Still in Limbo

by Mary on October 16, 2016

I visited both my doctors for my back last week, and as I feared they disagreed about what I should do next. Dr. A. said we are “still in limbo” on deciding whether I should have surgery to decompress the spinal nerve that’s taking pressure from an extruded disc. He said I could wait and see if I get further improvement from the second steroid injection I had or whether it wears off. Then I could get a third shot if necessary. He wants me to exhaust the conservative options for treatment before moving on to surgery.

The orthopedist Dr. A. had sent me to ordered a second MRI, which showed no change. The extruded disc is not reabsorbing naturally, at least not yet. Sometimes they reabsorb and sometimes they don’t. I’ve read that most of the absorption tends to happen within the first three months, so hearing that it was unchanged was disappointing.

Dr. A. asked what my takeaway had been from my orthopedist visit. I relayed how the orthopedist had told me that surgery would not necessarily help the nerve recover, I should only choose surgery to relieve pain. (The orthopedist may have been referencing this study.)

The orthopedist also told me that since the weakness had been going on for three months it would likely continue for a long time even if I had surgery. My own reading did not support that. It seems that surgery can produce quick improvement in strength. Usually most of the improvement comes within the first six weeks.

Dr. A. seemed to indicate that he disagreed with the note the orthopedist had sent him after seeing me. He said that “I must have seen him on a really good day.”

I asked Dr. A. what affects the nerve’s chance to recover. He said it’s based on the degree and length of time of the compression. But he doesn’t want me to go to surgery too quickly because it doesn’t always have a good outcome, and he doesn’t want me to have any regrets in case I don’t do well.

Dr. H. on the other hand thinks I should go directly to surgery without further waiting or trying a third injection. He says the chance of the nerve recovering starts to diminish at 4-6 months after the injury, and is definitely worse after six months. Four months from the injury is only a week and a half away for me.

He was pretty insistent with me that he’s not comfortable with my situation considering that I’m active and want to be able to do sports. My hip abduction is pretty weak on the left, as is ankle dorsiflexion and the strength of the big toe. He says he’s seen me three times and there’s been no improvement in my strength, no slope of gradual healing.

He sent a referral for me to a neurosurgeon and I’ll arrange to see that doctor as soon as I can, probably in a couple of weeks. I’m also going to see a second orthopedist. I told Dr. H. he was making me nervous that it could already be too late for the nerve to recover. He said it could be. At the end of the visit he said that he has strong opinions but of course I’d have to make my own decision.

So it’s down to the risks of surgery versus the risks of putting surgery off while waiting for more improvement. The offending disc matter is not reabsorbing, not taking the pressure off the nerve, so that’s a point against waiting. I need to understand better the negative surgical outcomes that Dr. A is concerned about. I imagine the problems stem from removing the cushioning action of the disc.

I’ve tried to read on it a little and I see that there are two ways to surgically treat this problem: aggressive removal of the disc matter, and removing only the part of the disc that is extruded (sequestrectomy). My instinct would be to go for the sequestrectomy and keep as much of the cushioning disc as possible, and my reading seems to support that. I don’t know which technique the surgeons I’ve been referred to favor.

I’ll report back again when I can.

{ 6 comments… read them below or add one }

Jo October 16, 2016 at 3:22 pm

I am glad you are getting more opinions on the surgery, Mary. It sounds like the insistence of both doctors on different treatment makes it really hard to figure out what to do; I wonder if it boils down to the “surgery as a last resort” versus “surgery will fix it” approaches. At any rate, this all sounds really stressful and I’m sure the anxiety is not helping you heal. Fingers crossed that the second shot will continue to improve pain (which is connected to weakness, I think?) Take care–lots of fans thinking of you!
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Mary October 16, 2016 at 9:32 pm

Maybe a little? Since neither is a surgeon himself, I’ve thought I could trust both of them to not recommend surgery unnecessarily. I remember Dr. A saying one time 10 or more years ago that the epidural injections were a good treatment, but surgery was not, so at least in the past I think he hasn’t been a fan. I’ve been seeing him for 20 years and he’s never put surgery into the mix of considerations before now, he always throws me to PT, which is what I’ve wanted up to now. Maybe he’s had patients have bad surgical outcomes and that’s influenced him. He teaches at the med school and I do respect his opinion. Dr. H shared an experience with me about being advised by his colleagues that earlier surgery would be better for restoring function, I’m sure that’s influenced him. Pain can certainly cause muscle inhibition, I think the fact that I had less pain but the same weakness went into Dr. H’s recommendation.

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Eva October 16, 2016 at 8:00 pm

I’m with Jo – I’m glad you’re getting a second opinion. As I’ve mentioned before, you know your body best, so you should do what your instinct tells you. Science is not always right so don’t let that guide your way. (I have a skating friend who suffered a stroke 7 months ago and lost all feeling on one side. She defied the doctors’ odds and has been landing her axels again.)
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Mary October 16, 2016 at 9:41 pm

That is a great story about your friend, I’m really glad for her, not just about the axels, but for her life in general that she’s recovered her full function. I tend to be an analyzer as you can see, but certainly my instinct tells me that this injury has been quite different from all the other back episodes I’ve had in my life, and I’ve had to respond to it by trying treatments that I’ve never tried before.

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Melissa October 17, 2016 at 3:02 pm

This is so hard, Mary! Hope you can quickly get an appointment with the neurosurgeon and the second orthopedist. I’m sure you already have a pros and cons list for all of your options – that often helps me, but in the end I usually come down to a gut feel about which option is best for me. I think compiling the pros and cons list helps me get to the gut feel, though. I wish you had an obvious clear path! I am saying prayers for healing and for guidance for your decision. The ice will be waiting for you!

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Mary October 19, 2016 at 5:45 am

Thanks so much Melissa. I’m getting in to the neurosurgeon faster than I expected, they called today and offered an appointment Thursday. The second orthopedist will be a week after that. I don’t have a pros and cons list yet, but you are right that it does come down to a gut feeling. For me the pros and cons list can sometimes obscure the gut feeling. I’ve learned about that pitfall for me and am more aware of it now, so hopefully I can let the gut have the last word. I talked to my sports medicine doctor today and it really helped, he just wants me to get the opinions and then decide.

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