[karob401]

#11695

Johns Hopkins Neurosurgeon 2 – this is the director professor of students who initially, thought I’d want to perform my surgery responded to me today via email and in brief said the following:

1. Interbody
2. Back
3. Carbon fiber cage in the disk space and screws in the pedicles
4. Not from your hip. Synthetic.

Interesting to me the different approaches. Any thoughts as to which might be better in my case. The two primary issues I consider for such a (scary to me procedure) are:
1) recently previous smoking
2) auto-immune disorders – random, inconsistent. None the less still there.

Thanks,
KS

[Donald Corenman, MD, DC]

#11700

I am always a fan of the posterior approaches as they are less invasive. It really comes down to the skill of the surgeon. A bad posterior approach is not as good as a great anterior approach but all things being equal, I would want a posterior approach for my back.

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]

#11703

So, two different JH doctors (both neurosurgeons) who will go in through posterior but, their approaches for the fusion are different. Which one is “better” for me considering my history of the rehernations and background? Is the synthetic bone with a carbon cage better, due to my history of smoking or, is the using my own bone with cadaver bone and no cage the better route?

I’ll be curious to know what my original surgeon says as to his approach to fusion although, Iikely won’t go to him because of the 3 month wait on the smoking.
By the time I go in to John Hopkins for the surgery, it will be at least 6wks smoke free and I will not pick up the habit ever again.

All of this is so confusing. However, I’m glad that I’ve been taking the time to learn and understand exactly what’s entailed this time around. I didn’t do it the first two Micro-D’s and really want to be certain this fusion and the type of fusion is the right thing to do all things considered.
First, it was the fusion that scared me to death but, now the smoking complications have me wondering if a 3rd disectomy and waiting to see what happens is the best thing while smoke gets out of my system.

[Donald Corenman, MD, DC]

#11706

Well, one of your difficulties is that you only saw only neurosurgeons and not spine surgeons. Generally, neurosurgeons tend to think somewhat differently than spine surgeons.

Nonetheless, it has been demonstrated that your own bone works better than allograft bone. If the “cage” is really an allograft (designed as a spacer as a cage would be), then the surgeon who will use your own bone should have a better fusion rate. In either case, they both should be using pedicle screws and I would hope they would use the O Arm to insert these screws.

Again, a third microdiscectomy is something I would not consider as the reherniation rate is high and the root cannot tolerate further compression without injury.

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]

#11709

Spine surgeon? I feel somehow that I’ve approached this situation improperly. Do you mean an orthopedic surgeon or a spine surgeon, specifically? Initially, started this process 18 mo ago was referred to a neurosurgeon because of fragments that were sitting on my nerve and due to the continued nerve damage, I thought I was going the right route for a fusion. Both surgeons said the fusion will not make me pain free – in fact, the 1st surgeon said imphatically I won’t be pain free.

Looks like the first JH is planning for own and cadaver bone but no cage. (Unless requested).

I sent the 2nd doc info and he is talking about allograft for everything – bone & cage.

So, even with the smoking – sounds like 1st JH doc approach would be best and perhaps I should ask for the cage?

Do you think I should see another opinion from a “spine surgeon?”

Thank you,
KS

[Donald Corenman, MD, DC]

#11717

Neurosurgeons and spine surgeons generally do the same thing but come from different backgrounds. Spine surgeons originate from orthopedists who are speciality trained in spine surgery. Spine surgeons were the originators of stabilization surgery for scoliosis and trauma. Neurosurgeons originated tumor work in the brain and spinal cord.

Now, some individuals are interchangeable but there still can be real differences in the two specialities.

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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