3 Diff. Surgeon Opinions for Surgery

[rzbud]

Hi All,
I have sent some private notes in the past. I have seen all 3 doctors - one in Temecula wanting to fuse between C4-5-6 and T10 to Sacrum, but had stated he would need to fuse all to give it stability. I have seen Dr. Pashman/Cedar who states he would do C4-5-6 and T10-S1. He would do procedure, neck first awg. 3 mths, then S1 from anterior then await 3 days and do balance posterior. Dr. Pashman says my posture is so good and balance that he doesn't feel a need to do entire back. Then this week I saw Dr. Bhatia out of UCI. He states that he would not do any neck surgery until the signs of the cervical appear such as numbing, tingling etc. It will not make things any worse waiting. He would do T11 to L5 posterior. No sacrum since he felt and you could see on the xray my disc was in good shape there. Why do 2 doctors want to include the sacrum and one does not? Might it be to avoid me having to come back in case of a stability issue?
How do I go about determining this? I met a patient of Dr. Abshire in Temecula who had a fantastic experience of total fusing T1-S1 at 58 yrs. old.
He is a nuerosurgeon specializes in Spine/scoliosis surgery and the other 2 doctors are orthopedic spine surgeons. Wondering?
Rzbud
54 yrs. old

[loves to skate]

Hi Rzbud,
It certainly would make it easier if all three Doctors would agree, but that is why you need more than one opinion. It sounds like Dr. Bhatia takes the more conservative approach. I wouldn't let anyone touch my cervical vertebrae until, as he says, you have numbness and tingling. Physical therapy really works if you have issues with your neck. I had numbness and tingling ten years ago and was referred for PT. It took six months of faithfully (as in twice a day) doing the exercises for the neurological symptoms to go away. I still do them although not as faithfully, but seemingly able to maintain things. Are the discs in your neck in good shape or are they totally degenerated? For my lumbar scoliosis, my discs were badly degenerated so that is why I was fused to the sacrum. Others on this forum have been fused to L5 because the disc at L5-S1 was still in good shape. Hopefully they will chime in to help you with that decision.

Good luck in your decision. It is a very difficult one to make.

Sally

[LindaRacine]

Hi All,
I have sent some private notes in the past. I have seen all 3 doctors - one in Temecula wanting to fuse between C4-5-6 and T10 to Sacrum, but had stated he would need to fuse all to give it stability. I have seen Dr. Pashman/Cedar who states he would do C4-5-6 and T10-S1. He would do procedure, neck first awg. 3 mths, then S1 from anterior then await 3 days and do balance posterior. Dr. Pashman says my posture is so good and balance that he doesn't feel a need to do entire back. Then this week I saw Dr. Bhatia out of UCI. He states that he would not do any neck surgery until the signs of the cervical appear such as numbing, tingling etc. It will not make things any worse waiting. He would do T11 to L5 posterior. No sacrum since he felt and you could see on the xray my disc was in good shape there. Why do 2 doctors want to include the sacrum and one does not? Might it be to avoid me having to come back in case of a stability issue?
How do I go about determining this? I met a patient of Dr. Abshire in Temecula who had a fantastic experience of total fusing T1-S1 at 58 yrs. old.
He is a nuerosurgeon specializes in Spine/scoliosis surgery and the other 2 doctors are orthopedic spine surgeons. Wondering?
Rzbud
54 yrs. old

Hi Rzbud...

There are so many issues. It's really difficult for a lay person to know what's right when plans from physicians don't agree. I usually tell patients to find a surgeon they feel they trust, and for whom they've checked on references, and trust that they're going to do the right thing.

With that said, there are some details that might (or might not) be important. First, I think that the top experts would tell you that when there's a question as to whether to fuse to L5 or S1, the deciding factor should be whether L5 is level. If it's not, I think there's a significant likelihood that you'll eventually have to be fused to S1 anyway. Then, as to whether to fuse your cervical spine, I think those same experts would try to determine if you have any significant neurologic issues. If you do, there's more reason to fuse now.

Good luck with your decision.

Regards,
Linda

[JenniferG]

Such a difficult decision, I don't envy you. There are many here more knowledgeable than me but I just wanted to say that I was fused T4-pelvis two months before my 58th birthday and it has gone fine. I left the decision to a surgeon who came very well recommended and I'm very happy with the result.

[rzbud]

Thank you all for your responses. I have cervical canal stenosis going on and it has moved from last years MRI. The last doctor says to await this surgery until symptoms appear, so I will. Dr. Bhatia is the doctor who performed surgery on a person in a car accident who was a friend of one of the baseball Angel pitchers who died most recently in this accident along w/a few others. This man was internally decapitated (skull from spine). I had a ref. on the doctor from a very good friend and then found out he also had performed this surgery, which says quite alot. I also have a friend who is a dietician in his hospital who says his record is extremely good.
I am anxious to get on with this since pain has increased a bit. I am going to see about surgery in Oct. due to the fact I want to try and enjoy the summer
while it is still here since I know recovery will take quite a while and I will be spending alot of the time indoors it sounds from reading others stories.
Rzbud

[scooter950]

hi RZbud, I am facing surgery- and struggling with my decision too: either T2 thru L-5 or all the way to the sacrum. I just want to have the surgery done right, the first time. I think I want an A-P approach, because I think that will help me avoid revision surgery for flatback syndrome. By doing the anterior approach, the surgeon will remove the discs and replace them with some material that is shaped to maintain the natural front-to-back curves in the lumbar area. then, he will do the posterior correction with instrumentation.
But I'm unsure about how far to take the fusion- if we fuse to L5 I will probably need another surgery in a few years when the L5- S1 disc gives out. Maybe not, but I want to limit myself to just ONE major spinal surgery, thank you very much! :-)

Anyway- I'm sharing your dilemma, it's so nice to be able to share our views on this forum! God bless you, and enjoy the summer! Jamie

[jrnyc]

considering

Hi Jamie
read your post with interest..i think i have opposite curves as you...upper is 40 degrees, lower is 61...i am still debating surgery...scared i would still have pain after the healing! they want to do T11-S1 & L4-sacrum..with "bilateral pelvic fixation"...surgeons tell me discs degenerated & arthritis, etc..& i wouldnt be stable without fixation...upper curve would be ignored, as i get relief with botox shots...most of pain is in lower area...severe pain..epidurals have not helped..nerve ablation & facet block injections help somewhat, but they are all temporary, as they treat the symptoms, not the real problem! & i hate all the pain meds they give me...too strong, make me dizzy, dont like spending half my life in bed!!

so, i dont know what i will do..wish you the best in making your decision...it is a hard one to make!!!

best of luck
jess