Surgery BNH Cervical Spondylosis

[Green]

I saw Dr Wicharn yesterday at BNH about my CS, he looked at the MRI and said the problem was worst at C3-4. Also at C6. He didn't recommend surgery, but said it was up to me depending on my level of pain. He said 25% of people the vertebrae eventually fuses and corrects itself, the others continue to experience pain. I said it seems to make sense to do surgery sooner than later, the body would probably heal quicker at this age, and I might be able to enjoy more pain free years than what I have to deal with now 24/7. He agreed but said because at this stage he can only recommend a conservative treatment, the decision is up to the patient.

I am at a point where I would consider it. I did a new MRI of the whole spine with a detailed focus on the lower lumbar. (The nurses at Dr Wicharns office said and wrote down 15K, but when I went to the radiologist, she said it was 18k. A minor hiccup?).

I see Dr Wicharn again on Friday for the results. The 2nd major problem is the aggravated sciatica in the right leg, and pain in the right heal (feels like chronic plantar fasciitis) which tightens the ham string, very painful when massaged, and I unconsciously have been transferring weight to the ball of the foot which puts a great deal of stress on the knee which hurts, and up into the hip and lower right side of the back.

We discussed the possibility of a combination with fibromyalgia due to the wide spread systemic whole body chronic pain.

Will post more after Friday, but questions I have re surgery for the CS, is will it relieve most of the pain there and the radiation and numbness in the hands? Will the procedure lengthen the space between the vertebrae to a more normal extension, and will that allow for greater mobility?

I have never had surgery and feel quite nervous about that. What sort of costs are we looking at for a procedure like this? If I do go that route and the costs are exorbitant, I might return to Canada to have that done.

Comments from this thread were relevant here.

Edited February 26, 2014 by Green

[Sheryl]

Re the costs, probably in the range of 200,000 baht, give or take, but ask Dr. Wicharn. He also has privileges at Bkk Christian Hospital and having him do it there will reduce the costs a little (but not by all that much- maybe < 25K less).

The surgery will usually relieve the pain and numbness. It does not lengthen the space between the vertebra though, in fact usually the vertebra are fused so that 2 become one. This actually means a little less mobility but with only a single fusion most people do not notice the difference. It is possible to insert an artificial disk instead of fusing the vertebra (and Dr. W can do this) but it greatly adds to the cost as the devices are expensive, and is usually not worth it for a single fusion.

If Dr. Wicharn is suggesting conservative treatment at this point I would follow his advice -- conservative treatment is usually the first approach and then if it fails surgery can be considered. Both my sister and I have been patients of Dr,. Wicharn and I have also referred many other people there, in my experience when surgery is clearly indicated he does not hesitate to say so, so in your case there is obviously a possibility it can be avoided.

As for having the surgery now rather than later I don't think there would be enough of a delay to make you significantly older. A few months at most before conservative approach would be deemed not working (if in fact it does not work).

Another consideration is that the Canadian docs would likely not approve surgery right away without a trial of conservative treatment either.

[Green]

Thank you for that reply. I did inquire about obtaining records in the event I decided to return to Canada, and given the cost it would seem to make sense to have it done in Canada, where I could also have the option of an artificial disc at no additional cost (I am guessing at this point that that would even be possible). Perhaps there are other factors I am not seeing at the moment, but I am quite sure there will be issues with the lower lumbar, and some sort of work that will need to be done in the right leg - hip, knee, ankle.

While Dr. Wicharn did say he would continue with conservative at this stage, he also did say that surgery would most likely be required at some point, and did not object to the idea of doing it sometime soon. He said that we will see from the new MRI of the whole spine where to start and prioritize in order of seeming importance.

[Green]

S3-4 and S5-6 cervical spine, and from the new MRI a slipped disc at L5, spinal stenosis, he said its the cause of all the leg problems.

700-750 thousand baht was the quote the nurse gave me to put a new disk at S3 or S6. They are sending a quote for the L5.

That was a bit of a surprise, definitely am looking into options available in Canada.

Basically the verdict was if I want to be (virtually) pain free then surgery, if conservative he recommended traction, and maybe in 8-10 years I could reconsider surgery if it hasn't gotten worse before then.

I have been living with this for 15 years now, slowly burning itself out, the pain used to be worse, always moved around so thought it was something like fibro (it might also be present anyways), but I find that I'm slowing down, losing mobility, and my right leg is becoming more of a problem with spasm and knee popping out of joint if twisted the wrong way.

Edited February 28, 2014 by Green

[Sheryl]

The artificial disks ratchet up the cost enormously. If you just have a fusion (usual treatment), the cost would be considerably less. For a single fusion in the lumbar area, you really won't notice the difference in mobility. A double fusion in the neck, reduced mobility might be somewhat noticeable though I'm not sure it would matter enough to warrant the cost of the artificial disk. . (I assume you meant C3-4 and C5-6 not S as S would be the lower back).

[Green]

Yes c3-4 etc. in his report which the nurse showed me with the cost, he recommended L5 fusion and disc replacement for the neck. What about the risks? He said the procedure would take about an hour and just 2-3 days to book it, it sounded like it was a breeze operation, I'd be out and back to normal in a day or so? Thanks for that feedback,

[Sheryl]

For neck, usually 1 or 2 nights in hospital. You won't be completely back to normal immediately but the recovery isn't bad. You'll be up and walking the day after the surgery (maybe the same day if the surgery is in the morning).

For lumbar spine, I think 2-3 nights in hospital and a slightly longer recovery but again not bad. You'll be walking by the 2nd day post-op. First day may still have a catheter and be in bed as they need to let the pain and selling diminish a but before you put weight on it.

Any surgery under general anesthesia carries risks....more so if the patient is elderly, a smoker or heavy drinker and/or has any underlying chronic health problems.

With any surgery, there are also risks of infection and bleeding; infection risk is greater in diabetics.

In addition, surgery on the spinal cord carries a host of specific risks, worst case being paralysis but this would require significant error on the surgeon's part. Which is why this is not something to let just anyone do, need to be sure you are in the hands of a very experienced spinal surgeon. That said, the percentage of people suffering serious adverse effects is small, and relief of pain and numbness (in people with a clear indication for surgery) is almost immediate. The rate of neurological complications for this type of surgery is under 1% overall and with a really experienced surgeon would be lower still. But it is not zero.

My sister had both a cervical and lumbar fusion with Dr. Wicharn (at different times). As I recall the neck surgery was done in the evening, next day she was up and walking but needing some (strong) pain medication, day after she went home first thing feeling pretty OK. For the lumbar spine, 2 full days in hospital (plus maybe the evening before if the surgery was in the PM, I don't recall). First day was in bed, might have sat up and dangled a bit but basically in bed and getting serious pain meds, next day catheter out, got up, walked about but still a bit sore, day after that home.

She felt dramatically better as soon as she came out of the anesthesia in both cases i.e. the numbness/tingling was gone as well as the pain she had been experiencing although of course for the first 1-2 days there was significant soreness from the incision. After that much less, she was discharged with tylenol + codeine for pain but only ever needed paracetemol after the first 48 hours. But of course people do vary.

[Green]

That's very encouraging to hear, thanks for that. How has the it been in the long term, any more issues from the surgery or original disc problem?

[Pikiss]

I would like to thank Sheryl and others for sharing their experience and recommendation of Dr. Wicharn in BNH Hospital. My husband has suffered from lower back pain for a couple of years and the pain has been increasing significantly during the last six months.

He went the usual route: exercise, stretching and lots of sessions with a chiropractor and a physiotherapist with no improvement. Finally he had the lumbar MRI done back home in Europe and consulted a back specialist. The diagnosis was degeneration of L4/5 disc with a right-sided bulge. This doctor said there is no compression on nerve roots and he didn’t quite seem to understand why he is in such a pain and urged him to just keep on exercising more.

Back here in Thailand he made an appointment last week with a doctor at Bumrungrad Spine Institute. The (not so) good doctor glanced at the MRI pictures for a few seconds: no need for a surgery, just keep on exercising, the consultation was over and done with in 5 minutes.

Reading this thread he decided to give one more go and booked an appointment this week with dr. Wicharn at BNH. Dr. Wicharn’s way of doing things was completely different compared to two previous doctors. Before seeing my husband he took his time to go thru all the photos of the MRI and also wanted to take extensive x-rays to support his findings.

Thanks to Dr. Wicharn we now knows where he stands and can stop guessing. Dr. Wicharn could straight away point out that: 1) there is no infection in the spine area 2) there is a pinched nerve causing substantial pain 3) the disc degeneration is so far gone that he is not a candidate for an ADR, artificial disc replacement (which would have enabled to maintain natural movement in spine) 4) no amount of exercise will reverse nor better his condition (but is of course good for the overall well-being) 5) the discs will keep on deteriorating making the pain radiate to legs and he will eventually need a surgery. This surgery would be the "traditional" lumbar spinal fusion i.e. fusing together the vertebrae and using metallic screws to hold the spine still which sadly limits your back movement. The surgery takes 2 hours and 5 days at hospital. When the time comes my husband will undergo this surgery in home country where it is covered by national health care system.

[Sheryl]

Yes, he is excellent. (BTW I think I know whom you refer to at Bumrungrad and I had the exact same experience).

[bkkbudddy]

Green,

Make sure that the surgery is done in coordination between Orthopedic and Neurosurgeon! Don't let Orthopedic Surgeon perform the surgery by himself!

In fact, my first choice would be a Neurosurgeon, who had additional fellowship is spine surgery!

Edited July 11, 2014 by bkkbudddy