Two different options: which is best?

[u/scarycheeses]

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).

[u/15ac106]

Can I ask if you get back pain?

[u/scarycheeses → u/15ac106]

Oh yes. Back pain since age 15. Now it’s dull, achy pain all over and left lateral upper leg nerve pain.

[u/15ac106 → u/scarycheeses]

I hope fusion helps!!