The Pro's and Cons of Spinal Surgery

[Mike Lister]

It's not been a good year, in November my thyroid started to take over my neck and had to be removed, taken outside and given a thrashing, now my lumbar is playing up, big time!  I'm just not keen on a second op, if it can be avoided but the hip and sciatica pain is intense at times.

 

L4/L5 is prolapsed and L5/S1 is suffering from spinal degeneration. The surgeon only wants to operate, perform a discectomy and join the two vertebrae with titanium screws. I last had a prolapse 40 years ago, in the same place and managed to overcome it with chiropractic, but that was then and back over there and this is here and now. I've tried physio, mostly hot packs, ultrasound, electrical stimulation and ice packs, sometimes there's a short term benefit, other times there's just pain. Back muscle strengthening exercises are helpful and ongoing. Meds such as Myonal, arcoxia, Myospa and Gaba100 help in combination therapy but can only be short term solutions because of the potential for liver and kidney damage.

 

One orthopaedic surgeon advised me to avoid all surgery if possible because outcomes are uncertain, even with microsurgery - if you do those two discs, in a years time you'll have to do the next one up, because the weight load shifts. Wonderful!

 

Any useful tips, tricks or pointers, from first hand experience? I need to be able to exercise because of my absent thyroid and for cardio, it's becoming important to avoid weight gain, my diet is already down to two leaves a day and blade of grass!

 

 

 

 

Edited December 25, 2023 by Mike Lister

[carlyai]

Sounds like you need the operation.

From a work accident I had L4/5 disc excision, then a year later L4/5 fusion. This was in my 50s.

In those days they went thru the back and now I have no muscles in my lumbar spine as a result of the 3 operations. Muscles slowely died.

I had another L2/3 fusion (mimimal invasive through the front) 3 years ago.

Also have major arthritis in the lumbar region.

I had a Spinal Chord Stimulator for 8 years that cut down the pain level and probably getting another one in February.

 

So in saying all that, I think that these days they try not to take the laminar bone out during operations, to minimise adjacant spinal levels failing.

For me it's been about 30 years of reasonable good health, that I would not have had had it not been for the operations, so I think if you are older you may die before the other spinal levels cause a big problem.

Sometimes it's better to have the operation rather to be in constant pain and stress.

I think you can take Celebtex (anti inflamatory) for a long time, but just need to make sure your stomach doesn't get too many ulcers.

My only advice is to find the best surgeon you can (if you decide to have the op).

@Sheryl seems to have a list of the best surgeons in Bangkok.

 

 

[Mike Lister]

6 minutes ago, carlyai said:

Sounds like you need the operation.

From a work accident I had L4/5 disc excision, then a year later L4/5 fusion. This was in my 50s.

In those days they went thru the back and now I have no muscles in my lumbar spine as a result of the 3 operations. Muscles slowely died.

I had another L2/3 fusion (mimimal invasive through the front) 3 years ago.

Also have major arthritis in the lumbar region.

I had a Spinal Chord Stimulator for 8 years that cut down the pain level and probably getting another one in February.

 

So in saying all that, I think that these days they try not to take the laminar bone out during operations, to minimise adjacant spinal levels failing.

For me it's been about 30 years of reasonable good health, that I would not have had had it not been for the operations, so I think if you are older you may die before the other spinal levels cause a big problem.

Sometimes it's better to have the operation rather to be in constant pain and stress.

I think you can take Celebtex (anti inflamatory) for a long time, but just need to make sure your stomach doesn't get too many ulcers.

My only advice is to find the best surgeon you can (if you decide to have the op).

@Sheryl seems to have a list of the best surgeons in Bangkok.

 

 

Celebtex is a COX2 inhibitor which are scary creatures, the one I was prescribed, Arcoxia, is heavily controlled in the UK because of the link to heart failure. 

[KhunLA]

@Mike Lister If you can't avoid surgery and or avoid what is aggravating it (for me, it was work), then I'd avoid the screw surgery and opt for fusion, as options available when  I was a bit younger.

 

I had 2 herniated dscs (T12/L5 & L5/4), repaired, no screws or fusion.   When asked why not fusion, told too young, and you'll lose a bit of bending mobility if done.  Avoid aggravating it, and you won't need to return for fusion in the future.

 

Well ... 5 yrs later, and the pain is back.  Not quite a bad.   But aside from aggravating those 2, all 5 Lumbar disc were/are degenerative.  Passed on surgery.   So I stopped working, and behave myself.  Literally avoid lifting or bending with or without extra weight on upper body.  My weight for height and mass is good.  At most, 5 kg overweight at times, at 175cm.

 

24 years on, and I feel fine.  Very wee bit of low impact aerobic exercise (walking, cycling), some floor stretching exercises, when needed.  Haven't needed a chiropractor for more than a few years.

Edited December 25, 2023 by KhunLA

[HighPriority]

All I know about my back is that when it’s strong it’s strong until it’s not…

I herniated S3 mid year but I think it was a relapse from 9 years ago, I’m back at 95% but as I’m still working I know it’s only a matter of time and I’ll reevaluate when it happens.

Im resistant to surgery but if experts think it’s the best option I’m not going to tell them their job.

[Mike Lister]

57 minutes ago, KhunLA said:

@Mike Lister If you can't avoid surgery and or avoid what is aggravating it (for me, it was work), then I'd avoid the screw surgery and opt for fusion, as options available when  I was a bit younger.

 

I had 2 herniated dscs (T12/L5 & L5/4), repaired, no screws or fusion.   When asked why not fusion, told too young, and you'll lose a bit of bending mobility if done.  Avoid aggravating it, and you won't need to return for fusion in the future.

 

Well ... 5 yrs later, and the pain is back.  Not quite a bad.   But aside from aggravating those 2, all 5 Lumbar disc were/are degenerative.  Passed on surgery.   So I stopped working, and behave myself.  Literally avoid lifting or bending with or without extra weight on upper body.  My weight for height and mass is good.  At most, 5 kg overweight at times, at 175cm.

 

24 years on, and I feel fine.  Very wee bit of low impact aerobic exercise (walking, cycling), some floor stretching exercises, when needed.  Haven't needed a chiropractor for more than a few years.

Yes, I went 40 years following a prolapse and all was well, I was three days away from the OP when the chiro. fixed things. It can be done, I'm not going to \give into surgery yet because as my chro said, you can't unoperate if things don't go as planned.

[carlyai]

1 hour ago, Mike Lister said:

Celebtex is a COX2 inhibitor which are scary creatures, the one I was prescribed, Arcoxia, is heavily controlled in the UK because of the link to heart failure. 

Yes they are scary, like most drugs, but if it keeps you exercising and reduces the pain, It's a matter of what is best now.

[KhunLA]

20 minutes ago, Mike Lister said:

Yes, I went 40 years following a prolapse and all was well, I was three days away from the OP when the chiro. fixed things. It can be done, I'm not going to \give into surgery yet because as my chro said, you can't unoperate if things don't go as planned.

If you're not in almost constant pain with every movement, I'd pass on surgery also.   Before I had surgery, I couldn't even roll over in bed without pain.   Only regret is, I don't quit work right after surgery.

 

Next day, and I was up, walking around pain free.  Now simply some bending/mobility problem, nothing major.   Though sitting @ 90 degrees or less, doesn't work well.  Nor getting in and out of entry level sedans.   Can't go back after have even a small SUV.  

[dddave]

This is 2nd hand.  A friend with similar issues, paralyzing back spasms, sciatica and meralgia was being told by several orthopedic doctors that surgery was the only option. He kept digging and somehow found a Physical Therapist who was what one would call a minimalist.  She worked with him on a variety of exercises: strength, flexibility, motion, resting.  Her focus was always finding the minimum  amount of exercise that provided relief. Everything was done slowly and easy and not getting aggressive about the number of reps or testing the limits of motion.  She stressed allowing and encouraging long term healing of joints, bones, tendons, muscles. Not to aggravate then further but to just do the minimum to keep them flexible and maintain strength and motion. 

He said it was actually difficult to maintain such a minimalist program as it was in his nature to push himself but it seemed to work so he kept up with her and was amazed at how successfully it turned out.  His back spasms meralgia and sciatica attacks went away and have never come back. He was able to totally avoid surgery.   This was nearly 10 years ago and AFAIK, he's still doing well. 

I guess this kind of follows the "less is more" school of medicine but worth thinking about.

[treetops]

I had a partial discectomy on L4/5 I think it was about 20 years ago after the periods of excruciating pain started to get more frequent.  Physio had been helping but eventually an op was recommended.  Following the op the surgeon said it would never have got better on it's own as fragments of the disc "stuffing" had seperated from the rest and wouldn't recede as the rest of the material did with the physio treatment.

 

Played rugby and skied since then so pleased I had it done, but a colleague who was in at the same time as me for his second operation (I don't know the exact details) never worked again.

 

Go with the expert advice is my opinion, but ask more than one expert.

[Mike Lister]

3 minutes ago, dddave said:

This is 2nd hand.  A friend with similar issues, paralyzing back spasms, sciatica and meralgia was being told by several orthopedic doctors that surgery was the only option. He kept digging and somehow found a Physical Therapist who was what one would call a minimalist.  She worked with him on a variety of exercises: strength, flexibility, motion, resting.  Her focus was always finding the minimum  amount of exercise that provided relief. Everything was done slowly and easy and not getting aggressive about the number of reps or testing the limits of motion.  She stressed allowing and encouraging long term healing of joints, bones, tendons, muscles. Not to aggravate then further but to just do the minimum to keep them flexible and maintain strength and motion. 

He said it was actually difficult to maintain such a minimalist program as it was in his nature to push himself but it seemed to work so he kept up with her and was amazed at how successfully it turned out.  His back spasms meralgia and sciatica attacks went away and have never come back. He was able to totally avoid surgery.   This was nearly 10 years ago and AFAIK, he's still doing well. 

I guess this kind of follows the "less is more" school of medicine but worth thinking about.

I'm 100% on board with that and always have been, the problem here is trying to find a physical therapist who knows understand the problem, understands human anatomy and understand an approach to resolving issues. Thus far I've found people who have two out of three, others know how to turn on the hot pad, operate an ultrasound machine or give really painful unnecessary massages. I had one physical therapist who kept asking me what I wanted, did I want heat, did I want massage, he just didn't get what he was there to do. I live in hope.

 

[Moonlover]

1 hour ago, dddave said:

This is 2nd hand.  A friend with similar issues, paralyzing back spasms, sciatica and meralgia was being told by several orthopedic doctors that surgery was the only option. He kept digging and somehow found a Physical Therapist who was what one would call a minimalist.  She worked with him on a variety of exercises: strength, flexibility, motion, resting.  Her focus was always finding the minimum  amount of exercise that provided relief. Everything was done slowly and easy and not getting aggressive about the number of reps or testing the limits of motion.  She stressed allowing and encouraging long term healing of joints, bones, tendons, muscles. Not to aggravate then further but to just do the minimum to keep them flexible and maintain strength and motion. 

He said it was actually difficult to maintain such a minimalist program as it was in his nature to push himself but it seemed to work so he kept up with her and was amazed at how successfully it turned out.  His back spasms meralgia and sciatica attacks went away and have never come back. He was able to totally avoid surgery.   This was nearly 10 years ago and AFAIK, he's still doing well. 

I guess this kind of follows the "less is more" school of medicine but worth thinking about.

I completely agree with this. I was in severe pain and for a while I could only go to the bathroom on all fours. My symptoms were much as you describe. I fixed my own back using the gentle exercise routine as prescribed by one Dr. Leon Root in his famous book 'Oh my Aching Back'. This was many years ago, back in the 1980s and the pain has never returned.

 

Dr. Root has passed away now but his legacy lives on in the updated version of the book, now called 'No More Aching Back' and it's available in hard cover or Kindle form from Amazon. I highly recommend it.

[Mike Lister]

9 minutes ago, Moonlover said:

I completely agree with this. I was in severe pain and for a while I could only go to the bathroom on all fours. My symptoms were much as you describe. I fixed my own back using the gentle exercise routine as prescribed by one Dr. Leon Root in his famous book 'Oh my Aching Back'. This was many years ago, back in the 1980s and the pain has never returned.

 

Dr. Root has passed away now but his legacy lives on in the updated version of the book, now called 'No More Aching Back' and it's available in hard cover or Kindle form from Amazon. I highly recommend it.

I just downloaded it, thanks!

[Moonlover]

4 minutes ago, Mike Lister said:

I just downloaded it, thanks!

You won't regret I'm sure. Take care.

[Lorry]

9 hours ago, Mike Lister said:

if you do those two discs, in a years time you'll have to do the next one up, because the weight load shifts.

Correct. Ok, it may be a couple of years. 

 

Surgery is necessary if you have a motor deficit. Even then,  you can (and should) try conservative treatment for 6-8 weeks  (some say 3 months).

Immediate surgery is necessary only if urinating or defecating are affected. 

 

Pain is not a reason for surgery. 

The long-term results of surgery (if only pain was the reason for surgery) after 6 months or after a year or two, are not any better than conservative treatment.

Conservative treatment requires a lot more work from the patient.

 

[carlyai]

5 hours ago, Lorry said:

Correct. Ok, it may be a couple of years. 

 

Surgery is necessary if you have a motor deficit. Even then,  you can (and should) try conservative treatment for 6-8 weeks  (some say 3 months).

Immediate surgery is necessary only if urinating or defecating are affected. 

 

Pain is not a reason for surgery. 

The long-term results of surgery (if only pain was the reason for surgery) after 6 months or after a year or two, are not any better than conservative treatment.

Conservative treatment requires a lot more work from the patient.

 

I disagree. Constant pain is a reason to have an operation (if all else has failed).

If you are in constant pain, it's very difficult to function. You lose motivation and under continuous stress, which is not good for your blood pressure or mental state.

[Mike Lister]

6 minutes ago, carlyai said:

I disagree. Constant pain is a reason to have an operation (if all else has failed).

If you are in constant pain, it's very difficult to function. You lose motivation and under continuous stress, which is not good for your blood pressure or mental state.

Sure, but pain is relative and different for each of us, we all have different thresholds and tolerances. I'm a bit of wimp when it comes to pain but I'd describe my sciatic pain as an 8 or 9 but at the level it's less than 1% of my day. 

 

 

[Moonlover]

1 hour ago, Mike Lister said:

Sure, but pain is relative and different for each of us, we all have different thresholds and tolerances. I'm a bit of wimp when it comes to pain but I'd describe my sciatic pain as an 8 or 9 but at the level it's less than 1% of my day. 

 

 

That's very much how I was regarding sciatic pain. I can recall starting the day walking much like gorilla, gradually straightening the back and the legs as the pain dissipated. Which raises an important point. Walking is our most basic and our most important exercise and conversely, sitting is our biggest enemy when it comes to backache.

 

Even at 77 years I still exercise daily including walking and I try and avoid sitting for too long at a stretch. It takes self discipline but it's worth it.

[Mike Lister]

2 minutes ago, Moonlover said:

That's very much how I was regarding sciatic pain. I can recall starting the day walking much like gorilla, gradually straightening the back and the legs as the pain dissipated. Which raises an important point. Walking is our most basic and our most important exercise and conversely, sitting is our biggest enemy when it comes to backache.

 

Even at 77 years I still exercise daily including walking and I try and avoid sitting for too long at a stretch. It takes self discipline but it's worth it.

I used to run 3kms each morning but when I reached 73 that changed to fast walking, my time on my fixed route is my measure of how well my body is holding up. Now that I can't do that it's depressing and my single most important goal at present is to get back on my circuit. Last week for the first time in four months I made it half way around the circuit but at a slow pace, fortunately the views en-route are very relaxing, it's a case of a little bit more every day.

 

The getting out of bed part is a real bummer, the transition from straight and prone to vertical is like sticking your fingers in a 1,000 KV plug socket, it's a sure way to wake up quickly though! :))

[Moonlover]

2 hours ago, Mike Lister said:

I used to run 3kms each morning but when I reached 73 that changed to fast walking, my time on my fixed route is my measure of how well my body is holding up. Now that I can't do that it's depressing and my single most important goal at present is to get back on my circuit. Last week for the first time in four months I made it half way around the circuit but at a slow pace, fortunately the views en-route are very relaxing, it's a case of a little bit more every day.

 

The getting out of bed part is a real bummer, the transition from straight and prone to vertical is like sticking your fingers in a 1,000 KV plug socket, it's a sure way to wake up quickly though! :))

What's important for you Mike to have some incentive. And you have one right here, getting back to doing your circuits. It's a long time ago now, but if I recall correctly, I'd say it took me about 4 to 6 weeks of daily exercises as prescribed by Dr. Root to get me 'match fit' again. Now apart from the occasional twinge, which we probably all get as we age, I don't have any serious problems. 

 

Although I don't do the 'Root exercises' anymore, I can still remember them and could take them up again if necessary. I even have a wall chart stored on my computer, should I need them.

 

Set yourself a target Mike. 'I will walk that circuit again'. Make that your mantra and go for it.

[Sheryl]

The surgery described is a lumbar fusion. It may be possible  to avoid this in favor of minimally invasive approaches like endoscopic decompression and/or discectomy but you would need to discuss that with a surgeon skilled in such techniques. I had endoscopic  lumbar decompression in 2021 and can attest to the fact that recovery is quite swift, as no muscles or tendons are cut through.

 

Do not have this surgery upcountry, full stop.

 

Spinal surgery is highly specialized. There are some international-caliber, up to date spinal surgeons in Thailand but just a handful and only in Bangkok.

 

The very, very best is Prof. Wicharn at BNH hospital

https://www.bnhhospital.com/search-doctor/entry/4093/

 

He operated on my sister twice (cervical then lumbar spine) and I have since referred a large number of people to him, all with excellent results. Even if you are still on the fence as to whether to have surgery, he would also be the one to ask and it is worth the trip just to discuss with him, his judgement is excellent and his answers clear and to the point. He will completely disregard the MRI report in favor of his own reading of the actual scan so be sure to have it (and any Xrays) on disc to bring with you.

 

Prolapsed discs will usually retract on their own eventually, and do not  necessarily need surgical intervention.  However  if your spinal degeneration has resulted in insufficient space for nerve roots to exit the spine, that will nto only not improve with conservative measures but likely get worse with time so IF that is the case surgery is advisable, but might  be possible using less invasive approach - that is a complex judgement call and I would totally trust Prof. Wicharn's judgement in that regard.

 

[Mike Lister]

1 hour ago, Sheryl said:

The surgery described is a lumbar fusion. It may be possible  to avoid this in favor of minimally invasive approaches like endoscopic decompression and/or discectomy but you would need to discuss that with a surgeon skilled in such techniques. I had endoscopic  lumbar decompression in 2021 and can attest to the fact that recovery is quite swift, as no muscles or tendons are cut through.

 

Do not have this surgery upcountry, full stop.

 

Spinal surgery is highly specialized. There are some international-caliber, up to date spinal surgeons in Thailand but just a handful and only in Bangkok.

 

The very, very best is Prof. Wicharn at BNH hospital

https://www.bnhhospital.com/search-doctor/entry/4093/

 

He operated on my sister twice (cervical then lumbar spine) and I have since referred a large number of people to him, all with excellent results. Even if you are still on the fence as to whether to have surgery, he would also be the one to ask and it is worth the trip just to discuss with him, his judgement is excellent and his answers clear and to the point. He will completely disregard the MRI report in favor of his own reading of the actual scan so be sure to have it (and any Xrays) on disc to bring with you.

 

Prolapsed discs will usually retract on their own eventually, and do not  necessarily need surgical intervention.  However  if your spinal degeneration has resulted in insufficient space for nerve roots to exit the spine, that will nto only not improve with conservative measures but likely get worse with time so IF that is the case surgery is advisable, but might  be possible using less invasive approach - that is a complex judgement call and I would totally trust Prof. Wicharn's judgement in that regard.

 

Thank you for this Sheryl.

 

I'm pretty sure that a majority of my pain is beginning to subside, I was told that a combination of meds and physio was the best approach and that it would take time. It will take even more time before I understand what the effects are of my spinal degeneration and whether that results in pain or not, in the meantime I'm doing back strengthening exercises and taking things very very carefully.

 

I consulted with a spinal surgeon when I was in Sriphat having my thyroid seen to, when I quizzed him on his experience he claimed to do 300 spinal micro surgeries per year at different hospitals, mainly Bangkok in CM. He was referred to me by Prof Donyerat so a reliable source of referral, his name is Dr. Suthipas Pongmanee

[Sheryl]

18 minutes ago, Mike Lister said:

I consulted with a spinal surgeon when I was in Sriphat having my thyroid seen to, when I quizzed him on his experience he claimed to do 300 spinal micro surgeries per year at different hospitals, mainly Bangkok in CM. He was referred to me by Prof Donyerat so a reliable source of referral, his name is Dr. Suthipas Pongmanee

Sending  you a PM