I went to another surgeon in South Denver today to get a second opinion. I liked this doctor much more than the first. He was more personable and professional, took his time to explain everything to me and my husband and did not rule out non-surgical options right away.
I still have another appointment set up but kind of feel it's not necessary anymore (nor do I have time to wait any longer). As I just implied the first surgeon I saw didn't take much time to explain or discuss my case, and didn't even consider non-surgical options.
So, surgeon #2 laid out the pros and cons of possible four options that my case would allow for - in his opinion.
(1) Epidural steroid injections
(2) Anterior cervical discectomy and fusion
(3) Anterior disc replacement
(4) Posterior cervical discectomy
We logically ruled out epidural steroid injections because of (a) failure of other conservative treatment including rest, meds (anti-inflammatories, steroids, narcotics for pain), physical therapy, dry needling, chiropractic manipulation, and (b) the location and size of the herniation.
Left with the remaining hree surgical options. But which one should I do? he compared my case to Peyton Manning and his fusion and showed me X-rays of successful fusions he did on athletes. Manning had (4) done but it didn't work out so (2) was his next step. While I was set on disc replacement over fusion after having done my own research - relying more on European studies than US-based research, I began to doubt this was really the right idea. Yet, I kind of excluded option (4)posterior cervical discectomy.
Nonetheless, this procedure actually shows high success rates, yet, it still may lead to one of the other options down the road (think Peyton Manning).
So should I go ahead and do (2) anterior cervical discectomy & fusion (Manning did this after (4) failed) or (3) anterior cervical instrumentation (aka replacement).
This surgeon worked with athletes, and said (2) was the standard procedure for elite athletes in high contact/impact sports. (3) However, lacks US-based research although it appears to be the preferred procedure in Europe and South America. and research has been promising.
Thinking it over and taking to my PT, reading yet a few more scholarly articles on the topic and some rational thinking made me second-guess going for a big surgery right away.
So, option (4) is what I decided and now the insurance approval battle has begun again.
Here are the titles and authors of some of he articles I've read and found helpful
In making my decision for the less invasive surgery:
(1) Early outcome of posterior cervical endoscopic discectomy: an alternative treatment choice for physically/socially active patients
by Kim, Chi Heon / Chung, Chun Kee / Kim, Hyun Jib / Jahng, Tae Ahn / Kim, Dong Gyu;
Journal of Korean Medical Science
(2) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. by Ruetten S, et al.
Spine (Phila Pa 1976). 2008 Apr 20;33(9):940-8. doi: 10.1097/BRS.0b013e31816c8b67
(3) Minimally invasive cervical microendoscopic foraminotomy; Initial clinical experience.
by Fessler RG, Khoo LT
Neurosurgery 51(Suppl 5):S37-S54, 2002.
(4) Advances in Spinal Stabilization.
by Haid RW Jr, Subach BR, Rodts GE Jr (eds):
Prog Neurol Surg. Basel, Karger, 2003, vol 16, pp 251-265
(5) This one is open access: http://www.karger.com/Article/FullText/351887?hl=1&q=Cervical%20posterior
Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients by Dohrmann G.J. · Hsieh J.C.
Section of Neurosurgery, University of Chicago Medical Center
(6) Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes
by Hsu, Wellington K. MD
Spine Issue: Volume 36(10), 01 May 2011, p 800–805
I still have another appointment set up but kind of feel it's not necessary anymore (nor do I have time to wait any longer). As I just implied the first surgeon I saw didn't take much time to explain or discuss my case, and didn't even consider non-surgical options.
So, surgeon #2 laid out the pros and cons of possible four options that my case would allow for - in his opinion.
(1) Epidural steroid injections
(2) Anterior cervical discectomy and fusion
(3) Anterior disc replacement
(4) Posterior cervical discectomy
We logically ruled out epidural steroid injections because of (a) failure of other conservative treatment including rest, meds (anti-inflammatories, steroids, narcotics for pain), physical therapy, dry needling, chiropractic manipulation, and (b) the location and size of the herniation.
Left with the remaining hree surgical options. But which one should I do? he compared my case to Peyton Manning and his fusion and showed me X-rays of successful fusions he did on athletes. Manning had (4) done but it didn't work out so (2) was his next step. While I was set on disc replacement over fusion after having done my own research - relying more on European studies than US-based research, I began to doubt this was really the right idea. Yet, I kind of excluded option (4)posterior cervical discectomy.
Nonetheless, this procedure actually shows high success rates, yet, it still may lead to one of the other options down the road (think Peyton Manning).
So should I go ahead and do (2) anterior cervical discectomy & fusion (Manning did this after (4) failed) or (3) anterior cervical instrumentation (aka replacement).
This surgeon worked with athletes, and said (2) was the standard procedure for elite athletes in high contact/impact sports. (3) However, lacks US-based research although it appears to be the preferred procedure in Europe and South America. and research has been promising.
Thinking it over and taking to my PT, reading yet a few more scholarly articles on the topic and some rational thinking made me second-guess going for a big surgery right away.
So, option (4) is what I decided and now the insurance approval battle has begun again.
Here are the titles and authors of some of he articles I've read and found helpful
In making my decision for the less invasive surgery:
(1) Early outcome of posterior cervical endoscopic discectomy: an alternative treatment choice for physically/socially active patients
by Kim, Chi Heon / Chung, Chun Kee / Kim, Hyun Jib / Jahng, Tae Ahn / Kim, Dong Gyu;
Journal of Korean Medical Science
(2) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. by Ruetten S, et al.
Spine (Phila Pa 1976). 2008 Apr 20;33(9):940-8. doi: 10.1097/BRS.0b013e31816c8b67
(3) Minimally invasive cervical microendoscopic foraminotomy; Initial clinical experience.
by Fessler RG, Khoo LT
Neurosurgery 51(Suppl 5):S37-S54, 2002.
(4) Advances in Spinal Stabilization.
by Haid RW Jr, Subach BR, Rodts GE Jr (eds):
Prog Neurol Surg. Basel, Karger, 2003, vol 16, pp 251-265
(5) This one is open access: http://www.karger.com/Article/FullText/351887?hl=1&q=Cervical%20posterior
Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients by Dohrmann G.J. · Hsieh J.C.
Section of Neurosurgery, University of Chicago Medical Center
(6) Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes
by Hsu, Wellington K. MD
Spine Issue: Volume 36(10), 01 May 2011, p 800–805
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