Lower Back Surgery/Herniated Disc

[gskimbrell]

I have been diagnosed (via MRI) with a herniated disc in my lower back.  I'm about two months into a conservative treatment program and there has been some improvement in my symptoms.  However, in the event the conservative treatment fails, I'm beginning to research options for surgically repairing my herniated lumbar disc, specifically with a microdiscectomy.   There are a few hospitals in Thailand that have "spine centers" that specialize in microdiscectomys...these hospitals appear to utilize the latest technology/equipmemt and the doctors are experienced in the current surgical techniques for performing back surgery.  However, not much information seems to be available, particularly regarding patient feedback.  The only recommendations I've seen are for a spine surgeon at BNH.  Does anyone have any first-hand experence and/or recommendations for a spine surgeon in Bangkok or Pattaya?   

[carlyai]

I have been diagnosed (via MRI) with a herniated disc in my lower back.  I'm about two months into a conservative treatment program and there has been some improvement in my symptoms.  However, in the event the conservative treatment fails, I'm beginning to research options for surgically repairing my herniated lumbar disc, specifically with a microdiscectomy.   There are a few hospitals in Thailand that have "spine centers" that specialize in microdiscectomys...these hospitals appear to utilize the latest technology/equipmemt and the doctors are experienced in the current surgical techniques for performing back surgery.  However, not much information seems to be available, particularly regarding patient feedback.  The only recommendations I've seen are for a spine surgeon at BNH.  Does anyone have any first-hand experence and/or recommendations for a spine surgeon in Bangkok or Pattaya?   

It's a difficult decision.

Wait for more months and try all the recommended exercises, massage, aquaaerobics, acupuncture, hot water bottles, lose weight, straighten out your posture, feet and walking styles aligned, tens machines, or computer guided spinal injections and medication.

There are an amazing number of things you can do without going for surgery.

Many people have herniated discs and still have a good quality of life.

I have had 4 major back operations, and while I have a pretty good quality, I think it really pays to try all the conservative treatments first.

Just a question, but have you tried a hot water bottle, massage, acupuncture, self hypnosis relaxation tapes, water exercises etc.

I know how much it hurts and how helpless you may feel, but if it's getting better and not causing other probs. give it a couple more months.

I know I had a bad experience with my first operation on a herniated disc, by the supposedly top surgeon, and they damaged my nerves and I couldn't walk or use my leg from foot drop. It did recover after several years....most people probably have good results, but try all the conservative things first. [emoji3]



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[1FinickyOne]

If you can avoid surgery - avoid it. The question to ask the doctors is what are the potential consequences if things do go wrong... you may not want to take the risks... good luck to you. 

[Sheryl]

My only direct  experience is with the doctor at BNH, and very favorable.

 

A key point to understand is that surgery is not indicated for a herniated disc per se. With time, the disc will retract, and if the pain was only due to pressure from the disk, it will resolve. Only in very rare cases where the disc is actually compressing the spinal cord would surgery be necessary solely because of a herniated disc.

 

Where surgery becomes necessary is when, as a result of degenerative changes to the discs  and/or  formation of bone spurs there is  insufficient room for the nerve root to exit the spinal column and bone is pressing on it.

 

The other point to be aware of is that the fact that you have back pain and the fact that there is a herniated disc does not necessarily mean that the pain is due to the disc. Herniated discs can be an incidental finding and many are asymptomatic....which is why people sometimes undergo surgery, the surgery itself is successful (repairs what it is meant to) but the pain persists.

 

If surgery is contemplated it should be because there is clear indication of bone impinging on nerve, and nerve conduction studies to confirm that the pain is coming from where suspected are a good idea.

[chiang mai]

I was three days away from the same operation in the UK when I went to see a trusted chiropractor friend, his words, "you can't unoperate" have stayed with me for the past thirty years and he successfully treated the problem, I'm glad I went the route that I did because people I've met since who've had a discetomy and from what I've read about it subsequently have shown it to have mixed and unreliable outcomes. My recommendation would be to examine all avenues of treatment before having the OP.

[thaisail]

I am also looking for a good surgeon but my insurance will only pay at Bangkok Hospital Bangkok or Bumrungrad Hospital. If there is anyone out there who has any experience with the spine surgeons at either of those two hospitals, I could really use some advice. The surgery needed is called Foraminotomy. I hope that Bangkok Hospital is equipped with the most modern equipment for this kind of surgery. There are perhaps 10 surgeons that practice at Bangkok Hospital and I just want to know which one is the best.

[Sheryl]

What you want is an ortho surgeon specifically specializing in spine inc. minimally invasive approaches and has completed a residency or fellowship in a western country, preferrably at a hospital with strong reputation for this.I cannot say from direct experience but based on qualifications and clinical sub-specialty these doctors look good:

 

Bumrungrad:

 

https://www.bumrungrad.com/doctors/Rattalerk-Arunakul

 

https://www.bumrungrad.com/doctors/Monchai-Ruangchainikom

 

https://www.bumrungrad.com/doctors/Tawechai-Tejapongvorachai

 

https://www.bumrungrad.com/doctors/Areesak-Chotivichit

 

Bangkok Hospital: Dr. Arreesak above is also at Bangkok Hosp

 

 

[thaisail]

20 hours ago, Sheryl said:

What you want is an ortho surgeon specifically specializing in spine inc. minimally invasive approaches and has completed a residency or fellowship in a western country, preferrably at a hospital with strong reputation for this.I cannot say from direct experience but based on qualifications and clinical sub-specialty these doctors look good:

 

Bumrungrad:

 

https://www.bumrungrad.com/doctors/Rattalerk-Arunakul

 

https://www.bumrungrad.com/doctors/Monchai-Ruangchainikom

 

https://www.bumrungrad.com/doctors/Tawechai-Tejapongvorachai

 

https://www.bumrungrad.com/doctors/Areesak-Chotivichit

 

Bangkok Hospital: Dr. Arreesak above is also at Bangkok Hosp

 

 

Can you tell me who is the best ortho surgeon for Foraminotomy in Bangkok including all hospitals like BNH? My injury is a result of work accident and I might be able to get my company to pay any hospital in Bangkok under these circumstances. My experience with Bumrungrad last year when I had my gall bladder removed is that the endoscopic equipment is only 2D where as the endoscopic cameras at Bangkok Hospital at that time were 3D of a newer design. I also like the fact that Bangkok hospital has only private rooms where as Bumrungrad has double occupancy which my insurance will force me to pay the difference. I have read in former posts from a few year ago that you highly recommended a doctor who works at BNH but I can't locate that post. I live in Phuket so it makes it hard to do all this in Bangkok but the Bangkok Hospital in Phuket is only recommending for emergency procedures as the much of their equipment is outdated though the doctors are excellent. I also found on the Bangkok Hospital website that Dr. Arresak is not listed any more. 

Edited October 12, 2016 by thaisail
Forgot to add something.

[thaisail]

If anyone in Phuket has had any good or bad experience using Bangkok Hospital or any other hospital in Phuket for lower back surgery, please let me know.

[Sheryl]

The doctor I recommended at BNH is Prof. Wicharn

 

It would be odd for an insurance company to cover Bangkok Hospital and Bumrungrad but not BNH. Owned by same parent company.

 

https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

 

thaisail: really do not recommend doing this in Phuket, period.

[smo]

Sorry I caught this thread only now, hopefully my reply could  still be of use to the OP:

Yes, I’m the man you were asking for.  In 2004 I had a lower-back (L4-L5)  microdiscectomy at Bumrungrad done by one of the doctors listed in one of the posts above. It’s been a positive experience for me, considering that I had no choice since my herniated disk had bursted. Still I waited too long, for the same reason everyone feared in going into a spinal surgery. 8 months of hell on earth, not being able to walk, living with constant physical pain and mental torment, for the most part because there was no one with this kind of knowledge/experience to give guidance. Except for one member of Thaivisa - though not our valuable SheryL here - who, solely through PMing during my darkest hours, patiently explained and nudged me towards seeing the light at the end of the tunnel. (To whom I am forever grateful.)

Long story short, yes, surgery is the last resort. I say it again, in my case it was the only viable outcome as I painfully and much belatedly found out, as the disk had bursted. The operation turned out to be quite routine (a quick one + a 3-night hospitalization) and if it is at the lower back, as mine was, the spinal cord does not go down that far (big caveat emptor here, might be total BS but this was what alleviated my fear going in) to be in the way of the knife. Last thing I knew was that the anesthetician (spelling?) telling me I will be out counting 1 to 5, and the next thing I woke up hearing the doctor telling me try to lift my affected leg. I did, and it was without pain. I was back among the living.

Regarding choosing the right doctor, I saw most of them. One of them, in hindsight I had to thank him for his leveling with me, “What are you looking for, you’ve seen most of the doctors here (in Bumrungrad) and you told me they all give you the same diagnosis so what do you expect from me?” By the time I was wheeled into the operating room this is my observation – again caveat emptor, it could be totally wrong. “My” doctor was there only to grace with his presence. The one who did the heavy lifting was probably the “house” specialist. Namely across the whole panel of specialists in the hospital, a few are singled out to be the “core” specialists. i.e. Dr. A is the one who does microdiskectomy, Dr. B is the one who does another specialty and so on. So no matter whom you choose, when it comes to this kind of operation, Dr. A is the man, whereas your doctor, the one that you have so carefully selected in to whose hands you put your life, will be there only to give you moral support and to introduce: “This is Dr. A, he will help me in your operation…”

End result has been good, except that by waiting 8 months, a great deal of my nerves had gone to sleep, permanently (i.e. died) But as a physical therapist told me post-op, they could have gone already at the onset, in day 1 or in month 1, or month 2, or finally in month 8. Nobody could tell. He propably said that for my sake, so I would stop kicking myself. I did and learned to live with a leg a bit dumber (and a bit number, and bit larger, because the muscles have to do extra work) than the other. But I'm back living life in full technicolor!

Final word, the operation – for the LOWER back - is nothing to fear (also doesn’t have to be at Bum or BNH – a mid size but competent and less commercial venue will do).

But consider it as the very last - the LASTEST - resort.

Wish you the best of luck  (and pluck).

Edited November 4, 2016 by smo

[thaisail]

Thank you SMO and Sheryl! I have been in contact with Prof. Wicharn and he has seen my MRI's from Bangkok Hospital (2016) and Bumrungrad (2010). He will not agree to perform the surgery without my traveling from Phuket to Bangkok first. I understand his position but it now my 4th trip to Bangkok to deal with this issue and I will wait until I have to go to Bangkok to make my final consultation with Prof. Wicharn.

 

After my original posting, I received the medical report from my specialist in San Francisco and he does not recommend surgery in my case. However, the decision is mine and I have read this entire thread about how surgery is absolutely the last resort. My spine is suffering from degeneration as well as the two herniated disks along with nerve root compression. I do have bone spurs that are also causing pain and it is not getting better. I want to let you know that after consulting with my insurance company, Companion Global from the US, that they agreed to include BNH in their list of covered hospitals. They still will not allow Bangkok Hospital in Phuket into their network and I agree totally about this because the hospital in Phuket is run by a very poor administrator and though the doctors are very talented the hospital is still very "third world". I am planning our next trip to Bangkok around New Years and will try to see Prof. Wicharn on the way to our rice farm in Loei and if he agrees to surgery, it may be scheduled for after New Years on our way back to Phuket. 

 

SMO, please can you give me the name of the doctors that performed your surgery? I just want to absolutely certain that I have the absolute best one for this surgery if I end up doing it. Right now I have the good fortune of finding excellent physical therapy in the new building at Mission Hospital in Phuket. They just received the new hot laser machine and it seems to help a lot. They have an excellent team of therapist and they do a much better job than Bangkok Hospital Phuket for half the price. 

 

Again I want to thank all of those who have posted in this thread and I will post one more time after the New Year with the final decision. 

[smo]

 

https://www.bumrungrad.com/doctors/Areesak-Chotivichit

"Dr. Arreesak above is also at Bangkok Hosp"

 

The reason I chose this doc was that he spoke good english and according to his hospital bio, had long + solid training in the US. The fact that he was quite senior bothered me a bit at first, but turned out to be an asset: meaning that he knew well his cadre of fellow doctors/surgeons and simply for his own reputation, would go after the best "helper."

The helper, in my case, turned out to be one of the couple of docs at Bum that I had not had consulted with. I can't remember the name, even though I could have remembered the face. I Just looked up his link, but Dr. Wicharn wasn't the one. Neither were the others in links posted by SheryL.

 

Wishing you the best of luck and please keep us posted.

 

Edited December 13, 2016 by smo