When is spine surgery the answer?

[@number6photo]

I have severe hypertrophy / arthropathy in my L4-L5 facet joints, and some of that bony growth has trapped my S1 nerve at that location. Injections and PT haven’t helped over the 20 months that I’ve had the pain. I’ve had various doctors recommend various procedures. One surgeon recommended a laminectomy, and another suggested that, given I’m relatively young (59) and physically fit/active, that a laminectomy would lead to instability which in turn lead to one or more fusion surgeries down the road. He suggested a laminotomy to remove less bone - enough to decompress my nerve(s), but preserve as much bone and spinal stability as possible. The issue, he said, was finding a surgeon in the USA that would do the surgery that way. He said that nearly every surgeon over here would err on the side of a full laminectomy, taking away too much bone in general. So I was intrigued by the minimally invasive procedure you showed where it looked like a small hole is made and then small amounts of bone removed. Is there a specific name for that procedure, and do you know if it’s common outside the UK (I.e., in the USA)?

[@vincl7578]

I had nerve block injections which helped and then a rhizotomy was done which failed now my pain is back, doesnt shoot down the leg or anything like that. Whats next?

[@Alex-tg2uj]

Thanks doc, How about arachnoïditis ? I heard McGill say he can’t help those patients sometimes I have a few arachnoid cysts in the lumbar, surgeons I saw all said it’s constitutional but I’ve been experiencing ongoing flexion intolerance for 5 years despite consulting endless physios including McGill practitioners

[@joelangford7601]

No mention of surgery for scoliosis. I know four people who have had scoliosis surgery which they say has greatly improved their lives (all four say it "gave them their lives back."). Dr. Ghosh -- any comment or point of view? Thanks.

[@SpineMDT]

Thank you for your interest and well pointed out. I'm going to do a whole separate video on deformity. In my practice I am an adult only surgeon. So the only scoliosis I treat is secondary to worsening degenerative changes that lead to it and the reason I would operate is to untrap nerves as a result or treat any instability as mentioned in the video. Adolescent long segment scoliosis (that continues to adulthood) is a whole separate entity carried out by adult and paediatric spinal orthopaedic teams in subspecialty centres. And yes, I agree the results of surgery are usually really good. I hope this answers your question and thanks for your interest.

[@joelangford7601]

@@SpineMDT Thanks for your response.

[@danijelbratina]

I have a similar MR as the last one. No physiotherapy works. What kind od injections exist? My doctor wants to do an injrcion to confirm that spot causes pain, but shouldn't we be trying to reduce edemas somehow before surgery? What injections can help reduce it?

[@SpineMDT]

Thanks for your interest. That's a great question. The trouble is there is a presumed driver for that oedema - abnormal mechanical motion at the segment (so small that it is not detectable with dynamic x rays). So steroid injections won't eliminate it permanently but can give a diagnostic response. The trouble is there are many patients with similar scans who never experience back pain, that is why it is important to use as many tools in our diagnostic arsenal to be sure that that is indeed the source of the pain.

[@danijelbratina]

@@SpineMDT thank you for your fast reply. My pain has been there for 30 years... but when young it lasted for 2-3 days, now it is permanent.

[@TDubsKid]

Spine surgery was the right answer for me cause my T12 literally exploded

[@DamienMearns]

This patient had loss of function, but the ASMI fixed it: kzbin.info/www/bejne/qquqp6GtftCjb7c