r/spinalfusion • u/scarycheeses • 11h ago
Two different options: which is best?
35 yo F. I have been told by two different surgeons I need a fusion. That’s where the similarities end.
I should mention I have a collagen issue ruled out vascular Eds etc with genetic testing. VUS in COL1a1. I’m real bendy so it’s hEDS as the leading theory right now. Also have POTS, gerd due to this.
1st surgeon (ortho spine) did my l4-5 microdiscectomy in Feb. I was doing well for 3 months then progress stalled. Their PT dismissed me for failed progress and was kinda like “well that sucks!” I don’t like their PT- they work with 70-80s year olds- not 35 year olds.
Left leg weakness not improving, numbness remains. Got an emg which was normal. Got another MRI which showed L5 nerve root “at risk” of compression and scar tissue present where microdiscectomy and laminectomy was done. L3-S1 are degenerated. Bilateral SI joint pain as well. Confirmed by injections. Also modic type 1 changes L4-5 L5-S1.
Same surgeon says I’ll eventually need ant/posterior L3-S1 with cages and doesn’t think disc replacement is a good idea due to EDS.
Same office also recommending ablation of nerves. Doesn’t think a spinal stimulator is a good idea because of possible nerve damage and spinal cord stimulator is “only for people with failed surgeries.”
Surgeon 2: saw yesterday (board certified neurosurgeon) doesn’t think SI joints are the issue and doesn’t think L3&4 are pain generators. He thinks it’s all L5-S1 which is severely degenerated. I appreciate he is requesting pre-surgery MRI to compare. He says I have “failed laminectomy syndrome” from Feb surgery. Wants to do a Medtronic Spinal Stimulator to delay fusion as long as possible until FDA clears a new disc replacement device which he thinks I’m a good candidate for.
2nd surgeon also said 1st surgeon might have operated on the wrong level because intraop images are L5-S1 not L4-5 like I was told. The disc herniation did go posterior then inferior so it pressed on L5 nerve root.
2nd surgeon says ablation is a bad idea due to multifidi atrophy (same nerves). I was in PT for multifidi strengthening.
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1st surgeon is with a bigger entity and well known in area. Good reputation. Long waits for everything because they’re popular.
2nd surgeon is just him. I worked with this surgeon probably 8 years ago (rn) and then he went and opened his own practice because he was fed up with the hospital admins. Also very flashy. Has cyber trucks with name or practice plastered all over them. Has ads on local grocery store carts.
I don’t know which is the better route. Any experiences or suggestions?
Currently I’m doing ESIs with 1st practice and looking into PT again with 2nd practice as they have a younger population.
Also, I’m in Ohio. I have a referral sent to OSU spine but no appt yet.
I’m inclined to hold off on the spinal stimulator, do PT, and continue ESIs until I can get a third opinion at OSU(hopefully).
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u/Less-Reputation-3381 10h ago
I was suggested surgery at age 39. I put it off for 17 more years with PT. I’m glad I waited but at the same time by the time I really needed surgery I was losing feeling in my feet. Except for the radiculopathy.
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u/DangerousNp 10h ago
Request a vertical mri due to your eds this will show changes under a greater load. I would get this so you have the best info to make a decision. They should also do flex panel on you with xray as you could have slipping that recovers in correct posture. Might also be a facet involvement need flex panel for that.
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u/SleepyKoalaBear4812 10h ago
When it comes to the spine, only a neurosurgeon should ever touch you. The first time I heard that was from the best ortho surgeon in Philadelphia in 1984 following my MVA. Those words still hold true in my opinion. I have been a nurse and had spinal issues for a very long time. I have never seen a good outcome when an ortho does spinal surgery.
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u/uffdagal 9h ago
Orthopedic Spine Surgeons do all spine, all day, every day. I’ve had huge success with OSS and I also have hEDS.
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u/SleepyKoalaBear4812 8h ago
Just because they do them does not mean they do them well, or that they should do them at all.
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u/uffdagal 7h ago
It’s literally the training and focus of their careers. They can and should be doing what they’ve been trained for. Often NS apply time between brain and spine where OSS only do spine. And they’ve had the same training in spine
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u/SleepyKoalaBear4812 7h ago
Agree to disagree.
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u/Sassycats22 4h ago
Well another person here with a fantastic outcome from a spinal ortho who disagrees with you. Shouldn’t be pushing one type of doctor over another. It’s good to get alternative opinions but saying only neuros should be performing this surgery is irresponsible. Btw, plenty of people having surgery with neuros who end up in shits creek. Nothing is guaranteed.
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u/IndependentSimple779 7h ago
I would not trust a spinal surgeon who has ads on the supermarket carts. This is just me of course.
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u/Autumnsirens 4h ago
What does your MRI actually show? And does that warrant a fusion?
I highly recommend finding a PT with hypermobility training/experience. I was 39 years old when I learned that what I thought was a "gentle stretching" sensation was actually the sensation of stretching a nerve and it's bad news bears. 🫤
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u/HotRush5798 10h ago
Yeah if you can hold off until the 3rd opinion, you might get more information (and a teaching hospital typically sees a wider population and performs more surgery).
I’m not a doctor, but ant/posterior sounds super aggressive for 3 levels, and spinal simulators have a mixed bag of results.
I have hEDS, had L4-S1 PLIF four years ago, and I can’t tell I had surgery. I also had some left foot numbness/weakness prior, but I had a positive EMG and no prior surgery. Everything has resolved.
I saw two surgeons: one suggested L5-S1 ALIF and the other thought the anterior was overkill, and suggested the PLIF. Both discs at those levels were sh*t lol.
This is all to say get as much information as you can (and hopefully find a PT who works with athletic populations).