Denervation...advice

[rohrer01]

My personal opinion is that if you just have the lumbar minimally invasive procedure done, it will put stress on the discs above/below the fusion making that area worse. I believe, and someone correct me if I'm wrong, that messing with short areas of the spine is usually contraindicated when scoliosis is present. Thus, your surgeon's advice to have the larger fusion. It will probably save you from having to have repeat surgeries. I really hope things work out for you.

[susancook]

Hi Susan,

I am so sorry to hear that your appt with Dr Sibell was so disappointing. I can't help wondering what changed that he had previously recommended the blocks followed by the denervation, then changed his stance on that. I thought they figured these things out from looking at MRI's, not from having you bend on physical exam. What do you make of that?

I had another opinion several years ago in Eugene from Dr Chris Noonan, who is a spine specialist but not a deformity specialist. He told me I could try some epidural steroid injections but he was doubtful they would help me for any period of time, I think because my spine was unstable and the pain was mostly due to mechanical slippage/instability. As I think I mentioned when we met, I did try two rounds of these injections, at a pain clinic in Eugene which did not impress me at all. I got no relief from these injections, and the second one made things temporarily worse. So perhaps the pain doc recognizes that your problems can't be helped by nerve ablation. I am guessing that you have a lot of these same problems.

Dr Hart will be happy to give you the names of several patients similar to you, so that you can speak to them by phone. I did this and found it very helpful before having surgery. If you call and ask for Robin she can help you with this.

I was offered gabapentin by my primary care doc at one point about two years before my surgery, but I am really sensitive to a lot of drugs, and the descriptions of it made me decide not to take it. I am really sorry that your prescriptions make you feel foggy but with unrelieved pain. That's a crappy combo.

Hang in there...

I didn't see your reply before now. I was so angry about not having the procedure that I didn't look at this blog. Well, the increased narcs and the additional Gabapentin was a disaster! I had double vision when driving home late at night [after the 4 PM dose, the second of the day], and almost ran off the road a few times. Sorry to say that happened a few times, so now I am back to my old regime of meds. Dr. Hart did offer me a hookup w/ prev patients then did not follow through, so I sent him an email on Friday to remind him.
Right now I am considering "minimally invasive" lumbar surgery for my sciatic pain. I asked Dr. Hart if he did the procedure and all he wants to do is the whole S curve, so a neurologist in Vancouver is looking at doing the procedure on my, I think L4. Sciatic pain is radiating around to the front of my thigh. Ugggggghhhhhh.
Susan

[susancook]

My personal opinion is that if you just have the lumbar minimally invasive procedure done, it will put stress on the discs above/below the fusion making that area worse. I believe, and someone correct me if I'm wrong, that messing with short areas of the spine is usually contraindicated when scoliosis is present. Thus, your surgeon's advice to have the larger fusion. It will probably save you from having to have repeat surgeries. I really hope things work out for you.

So confused. I need more information from the minimally invasive procedure MD on exactly what the surgery entails, and then go back to Dr. Hart, the "do the BIG surgery" [he will not be pleased with me, I am sure] and ask his opinion of how he think that the minimal procedure will affect my whole back. Your concept of the "deck of cards" makes sense. Just sounds so appealing to have a surgery that has a very minimal recovery for the area that is giving me [think it's L4] the most pain right now vs. a really BIG T3 to S1 fusion....I think I'll just run away......
Susan

[jrnyc]

suggest a consult with Dr Anand in LA...
he might do one online if you send him your X rays, etc
his receptionist offered that to me, but i flew out to see
him a few years ago instead...
he claimed all scoli fusion can be done with minimally invasive approach...
also, the danger of above and below the fusion having problems
later on is true regardless of the surgical approach used...
i need a full fusion, so that was not a concern for me...

jess

[rohrer01]

Susan,
Just an FYI. You only have 5 lumbar vertebrae. There is no L6, unless you are talking about S1. The sacrum is a fused mass of vertebrae and they use the term S1 for the top portion as far as I know. I hope you can get this worked out. It is frustrating when you don't know which option to take. But be glad you have options. I don't have any surgical options right now. I have to go with injections of different sorts. I would take Jess's advice and speak to Dr. Anand if that is possible for you. I believe, since he's worked with minimally invasive procedures and scoliosis for a long time, he'll give you the straight scoop on what "can" be done from his perspective. Then go back and discuss with Dr. Hart the options and see what his opinion is and if he thinks it will work. I wish you all the best.

[LindaRacine]

Susan,
Just an FYI. You only have 5 lumbar vertebrae. There is no L6, unless you are talking about S1. The sacrum is a fused mass of vertebrae and they use the term S1 for the top portion as far as I know. I hope you can get this worked out. It is frustrating when you don't know which option to take. But be glad you have options. I don't have any surgical options right now. I have to go with injections of different sorts. I would take Jess's advice and speak to Dr. Anand if that is possible for you. I believe, since he's worked with minimally invasive procedures and scoliosis for a long time, he'll give you the straight scoop on what "can" be done from his perspective. Then go back and discuss with Dr. Hart the options and see what his opinion is and if he thinks it will work. I wish you all the best.

Actually, some people have 7 lumbar vertebrae.

[Pooka1]

Actually, some people have 7 lumbar vertebrae.

Yeah Rohrer. I can't believe you didn't know that!! :-)

[susancook]

suggest a consult with Dr Anand in LA...
he might do one online if you send him your X rays, etc
his receptionist offered that to me, but i flew out to see
him a few years ago instead...
he claimed all scoli fusion can be done with minimally invasive approach...
also, the danger of above and below the fusion having problems
later on is true regardless of the surgical approach used...
i need a full fusion, so that was not a concern for me...

jess

Opinions, opinions....I asked Dr. Hart whether the minimally invasive appoach would work for me and he has said no twice. So, unsure who to believe. Some of the medical literature that I have read says that the jury is still out on the minimally invasive surgery....again, I just want to run away sometimes..... Thanks for the info though, Susan [and sorry about being so snappy on the other blog. I was trying to be funny and I realize that you don't know me, Sorry]

[susancook]

Susan,
Just an FYI. You only have 5 lumbar vertebrae. There is no L6, unless you are talking about S1. The sacrum is a fused mass of vertebrae and they use the term S1 for the top portion as far as I know. I hope you can get this worked out. It is frustrating when you don't know which option to take. But be glad you have options. I don't have any surgical options right now. I have to go with injections of different sorts. I would take Jess's advice and speak to Dr. Anand if that is possible for you. I believe, since he's worked with minimally invasive procedures and scoliosis for a long time, he'll give you the straight scoop on what "can" be done from his perspective. Then go back and discuss with Dr. Hart the options and see what his opinion is and if he thinks it will work. I wish you all the best.

Thanks Linda and Rohrer, my specialty is OB GYN. I was actually referring to L4, I talked w/ the Dr.'s PA today. The nerve from L4 is the one whose compression causes ant thigh pain. Thanks for keeping me straight!....hahahahaha.....that was a joke and I didn't even mean it! Susan

[loves to skate]

Susan, My Doctor told me that minimally invasive surgery would not have worked for me. I think a lot depends on how trapped the nerves are and mine were very trapped.
Sally

[jrnyc]

i think it is also partly how much
experience a surgeon has with the approach...
Dr Anand swore by it for all kinds of scoli...
the two patients i spoke to who had surgery with him
were pleased with the relief of nerve related pain they got...
both were women over age 58, both with total MI approach...
Dr Lonner offered me "partial" minimally invasive back and
side approaches and i have a great deal of nerve related
stuff going on, especially in lower spine...
i would at least seek one consult with a surgeon who
has done quite a few minimally invasive surgeries for lumbar scoli...
the more experience a surgeon has with an approach, the
better familiar he/she would be with who benefits from
what...
i do remember when MI for knees first started...and the
surgeons who didn't trust it in the beginning...
i personally had MI for ankle surgery...
someday i think lots of current surgeries will be MI approached...
i realize spinal surgery involves a lot more than an ankle....but i also
know i trust Dr Lonner and his opinions for good reason....

jess...& Sparky

[susancook]

Funny thing when I went back to the Pain Management MD. He had me do the movement maneuvers, "tell me where your pain is..", an exam and now he has me scheduled for L4,5 S1 medial branch block. Go figure! I have the same pain as before, only for some WONDERFUL reason instead of spine pain and R sided burning pain....I just have uncomfortable spine pain. Some days better than others....but it seems reasonable to try all options before THE SURGERY....which I am clearly trying to avoid!
Wish me luck on Friday....no sedation...maybe a silver bullet to chomp on? Who am I kidding? I'm on Medicare, no bullet for me!
Susan

[loves to skate]

Susan,
I think it is typical not to use sedation for most spine procedures, but I am sure they will use Novocaine on the area before they put the needle in. I will pray that this procedure will work for you.

Sally

[jrnyc]

never seen sedation used, as you said Sally....
doesn't matter the medical insurance....
doctors do not feel it is needed...
novocaine numbs the area....
most i ever felt was temporary stick from needles, and some pressure...
not intolerable pain....
IF an area is stenosed, then the pain seems to get worse, as the area i was
having injected was very narrow....but that was it...

jess

[susancook]

Thanks Jess and Sally. I am in such pain right now, that any relief would be welcomed. I didn't use my ice packs nor Lidocaine patches today and did LOTS of walking and I am paying for it.
I was just kidding about the silver bullet, but some sites said that they offer some sedation. Dr. S said that I would not have sedation, but yes, we do use lidocaine in Oregon.
Susan