Neurosurgeon question

[Guest guest]

Hello everyone,

I was at a party of a friend who is an MD. She suggested I try to see a

neurosurgeon for my

back pain. She said they also work on backs. I was surprised, I've always

thought of bone

issues being orthopedics only. She said it's a different approach... " they deal

with patients

with microscopes instead of hammers " ... is how she explained it. Has anyone else

tried this

approach with any success? What are your opinions? What kind of questions should

I prepare

in advance.

Also has anyone found a non-narcotic pain med that works like an NSAID without

the

digestive issues? The NSAIDs work wonderfully, but my stomach is getting very

upset.

Thanks,

-Dyann

[Guest guest]

Dyann, I can answer on the pain med issue. Celebrex is an

anti-inflammatory, but is designed not to upset the stomach like many

NSAIDs do. There is still a small risk of stomach bleeding, but the

benefit of having pain relief without cognitive side effects is of real

value in my book. I'm also currently on Elavil, Flexeril, and Lyrica,

having recently switched to Lyrica from Neurontin. None of these meds

are NSAIDs or narcotics, but they can have the effect of making you

drowsy or dopy.

There are at least a couple neurosurgeons who do scoliosis revision

work; Dr.s Ondra and Koski, both of Chicago, come to mind. But I think

your friend was talking about a less invasive approach. My personal

experience with a neurosurgeon was the one who did my prerequisite

split spinal cord repair before my orthopedic revision. That was also

extremely invasive, as you can imagine. I'll be interested in finding

out what you learn in this direction. It may be that a neurosurgical

"microscope" approach may help with some symptoms, but of course would

not touch the underlying postural imbalance, assuming that is an issue

for you.

Sharon

dyanndiamond wrote:

Hello everyone,

I was at a party of a friend who is an MD. She suggested I try to see a

neurosurgeon for my

back pain. She said they also work on backs. I was surprised, I've

always thought of bone

issues being orthopedics only. She said it's a different approach...

"they deal with patients

with microscopes instead of hammers"... is how she explained it. Has

anyone else tried this

approach with any success? What are your opinions? What kind of

questions should I prepare

in advance.

Also has anyone found a non-narcotic pain med that works like an NSAID

without the

digestive issues? The NSAIDs work wonderfully, but my stomach is

getting very upset.

Thanks,

-Dyann

[Guest guest]

Dyann,

Hopefully more will chime in on this, but my guess is no matter who you go with, bone work is a key part of any revision done to us patients with previous fusions, thus the hammer. I think opinions are great, and Neuro's, can and do play a part in some complicated revisions, As Sharon shared, and hopefully will too. Some revisions do have to be a team effort, especially when dealing with a split spinal cord like Sharon's. Far more of us have gone the Ortho route, just why, I think, and only my thought, is we get sent to ortho's, secondly, the people that do this work, and have reps doing them are mostly orthos. I guess, ask the right questions, and see what they have to say. I still would ask how many revisions they have done in previous long fusion patients, and yes numbers count, I'd hate to be one of only a handful. Cam has an excellent list of questions to ask a future surgeon on the site, print it out, and add to it according to your case. As to the choice between them, Ortho -Neuro, I'd see both, and see what developes in their plans that are differing and why. For me though, and after being on these boards for a long time, experience always helps a patient, thats why a couple of handful of names of doc's always come up, they do this surgery alot, and have a proven track record.

I think the term hammer versus microscope paints an image in your head, that a surgery with a neuro would somehow be easier, or easier on you, and I don't think that would be true, as the work that needs to get accomplished does include bone work. I think if neurological issues are involved, as with having MS, and Sharon's split spinal cord, a Neuro is key. So my best advice is, see both if you would like, ask questions, compare, but for me, experience doing this work is key, the more they do the better they get at it, and have seen and experienced complications, and know how to handle them. The decision is yours, plainly, but get opinions, only after you have talked to more than one doc will you see how plans can differ, and just what to ask beyond the basics. You will also get the feel for a doc you can work with, are they available to ask questions to, either the doc or his/her assistant, do they get right back to you? Does the doc cut you off short, or plain not answer things, red flag for me. Does the doc make available to you past patients that had the same surgery to speak with, ask to speak with at least two or three, I do this for my surgeon. You might also want to speak to someone who's surgery was done a while ago, not just in the last year, see how they are doing with time under their belts. Also ask about the hospital they practice at, with the patients, forwarned is always best, some care can really be terrific, and some hospitals are really understaffed, good to know in advance. Your doc isn't always with you, and you are in the care of floor nurses, so it's good to know just how care will be there.

Ask your doc about pain med options. I took over the counters for years and years for my pain, didn't have stomach upset, lucky I guess. Better to have your doc control that, and know exactly what you are taking and how much, especially in the run up to surgery.

I sure wish you luck in your quest for the right doc for you, it's one of the hardest parts of this journey. I knew when I found mine, hopefully you too will know it.

Colorado Springs

[ ] Neurosurgeon question

Hello everyone,I was at a party of a friend who is an MD. She suggested I try to see a neurosurgeon for my back pain. She said they also work on backs. I was surprised, I've always thought of bone issues being orthopedics only. She said it's a different approach... "they deal with patients with microscopes instead of hammers"... is how she explained it. Has anyone else tried this approach with any success? What are your opinions? What kind of questions should I prepare in advance. Also has anyone found a non-narcotic pain med that works like an NSAID without the digestive issues? The NSAIDs work wonderfully, but my stomach is getting very upset. Thanks,-Dyann

[Guest guest]

Dyann,

As others have stated, most people go with an orthopedic surgeon who

specializes in adult spinal deformities such as ours when choosing a

surgeon. I may be wrong, but most of these orthopedic surgeons

likely have a good amount of cross-training in neurosurgery since the

spinal cord is involved (versus an orthopod who does knees or hips

primarily). And many orthos will have a neurosurgeon as part of

their surgical team. My surgeon (Tyler Koski at Northwestern in

Chicago) happened to be a neurosurgeon who has extensive cross-

training in orthopedics. His partner (Dr Ondra) is the same. They

run a special spinal deformity clinic and have a lot of experience

with adult post-scoliosis cases such as ours. And even though my

surgeon is a neurosurgeon, he had to use a hammer, not a microscope,

to do the surgery

I also happen to have mutliple sclerosis am an in a wheelchair

fulltime now (though I was only using a walker at the time of my

revision). My surgeon has no experience with MS, but he was open &

willing to work with my neurologist to make sure that any MS issues

that may have arisen during surgery were taken care of.

My personal opinion - I don't think that it matters so much if you go

with a neurosurgeon versus an orthopedic surgeon. Usually a surgeon

will use a team approach to include specialists in other fields as

needed. What really matters is that he/she has extensive experience

with flatback revisions. It is a very specialized surgery, and you

don't want to be part of their learning curve

>

> Dyann,

>

> Hopefully more will chime in on this, but my guess is no matter who

you go with, bone work is a key part of any revision done to us

patients with previous fusions, thus the hammer. I think opinions are

great, and Neuro's, can and do play a part in some complicated

revisions, As Sharon shared, and hopefully will too. Some

revisions do have to be a team effort, especially when dealing with a

split spinal cord like Sharon's. Far more of us have gone the Ortho

route, just why, I think, and only my thought, is we get sent to

ortho's, secondly, the people that do this work, and have reps doing

them are mostly orthos. I guess, ask the right questions, and see

what they have to say. I still would ask how many revisions they have

done in previous long fusion patients, and yes numbers count, I'd

hate to be one of only a handful. Cam has an excellent list of

questions to ask a future surgeon on the site, print it out, and add

to it according to your case. As to the choice between them, Ortho -

Neuro, I'd see both, and see what developes in their plans that are

differing and why. For me though, and after being on these boards for

a long time, experience always helps a patient, thats why a couple of

handful of names of doc's always come up, they do this surgery alot,

and have a proven track record.

>

> I think the term hammer versus microscope paints an image in your

head, that a surgery with a neuro would somehow be easier, or easier

on you, and I don't think that would be true, as the work that needs

to get accomplished does include bone work. I think if neurological

issues are involved, as with having MS, and Sharon's split

spinal cord, a Neuro is key. So my best advice is, see both if you

would like, ask questions, compare, but for me, experience doing this

work is key, the more they do the better they get at it, and have

seen and experienced complications, and know how to handle them. The

decision is yours, plainly, but get opinions, only after you have

talked to more than one doc will you see how plans can differ, and

just what to ask beyond the basics. You will also get the feel for a

doc you can work with, are they available to ask questions to, either

the doc or his/her assistant, do they get right back to you? Does the

doc cut you off short, or plain not answer things, red flag for me.

Does the doc make available to you past patients that had the same

surgery to speak with, ask to speak with at least two or three, I do

this for my surgeon. You might also want to speak to someone who's

surgery was done a while ago, not just in the last year, see how they

are doing with time under their belts. Also ask about the hospital

they practice at, with the patients, forwarned is always best, some

care can really be terrific, and some hospitals are really

understaffed, good to know in advance. Your doc isn't always with

you, and you are in the care of floor nurses, so it's good to know

just how care will be there.

>

> Ask your doc about pain med options. I took over the counters for

years and years for my pain, didn't have stomach upset, lucky I

guess. Better to have your doc control that, and know exactly what

you are taking and how much, especially in the run up to surgery.

>

> I sure wish you luck in your quest for the right doc for you, it's

one of the hardest parts of this journey. I knew when I found mine,

hopefully you too will know it.

>

>

> Colorado Springs

> [ ] Neurosurgeon question

>

>

> Hello everyone,

> I was at a party of a friend who is an MD. She suggested I try to

see a neurosurgeon for my

> back pain. She said they also work on backs. I was surprised,

I've always thought of bone

> issues being orthopedics only. She said it's a different

approach... " they deal with patients

> with microscopes instead of hammers " ... is how she explained it.

Has anyone else tried this

> approach with any success? What are your opinions? What kind of

questions should I prepare

> in advance.

>

> Also has anyone found a non-narcotic pain med that works like an

NSAID without the

> digestive issues? The NSAIDs work wonderfully, but my stomach is

getting very upset.

>

> Thanks,

> -Dyann

>

[Guest guest]

Hi Dyann,

Trying to catch up around here....sorry for the delayed response!

Your question about surgeons reminded me of a post that was written a

few years back by Kam. She speaks about the chances that a prior

surgery such as a laminictomy or discectomy ( I believe just the kind

of procedures that might be done by a neurosurgeon under a microscope

to address issues related to nerve compression/pain) may make it

difficult at best to later get a good solid revision for flatback

accomplished. Her referenced Drs were Bridwell and LaGrone, probably

the most recognized names around here. As others said, generally in

order to realign the spine after flatback is established most of us

have had varing degrees of the old " hammer, chisel and drill " , or a

combination or disc removal/cage geomtetry used to re-establish lordosis.

Of course that is not to say that a neurosurgeon might not have just

the bag of tricks that YOU need...and by all means I strongly

encourage anyone thinking about this surgery to get at least 2 or 3

very highly qualified surgeons to review their cases...but other than

the surgeons who often deal with this malady, I think you would be

very brave to consider a surgeon who didn't have a long track record

with success in this surgery to start with.

I recommend you go back and read Kams post...its # 10699...if you read

from the main site just put that number in the box in the upper right

hand side and you can see if what she was talking about is relevant to

you.

On the pain med question...I couldn't take anything narcotic because

of my job and I had to make do with Celebrex and gel ICE pack

.....which was my savior on really bad days....but was not a long term

solution. I guess thats why I finally saw that if I wanted to make it

to the end of my career, which prohibited narcotic intake...surgery

was the only option.

Others have used Ultram successfully, which may or may not be an opiod

depending on who you ask. In any event...if your current regime isn't

working then you have every right to ask for another regimine so that

you can stay somewhat functional!

Take Care, Cam