Microendoscopic Discectomy

[fyrekrig]

My wife is experiencing the typical symptoms of a herniated disk and I found out that there is a specialized

hospital in Bangkok called BNH Spine Centre for this kind of back problem.

Has anybody had any experience with this hospital?

What is estimated cost for Microendoscopic discectomy?

[Sheryl]

Some excellent doctors there, especially Dr. Wicharn. He operated on my sister and, if my own cervical spine issues don't resolve with conservative management, he'll operate on me as well. he is a US trained and US board certified specialist and holds a senior faculty position at a leading medical school; as such his services do not come cheap -- if surgery required, which it is not always with a herniated disk, will cost more with him than with most surgeons but well worth it IMO. If there is anything you don't want done on the cheap it is surgery on your spinal column. And getting the right advice/right surgeon up front can save you a small fortune in expense, pain and even disability down the line.

The fact that someone has pain and has a herniated disc does not necessarily mean the pain is being caused by the herniated disc (one reason why pain is sometimes not relieved by surgery). And if it is caused by a herniated disk, it may resolve spontaneously over time, with conservative management like anti-inflammatories and physical therapy aiding that process.

However sometimes as a result of degenerative disk disease there has been a formation of bone spurs which are impinging on a nerve, and/or the vertebrae have somewhat collapsed on each other narrowing the space through which major nerve roots exit and "pinching" them,. Unlike pain from an impinging disk, these sorts of problems will not resolve spontaneously.

So a thorough evaluation is needed to determine what is actually causing the pain and whether surgery is indicated. If it is indicated, the nature of what is involved will determine the best type of surgical approach.

Take all MRIs/CT films and Xrays and go see Dr Wicharn or, if unavailable, Dr. Eakpatipan at the same clinic has gotten favorable reviews from some members.

If he thinks surgery is indicated, he may suggest undergoing a nerve conduction test first to verify that what is thought to be causing the pain, actually is. Although it takes several hours and is costly, I recommend getting it if he does. It is a safeguard that can potentially avert undergoing costly surgery only to find the pain is still there.

I find that many people are resistent to getting "too many expensive tests". When surgery is being contemplated, the more information the surgeon has beforehand the better both to be able to advise if surgery is the best option and to plan the surgical approach. Surprises are not a good thing in the OR.

[fyrekrig]

Thanks for your extensive reply.

We are aware of the fact that surgery might not be neccessary and of course do all required tests before going any further.

Can you just give a ballpark figure of cost for tests and possible surgery.

[wpcoe]

I am currently am under Dr. Eakpatipan's care and give him very high marks. His English is flawless, has excellent bedside manner (and takes whatever time necessary to explain things), and is able to "think outside the box," which is a somewhat rare skill in Thailand, it seems.

I also give high marks to the Physiotherapy Department, which is adjacent to the Spine Center.

[Sheryl]

Thanks for your extensive reply.

We are aware of the fact that surgery might not be neccessary and of course do all required tests before going any further.

Can you just give a ballpark figure of cost for tests and possible surgery.

I can't begin to give you estimates for surgery without knowing what procedure. I suggest you leave that for later as you are some way from even knowing if surgery of any type is indicated let alone what the surgical options are. The exact same condition can have more than one surgical option, and there are different pros, cons and cost implications for each of them. Procedures involving implant of patented prosthetics/devices (for example, an artificial intervertebral disk) and less invasive procedures (endoscopic etc) always cost more than those without. The previously mentioned doctors are very good about explaining all this and you should be up front in letting them know that costs are a concern.

There are also variations in cost depending on where performed, with government hospitals being the least expensive and the private "international" hospitals the most. Surgeons often have privileges at more than one hospital.

For consultation, for the doctors mentioned here, cost will be around 1,000 baht exclusive of drugs and tests (do not buy drugs at hospital pharmacy, and be aware Thai doctors over over-prescribe as this is assumed to be what patients want). For tests, if done at BNH maybe 20,000 baht total for an Xray and MRI. You can get these tests done for less elsewhere so if money is a constraint, going to a less expensive hospital (mid-sized private hosp or one of the non-profits)for the initial tests and then taking the films with you to the BNH spine center can cut these cuts almost in half. That is actually what I did with my sister. It is worth paying extra for the expertise of top notch specialists in spinal problems but not IMO worth paying more just to have a test done in a place with a fancy lobby. Of course, this does mean more running about on your part, and some people prefer to get everything done under one roof for the convenience.

Since it sounds like you do not have insurance, another thing to consider is that once you go for consultation and undergo tests you will have created a paper trail for a pre-existing condition. Depending on what the symptoms are, can sometimes be not unreasonable to go straight to conservative management and wait it out to see if it improves. This is what I have been doing myself with what was probably a bulging disk in the cervical spine -- and (knock on wood!) after about 5 months of no treatment other than gentle exercise and time, it seems to be resolving. But do not take that chance if there are signs of nerve impairment such as loss of sensation or loss of function in a limb.