Viewing 6 posts - 7 through 12 (of 30 total)
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  • karob401
    Member
    Post count: 13

    Thank you. This is very helpful. I’m continually surprised with the notion of – what I don’t know, I don’t know – and how important that what I don’t know, is so critically important to my immediate health and post-surgical success.

    Your advice regarding teaching university hospitals; in our community, Johns Hopkins is so highly regarded, I find that no one asks too many questions upon their initial treatment recommendation or, in some cases even they won’t bother with a 2nd opinion. Asking whether or not the fellows will be assisting during such an important and complex surgery seems so obvious, yet one that I’ve not come across to date. Wow!

    I agree with you that the benchmark questions are an excellent idea in order to narrow down and find a proper surgeon. Are there any others that come to mind which, you feel may be important and relevant (in addition to dural leaks) regarding a one-two level fusion – and/or even a 3rd Micro-D (yes, still having difficulty giving up this option but, I know I will have a fusion)? The answers from the surgeons are quite critical and may give me the peace of mind (and hand holding) needed to make my appointment.

    I have an additional question for you which, recently came to my attention. I’ve been a smoker for the past year – picked it up (after quitting 10 years ago), post my 2nd Micro-D…I think out of sheer boredom and then continued as my situation did not get better over time. I had no idea how (other than the obvious health concerns) I was affecting the healing of my back surgery. The surgeon who performed my initial Micro-D surgery never mentioned the risks – probably because, at that time, I was a non-smoker since college. When I revisited him a month ago regarding the new herniation, he noticed that I indicated that I was a current smoker and said he wouldn’t perform a fusion for 3 months post quit. He never mentioned that this included quit smoking aids, such as, patches, gum, etc. Immediately, I quit smoking cigarettes and started using a patch for help, just in case I opted for a fusion in the near future.

    The two JH surgeons said the following:
    JH surgeon 1: Director of Neurosurgery program – quit by day of surgery and don’t smoke thereafter. Schedule surgery asap.
    JH surgeon 2: Neurosurgeon & Professor Director – quit 3 months prior to fusion, including quit aids like patches, gums, etc. (this is the surgeon I’d planned to do my surgery).

    My current condition continues to worsen by the day to the point where current pain is allowing for 4-5 hours of sleep or less; nerve, NSAID and strong pain medications are barely working at all. I notice more limping and some possible urinary dysfunction (less time from needing to and getting to bathroom). I don’t know that I can wait an additional 3 months for a fusion surgery. Do the risks of fusion surgery being a smoker, outweigh the benefits of waiting to have surgery for 2 more months? I’m already afraid of having this surgery. I need to be 100% committed to knowing it will work so it does in fact work but, I don’t want to compromise having a fusion by having smoked/used nicotine quit aids too soon. The research I’ve done online points to waiting but, again…risks/benefits?

    One more question…in my reading I keep coming across statements with regard to fusion surgery as “elective surgery.” Does this mean what I think it does? If so, that widens my net of surgeons, since my insurance won’t extend outside of Maryland. Also, means I could take the trip to Colorado.

    Thank you again,
    KS.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You should stop smoking not only for the dreadful things it will do to you but for the obnoxious smell and tooth staining that many people find offense. One of the biggest problems is the cost.

    Do you know that you could take the money you spend on cigarettes, put it in a jar on your kitchen counter and every year take you and a friend for a two week all expenses paid vacation to Cabo San Lucas? I would find that incentive very enticing!

    In my opinion, you do need to quit smoking for 4-6 weeks to prove to yourself that you can quit. The use of BMP (bone morphogenic protein) in surgery will generally overcome the negative effects of smoking if you do fail in your quest to quit.

    Fusion surgery is generally elective surgery (there is no urgency) but there is a time penalty for waiting too long as a compressed nerve root can develop chronic injury if compressed too long.

    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.
    karob401
    Member
    Post count: 13

    Agreed. I’ve quit in the past and no doubt I’ll do it again. However, wanting to do so 6 weeks or more prior to surgery – so, they went into the garbage upon reading your response. Still, there’s conflicting advice on exactly how long to wait and I am concerned.
    I’ve seen 3 neurosurgeons for opinions and with each, emailed a set of questions today, including the bench-marks as you noted.
    Today, I heard back from the first Johns Hopkins surgeon who came very highly recommended but, every time I speak to him, I’m left with a sense of dread although he is very prompt and I like that he seems “hand on” (is this dread due to of all the disclaimers?) – says he will perform an interbody spinal fusion without the cage, with the use of my own and cadaver bone. He does this normally without the cage but, I can have one if I “want it.” Also, he says that he can use BMP if I “want it” and indicated that while there’s no specific findings, I should note that there is some cause to consider cancer correlation with use of BMP. He didn’t have much in the realm of stats, unless I specifically insisted he look them up in advance of surgery; off top of his head, he quoted that he performed around 150 per year (including revisions) and probably had somewhere around 5-10 dural tears.
    Still waiting to hear from the other surgeons.

    Sincerely,
    KS

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You could stop smoking right before surgery and that would not affect the outcome but in my experience, the stress of surgery can make you light up again. The 4-6 weeks abstaining is important to give you some “space” between quitting and surgery.

    I cannot comment on your “dread feelings”.

    Where does this surgeon get “your own bone”. Does he obtain a graft from the back of the pelvis or where else?

    If this surgeon does not normally use BMP, I would not ask him to use it. BMP requires specific handling and care must be given.

    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.
    karob401
    Member
    Post count: 13

    “My own bone” would come from my own hip. In addition to my own hip bone, cadaver bone will be used. However, no cage (unless specifically requested and/or insisted). He doesn’t normally use a cage, but will do so if I really want it. Guessing but, I assume he feels this is another source of potential infection or, simply isn’t necessary? He didn’t explain.

    BMP – I didn’t get the impression that he’s isn’t comfortable using BMP; just that it wasn’t in his standard protocol. He said if I wanted and felt more comfortable since being a “smoker” that I could have it. However, in discussing this with me, he indicated recent studies that were just starting to gain some momentum regarding BMP and cancer – though, he was very clear to tell
    me nothing was definitive enough to prevent him or should deter me from using, if desired – only significant enough to bring to my attention.
    Out of all the neurosurgeons I’ve seen for opinion, he’s the only one who told me I could freely smoke until the day of surgery. Then, nothing thereafter. All others have said to wait at least 3 months or more. I don’t have that long. In the past 2 months, I’ve gone from standing and lying down to lying down on a hardwood floor only.
    Smoking is very harmful to ones health, in any and every case – I get it and agree. I can quit. I just want to know how/if it will contribute to fusion healing and how long I should wait (if I can wait). I can only tolerate this fusion experience once – I don’t even want to do it now, so definitely don’t want to have to do it again! I quit smoking forever if it means my fusion has the best results short and long term.
    My back and the freedom to move as I wish, is the most important thing on my mind at the moment. Anything that I can do to promote this movement is to my benefit. I wish a 3rd discektomy wasn’t out of the picture. Given that it is, I need the most knowledge and fortitude to move forward with my current circumstances.
    Thank you,
    KS

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    The “cage” does not have to be used if an organic spacer is used (normally an allograft cortical ring).

    The BMP and cancer question is one that is being disputed now. There was one paper that noted with a very large dose of BMP (about 10 times the levels used now), there might have been an increase of cancer. However, there are some studies that demonstrate the cancer risk goes down with the use of BMP. I think that both findings are spurious.

    I have not seen any increase of rate of cancer in my patients and the generally consensus from other surgeons I have talked to and who use BMP is that these risks are not accurate.

    Smoking exposes the body to nicotine. This chemical retards the bone cells (osteoblasts) from migrating and laying down the bony proteins. Without the use of BMP, smoking will prevent fusion in an additional 30% of patients. Smoking is an evil toxin and you need to stop smoking regardless of whether you undergo a fusion or not.

    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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