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Hello Doctor,
Hope you are dong well !!
First of all thanks for all the posts and the information that you have shared on the internet.
I want to discuss my brother’s case with you who is having D5/D5 disc herniation which is hampering his daily life to a great extent. Though he does not have any medical record before the accident but he used to have chest pain once in a while 2/3 years before the accident.
My brother (aged 36) reported problem in walking on 25/26 Aug’13 (2 weeks after he fall from his bike) which increases gradually and then he could not even walk up the stair (after about 2 weeks time) and reported numbness in the legs (L>R). After the MRI (done on 12 Sept’13) we got to know that he is suffering from the Spinal problem. His D5-6 Disc has displaced from its position causing severe cord compression and cord thinning.
We consulted couple of good local Doctors (which included both spine surgeons and neurosurgeons) and all of them have recommended immediate surgery to remove the compression except one experiences spine surgeon.
Its been 1.10 years now that he is suffering form this slip disc problem resulting in limited mobility.The problem started initially with the left leg but is now in both the legs and infact is occurring more in the right leg now.We had gone for the conservative approach on the recommendations of an good known experienced spine surgeon in our city.
Brief Patient History:
Age- 36 years, Job – Sitting, Past Medical history – No, Bladder – mild decrease, Bowl – mild decrease, Both Hands – Proper movement, Left Leg – Less movement, Right Leg – Improper coordination (Right>Left), Back Pain – No, Pain in Legs – No, Nerves Irritation – Right >Left, He never has or had any back pain.
Other Problem areas:-
– Improper coordination in walking.
– Hollow feeling in both the knees.
– Nerves Irritation in both the legs as if some water or blood is flowing down right from his buttocks to his toe. (R>L)
– Spinal StenosisStiffness and heaviness in both the legs.
Please advise if we had done the right thing by not going for the surgery till now or does this really need have a surgical intervention? Also, what are the risks involved if the patient has to undergo a spine surgery during operation and post operation and what are the chances of fully recovery? The doctor to whom he goes for regular checkup has recommended single level disectomy with fusion but I have heard of wooridul spine centre in south korea which specializes in thoracic spine surgery with percutanious thoracic endoscopic.
If we have to go for the surgery then should a neurosurgeon or a spine surgeon be a better choice in this case?
What should be the best approach for him – anterior or posterior if we go for the traditional surgery.
Please advise.
Thanks
AshishHaving a disc herniation causing spinal cord compression requires surgery much sooner than later. I would disagree with the spine expert that told you no surgery would be OK. This is the central nervous system and this system does not tolerate compression. It is my opinion that your brother needs surgery now. I am unclear how much recovery will take place but the best chance for recovery is surgery.
Percutaneous thoracic discectomy can be effective but is generally more technically challenging and more dangerous. A local discectomy and fusion is the typical procedure and has less “danger” although there still is some risk involved.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Okay, thanks for your prompt response and suggestion.
The thing is that at the time of injury he was not able to stand on his own and now he can walk some kilometers with some support in the form a stick. May be one of the possible reason is the reduced in swelling arond the injured area which has resulted in his apparent recovery. But now he has this problem of nerves irritation, feeling like water/blood flowing down to the legs and heaviness in the toe.
I have been to may surgeons and have boiled down to two or may be 3 who are best in the business.
1. An experienced aged spine surgeon in his mid 50’s who has adviced tradional open surgery from the back.
2. A young (in his intial 40’s) good surgeon who has adviced open surgery but from the front (anterior approach).Which type of surgery will give best results in this case? I know that to answer this questions requries verifying the MRI images and accessing the person clinically but would help if you can provide some inputs.
Most of the docotrs have said that his MRI findings and clinical condition doest not relate to each other, I mean the disc is quite large and compression is high but the power, flexes and other things while doing his physical examination are much better.
What are the chances of failed back surgery syndrome and how much time does it take in rehabilitaion to get back to normal life considering he ages 36 currently.
Just an FYI. Both the surgeons mentioned above are memmbers of the North American Spine Society.
Your brother will to continue have some deficits in spite of successful surgery at this late stage in the disorder. As far as the surgeons potentially involved, membership in the North American Spine Society is irrelevant.
Either approach can be effective but the anterior approach involves deflating the lung and the potential for chest irritability (intercostal neuralgia). The posterior approach (which I use) is somewhat less problematic in my opinion. I believe that this level needs to be fused to prevent future problems and a posterior approach is the best way to fuse this level.
Find out how may of these procedures each individual has experience with and talk to each about the potential for problems. The one who is more honest with potential problems post-operatively is the one I would choose. I tend not to like overly optimistic surgeons and like the “straight forward” ones. The one with the most experience (with good results) is also an important factor for decision.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Your brother will to continue have some deficits in spite of successful surgery at this late stage in the disorder. As far as the surgeons potentially involved, membership in the North American Spine Society is irrelevant.
Either approach can be effective but the anterior approach involves deflating the lung and the potential for chest irritability (intercostal neuralgia). The posterior approach (which I use) is somewhat less problematic in my opinion. I believe that this level needs to be fused to prevent future problems and a posterior approach is the best way to fuse this level.
Find out how may of these procedures each individual has experience with and talk to each about the potential for problems. The one who is more honest with potential problems post-operatively is the one I would choose. I tend not to like overly optimistic surgeons and like the “straight forward” ones. The one with the most experience (with good results) is also an important factor for decision.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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