karob401

“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

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.

Thank you for your response. I’ve been given so much conflicting advice that I certainly have a lot to think about and a difficult decision that needs to be made quickly.
I understand what you’ve said regarding the nerve root damage after a 3rd herniation and the risk for battered nerve root syndrome. This is my only concern that I have going in for a 3rd. I’ve had some nerve damage after the first discektomy so, this is an issue that weighs heavily on my mind. I’ve done a lot of reading and research on this specifically – especially on your website – which is wonderful! Thank you – it has been a great resource for me.

I’m still left wondering if a 3rd discektomy is worth just one more shot – with my 150% commitment of aftercare and rehabilitation, as well as the proper PT both pre & post surgery. I started PT again last week and changed my diet to one that will help with the pain and healing process, as well.

My biggest fear with the fusion is that it won’t work or, if it does, I’ll be headed down a road for more fusions in the near future, due to adjacent disc disease. (my S1 already showing slight bulge due to the L5/L4 weakness). Isn’t this also a high risk and consideration I should weigh against the risk of a 3rd discektomy and possible nerve damage?

When I ask the doctors on my “team” what they would do or recommend for their own wives, mothers, daughters – I get mixed reviews. I’m surprised when some say they would try the 3rd discektomy one more time and if they re-herniated would then, opt for the fusion.

What would you do, if it were you?

Thank you again for your thoughtful advice and great website forum. I’ll continue to keep reading.

Sincerely,
KS