that insurance accept for payment, not because insurance will pay for it, but rather because it is the only useful purpose for the ablation.

You can't just automatically use it and get relief. The patient must undergo facet injections with lidocaine to the suspected facets that are causing pain.
The lidocaine is injected as if it where an ESI and done under florscope.
The patient must then record the relief of pain on the specific areas that where injected, in great detail on forms that are provided by the doctor, for up to a 10 hour period.
If the results meet the criteria for thermal ablation on any an all of the facets that where injected, then the possible thermal ablation may be done.

It has to be done with the patient awake so that the nerves that are causing the pain can be found. Therefore it can be very painful to have this procedure done.
Lidocaine is used to numb the area for the needle insertion, but does not numb or deaden the nerve area.

After both the lidocaine injections to the facets and after the nerve ablation itself, most patients suffer quite a bit of muscle spasms and pain and are provided with both muscle relaxers and narcotics for pain relief.

The nerves that are severed are minor nerves that do not have any direct control of any body function or movement. They are just the nerves that cause pain in the area. There is no need to worry about them being burned, lasered or whatever is used to do it.

The simple fact is that the nerves wiil regenerate, they will grow back and when they do, your pain will return. Sometimes it is not as bad as before and other times it can be worse than you had to start with.

How long the pain relief lasts, if you are one of the lucky 50% that it works for, is any doctors guess. Relief would usually start to be felt about 2 weeks after the procedure and can then last anywhere from 2 weeks to 18 months, with the average being 3-6 months. Meaning that this procedure could become a routine, several times a year being done.
On the other hand, if you are in the wrong 50% and get no relief, then it can be just a waste of time, waste of money and it could potentially increase your pain level as well.

When I asked my doctors why the laser facilities use it for all kinds of treatments, they really had no answers other than something to the affect that it sounds good, makes a patient think it works, and with the number of spinal injections they give with steroids in it, it makes the patient feel like what they where charged with really works. More like the placebo affect.
All they where sure of is that they are not using it for what is standard and accepted medical use.

Then I asked both doctors how often their patients elect to try the thermal ablation after being told all the information that I was told and the response was "about 50% and they have about a 50% success rate with that half."

In my opinion the odds didn't look good in my favor and I appreciated the honesty from both of my doctors, which I've always had.
I also appreciated and always do, the fact that they constantly provide me with all of my options, all of the available courses of action to treat any problem that I do have, which allows me to make informed decisions based on knowledge.
Fortunately, they are not doctors that play games with their patients.

Fran

That makes sense Fran. But are those minor nerves causing pain and considered for Thermal Ablation impinged?? When I look at the images of the facet joints and see impingement of nerves, it looks like anything exiting those outlets would be causing pain. It probably is amazing that a doctor can find a minor nerve that causes the pain even with flouroscopy. I just know the more I learned and the more I listened, my move to the surgeon seems to have worked for me.
I wish all doctors would take the time to give a lot of information for a patient to make an informed decision.

Marie B.

I have a family member beside me. He just said that a doctor could spend a very long time giving explanations to a patient but because of the pain and stress the person was under, the patient might not fully understand or grasp all that he is being told.

Maybe we should be advising everyone to take a second pair of ears with them when they go to the doctor.
With me, I needed charts, models, grafts and pictures. Fortunately, my doctor had it all available and my second pair of ears couldn't follow because he had no background in Anatomy let alone physiology. This is a tough study this body given us.

Marie B.

Marie, I'm sorry that I didn't make that clear in my post. I was trying to hurry, even with the long post as my internet connection today has been very sporadic because of the snow storm.

What my doctors told me is that any nerves that are impinged i.e. compressed, need to be decompressed and that any kind of ablation, regardless of how it is done will do nothing to help nerves that are being compressed. Any doctor that tells you differently is out right lying to you.

The success for facet nerve ablation rests with these minor nerves that conduct pain but are free from any pressure, just sort of there and not being very nice to the body.

That's a common thing to happen with arthritis in the spine. Remember when you have the major nerves coming out of the spinal column they branch into different major nerves in the limbs, going all the way down to the feet. If those nerves are severed you can end up with paralysis.

the nerves that are "burned, lasered, severed" or what ever they call it with the ablation and very minor nerves to body function, but major nerves in causing pain.

And they do grow back and grow back very quickly too.

I recall a post that Joebob made either here or on the other site or it could have been both. too many pages her to go back and check to see if it was here.

He said that the way bonati did facet nerve ablation was different than other places and it prevents the nerves from growing back ever.

That's a standard line from Bonati and it is impossible for the nerves to not regenerate and grow back no matter what Bonati says. All of these minor nerves that are burned grow back and there is nothing that can be done to permanently stop it.

As for finding the nerves with floroscope. the floroscope is used to be able to see where the needles are going and to see the nerves they are touching, but it's touching each individual nerve that tells the doctor if the right nerve is touched. If it is the right nerve, the patient is in pain, lots of pain. If it's the wrong nerve the patient just feels something being touched.

Doesn't sound pleasant to me, especially when the odds of getting pain relief this way are low and doesn't last long either.

Fran

Hello Fran and Marie,

Regarding "those minor nerves causing pain" - The nerves do not of themselves cause pain, but rather the nerves send signals to the brain that something isn't right, and that "something" that is not right is "registered" at a point in our bodies as pain. Such is my understanding.

The nerves that sense the pain in our bodies are not severed because they are causing the pain, but rather they are severed so the message of pain never gets to our brain. THAT is what is SOOOooo concerning to me about that procedure. I WANT to know when something is not right with my body. Sever those nerves and you will never know. You will never know until your whole backbone collapses.

Fran, did you have a recorder with you during your conversation with your two doctors or do you have a photographic mind? You are amazing.

Thanks so very much for the "reporting". I greatly appreciate all that you share with us.

Well Fran, seems like it is time for me to just move to where you live. I have not been to one doctor in my area who has listened and "heard" my questions and given explanations like you get with your doctors. Simply amazing. I truly envy you.

Or Marie, perhaps I need to move close to where the clinic is that you go to, as you also have a superb doctor.

Take care ladies.

RichT

i have read a few posts of yours, and i would like to know what kind of doctor you are, if you don't mind. i just have to say they can fix a person w/ a bad heart, broken bone, cancer and many other ailments, why can't they help someone that has chronic back pain, as my spouse has had for 7 years now. isn't there anything for people like him, besides pain meds that make them zombies or don't care to have a life anymore. because of the pain they are in all the time. what causes someone to have the pain that they do? i haven't found anyone to tell me that, and i find that amazing. with all the knowledge of the medical field, it seems like they could help people like that. my husband is a 140 lb. man and use to be very active, unitl one day his back started hurting and just progressively got worse. he has a mild disc bulge @ L4-L5 with mild bilateral facet arthropathy, and mild bilateral neural foraminal narrowing. @ L5-S1 a right paracentral disc protrusion extending into the right subarticular region. the right S1 nerve root is compressed and there is diminsihed filling of the right S1 nerve root sleeve of contrast. with mild bilateral facet arthropathy. could you tell me what you would think might help him, if anything. i would appreciate someone with the knowledge of the back to help me with some answers. thank you and god bless !!! mary

Obviously your husband must have a doctor. And he has had an MRI done. Has he had spinal surgery before?

Can you be more descriptive of the pain symptoms and where they are located? Does he get any relief by sitting, standing or walking. All of this type of information is required when a patient sees a spine specialist. It is doubtful that algosdoc can provide you with the answers that you are requesting because most doctors need to examine the patient as well as having multiple tests.

Where are you and your husband in regard to searching for a good spinal specialist?
Is your husband receiving no recommendations in what needs to be done to relieve his pains other then meds?

I know it must be terrible for you to see a loved one in pain and worse yet, to see the drugged person that meds can leave a formerly active person.

God Bless You in being such a loving care taker.

Marie B.

Well it's been just over six weeks since my laser surgery at MicroSpine and still 100% pain free! Hope all in here find the answers to their problems.

Scott

Glad to hear you are doing well Scot. If I remember correctly you had a problem with a herniation at the L4 L5 area and that was all you spoke about.

What exactly did they do to you during your surgery? I have read posters who have had herniated discs, experienced pain but with time the situation resolved itself with no surgery required.
Did they tell you what they did at micro spine?

Hope you remain pain free.

Marie B.

Hello Scott,

Wonderful news that you are still 100% pain free since your surgery at MicroSpine. You made my day with your uplifting update. You have given me cause to look into MicroSpine more than I have in the past.

I too "2nd" Marie's questions to you. We look forward to your reply.

Thanks so very much for sharing.

Have a GREAT Day!!!!

RichT

Hello Everyone,

During the past 18 months I have seen six spinal surgeons and one pain management doctor. None of the six spinal surgeons seemed to have time to answer questions or REALLY explain things to me. When the 10-15 minutes were up they were out the door. My PM doc has been great, though he too seemed a bit "rushed" to see the next patient.

A couple of weeks ago I was speaking with the young lady who cuts my hair. She had been in a very bad car accident and ended up with back issues. So back issues was the subject of conversation. During our conversation she meantioned that she is going to a GREAT neurologist.

To make a long story short, I had an appointment with her neurologist today. WOW was it ever worth the 25 minute drive. He asked questions to get a better understanding of my situation. We talked, he answered my questions, and did his exam to get an understanding of the condition of my nerves in my legs and arms, as well as checking out my back. I gave him the x-ray and MRI CDs I had. He said he would review the images on the CDs and then go over his "findings" with me in a future appointment.

I told him that I have learned what I must not do to minimize back pain, like not standing in one spot, or sitting in uncomfortable chairs, etc. After a bit of discussion he looked at me and said "You are your own very good doctor. You are listening to what your body is telling you.". I had to smile with that.

His "analysis" was - as long as I can function and do most of the things I want to then there is no need at this time to be concerned about surgery. I will see what he has to say at my next appointment with him after his review of the images on the CDs.

NOW THE SURPRISE!!! He ASKED if I had any questions several times. There was no feeling of being rushed. He told me that if I had any question in the future to call him. Not one of the six spinal surgeons ever asked if I had any questions. Not a one!!!!

What an amazing feeling to have FINALLY found a doctor who will take the time to listen to me and discuss my ole back and ASK if I have any questions. WOW!!!!!

A most uplifting experience. We are celebrating this evening with a gourmet "Martha Stewart" dinner my wife and daughter are preparing. I open the wine bottles. lol

RichT

I can't believe Rich that you kept that conversation with the hair stylist quiet for a "couple of weeks."

See, The good doctors are out there. They really are. Boy what a pain it is to have to constantly look for them. It would be nice if there was some halo around their heads so they could be instantly identified instead of going through appallingly long searches all the while having pain.

Marie B.

Hello Marie,

I especially liked "It would be nice if there was some halo around their heads so they could be instantly identified" AMEN!!!! Then the rest could work in areas more suited to their lesser talents.

I wish like H$ll that the medical schools would read our posts and come to realize how they have failed their medical students.

RichT