Sorry for the off topic post, but there is more knowledge here than anywhere else I know of and I had some good input to the question of whether I'll be able to shoot my big bores when this is all said and done....

Saw my regular Doc this week for the MRI results......herniated discs at c3/c4 and c5/c6 with bone spurs and compression of the cord, from the pic I saw, looks like 25%-30% compression....... Doc says the only solution at this point is surgery......so I'm waiting for a call from a neurosurgeon.

Since this is all new to me, I have a few questions.

Apparently, the way this works is my regular Doc refers my case to someone that is affiliated with the same "group" that my Doc is with (OMNI)......

So.......how does a person know whether the Doc he is referred to is any good??? I mean, somebody has to finish last in the class! The way the nurse talked, they send the referral to a group of Doctors and whoever decides to see me is the one I go see???

Since we are talking about my spine here, I obviously want to have the best Doc I can get......so, is there a rating system somewhere??

Seriously, how should I decide who gets to cut on me????

Thanks!

Very sorry to hear of you situation.
You are not compelled to "take" the first surgeon that comes along. You can interview any doctors your doctor is willing to recommend. Do some calling and talk with everyone around to find who they had personal experiences with. Believe me people are willing to talk about their surgeries.
Go with the surgeon that instills you with the most confidence. Generally the "group" will be top notch anyway but you should feel confortable no matter who does it.
I just went through something similar last August re: heart condition and it made me feel much better talking with a couple of different Dr.'s first.
Stay positve and know that your personal attitude will play every bit as much a part in recovery and the Dr. does.
Frank

My health insurance company recommends that doctors be checked out through www.healthgrades.com But, I have no experience doing so.

I recently asked my old boss about this. He and his wife have had major bouts with non-trivial back problems.

He recommended going to a major hospital in a big city and getting the surgery done by someone who has done a lot of them. Someone who finished last or doesn't do these very well will not pass this screen.

Second, going to a major hospital in a large city, you will be shocked at how long it takes to get nurse help if you need it. He highly recommended hiring your own private nurse. Otherwise, you might really be waiting 3 to 6 hours for things like adjustments up or down in your pain medication.

Good luck.

H. C.

(edit)
P. S.

If you have any dobts about your diagnosis or what needs to be done about it, he said a trip to the Mayo Clinic or the Cleveland Clinic or an institution in that league is a very good move and much more affordable than you'd ever imagine. Twelve hundred dollars rings a bell. He said the sophistication of the testing and the caliber of doctors who interpret the tests will leave you satisfied you are going to be getting the right surgery or therapy for what ails you.

My only suggestion to you is unlees you are 110% sure of his diagnosis & recommendation for surgery, I would go outside my ins. to get a couple of other opinions. Doctors are great, but they are just people w/ opinions & preferences (a lot like us here). Something as important as your spine, I'm getting more info. I'm not sure about any rating system, but often the best private hospitals have the best docs. HMOs, well, I've heard enough horror stories. Good luck, hope all goes well!

Not what you are going to want to hear...but,
I would go as long as I could, before I let
a profession that considers its members to
still "practice" after graduation operate on me.

Too many bull shit artists here. Class ranking in medical school is the last thing to consider. There can only be one first place and the difference between first and last could(like auto races) be in fractions of minutes. Next, spinal cord compression has severe consequences. The longer the pressure on the nerve, the more weakness and potential for permanent damage. If you go to any reputable facility for primary testing (MRI) and the results are conclusive, changing locations will only cost more money not give you a different diagnosis. In this day in time a reputable group only keeps good doc's as the reputation of all is at stake. There can be alternative treatments if you wish and the doctor concurs, however, after about 30 years of medical experience, if you REALLY have two compressed disks with resulting nerve damage you are the only one that can loose by experimenting with options! Get it done, do the rehab, and get on with life.

Questions for the neuro :

Is a minamally invasive approach avaliable?

Recovery time of traditional access vs. minimal?

How many similar operations have you done?

What are the complications that we could run into?

Are we on the verge of any technology like artifical cervical discs that would make it worthwhile to wait instead of disc removal or fusion now?

If you want to work with a large group of neuro's I can recomend Semmes-Murphey Clinic in Memphis. They have several world class docs and their head of complex spine is one of the best in the world.

I have a bulged, not ruptured, disc between C5/C6. It's quite a problem and I know I need to do something about it sometime.

I lost the website, but I remember a place that offered laser surgery for what I wanted -- which is, basically, just to blast the fusion between the two discs and free things up. There was a name for this procedure that I can't remember. Anyway, this topic always draws my attention. I just do not want fusion under any circumstances.

Russ

As I replied on your earlier post about your condition, I had C5,6,7&T1 fused almost two years ago. I have a titanium plate in my neck, and cadaver bone inmplants that my vertebrae have sucessfully fused to. For those reading this who don't know, this is not back surgery. It has to do with the neck. Compression on nerves at this level will affect your hands and shoulders. I still have some numbness in my fingertips, but have regained the strength in my left arm almost 100 percent. It was almost paralyzed prior to surgery. If it makes you more comfortable, get a second or even a third opinion. But remember, the longer you wait, the more nerve damage you will have, and some of it is irreversible. Again I wish you luck. I woke up in recovery pain free, and mended quickly. I wish you the same success.

1115 - You are lucky they didn't harvest the bone from your hip. That takes longer to recover from than the spinal surgery.

By the way, if you do go to a 'Major Hospital in a big city', chances are good that your surgery will be done by the resident---that's how we learned......

No comments on your insurance. But I have been under the knife with my back, L4,5.

I'm for a major market hospital/doctor. Get referals, more than one. Make sure thats what he does, not yes I can do that.

Tech,

My doctor explained that hip grafts fuse more reliably, but the recovery time is much longer as you stated, but since I was a non-smoker and non-diabetic that the cadaver implants would do the trick. I was totally fused at the sixth month checkup. Other that a little neck stiffness occasionally, I have no problems. Less than a year after my surgery, I spent 16 days in Africa, and shot 8 animals including a Cape Buffalo with a 375. I mention this not to brag. but to give encouragement.

This a subject of which I am familiar, having done nearly 2000 of these procedures. Surgery is mandatory because of the spinal cord compression. The surgery is technically easy and frequently done by most neurosurgeons (?50-80 a yr) The 'gold standard' is to remove the disk and spurs, fuse with cadaver graft and a titanium plate. Fortunately, complications of a serious nature are rare. I believe you can proceed with confidence.

azboy

I was hoping you would reply......thanks for the info.....I may have a few more questions as this proceeds.....hope you don't mind??

azboy: Is fusion absolutely necessary? Won't blasting the "bridge" (arthritis) between C5 and C6, with a laser, free things up so everything's okay again... or will the disc continue to compress until it finally ruptures? Isn't there some way around fusion if the disc hasn't ruptured? I just don't want to be "Ed Sullivan" for the rest of my life, if you understand my meaning.

Russ

I had almost the exact same surgery at Methodist
in Houston on the 3rd of Feb. Only difference,i did not get the plate or fussion,seems to be 2 camps there. I am NO doctor am not smart enough to know why or how and do not pretend so. But i feel that i am doing great. I am 56. ALL my preop complaints are gone and was off all pain meds in 4 days. I was limited to 5 lbs for 30 days & 20 for 60 more. NO fire arms for 6 weeks.
Now my Dr. wouldn't know a 458 lott from a 22. So i plan on giving at least 90 days before i break out the #1. If you want more info about how mine went email or email for phone#.GOOD LUCK Gene

I assume you have verified you can't just get a nerve block.

The operation requires removal of the material compressing the spinal cord and nerve roots(arthritic spurs and disk material). This generally cures the arm pain and numbness, and if the fusion is done, neck pain is usually better. Several studies have been done showing the best results are with a boney fusion (almost always cadaver) and a titanium plate (today' gold standard) A post-op collor is not necessary. However, I've done plenty of these operations without a plate or a fusion, with reasonable results. Lasers are amazingly useless for surgery, unless it would be for retinal or ob/gyn stuff. Nerve injections are not done with cord compression. I would hope that any neurosurgeon could handle this problem. You expect a darn good result from this surgery

Attaboy, azboy, get'm. There are too many arm chair quaterbacks here. It is easy to hit from the cheap seats. Too bad you can't sue them for opinions and not facts. I agree no nerve blocks for this guy. Bulging vs. ruptured is immaterial at this point. Waiting for several second opinions only risks the condition and damage could get substantially worse. Get the surgery by a qualified neurosergeon, do the rest and rehab, and get on with your life. Wait too long and risk getting paralized or perminant nerve damage.

I'd just like to say thanks to all above: the posters who in good faith offered their best suggestions & advice, and the real MD's who have taken the time to post their professional advice -- without charge!

Everybody should of course be careful in getting medical info from the internet. I'm sure nobody will base such an important decision as neck surgery on what ANY number of internet posters say. Having some neck problems myself, I have read the above posts with interest and have learned a thing or two about developments in recent years which I can now investigate further with my doctor.

Lastly, I have to agree with lb404 regarding the ranking medical school not being of such great import. I'm not an MD, but I am a university professor and I've taught lots of pre-med students who have gone on to become medical doctors. My choice of doctor among them would not be based on anything as simple as their rank in medical school -- when I think of my former students, I can see no relationship between their marks and if I would want them for *my* doctor. There are just too many other factors involved...

jpb

Being a generalist (family medicine) rather than neurosurgeon, I have little to add except to agree with azboy and lb404.

I have ordered a lot of MRI's, and CT scans before MRI, and diagnosed and sent off to neurosurgeons many people who were very glad they got their necks fixed. "Best thing I ever did" is a common refrain from their smiling lips.

This week I took care of a fellow in a car wreck, and the titanium steel plates were holding strong on his x-rays. He might have ended up like Christopher Reeve if he had not been so strong in the neck after his fusion.

There is a lot of mobility left in the C-spine with just a limited fusion involving 2 or three vertebrae. Most of the turning of head from side to side comes from the articulation between the first two vertebrae, C1 and C2, the atlas and axis. You ain't gonna be Ed Sullivan.

Remember, "Three four and five keep you alive." If you compress or injure the cord very much at those levels (C3, C4, C5), you don't breathe very well without mechanical assistance.

RIP: Thank you for your post. Yours was the most helpful (for me). It looks like I'm going back on active duty around the first of September. If I'm not killed, I'll buy the surgery when I come home. I feel much better after reading your "articulation" commentary. Thank you very much.

Lastly, to be clear, I was not attempting to give armchair advice nor anything else. I was inquiring out of ignorance. I don't know how else to find things out except ask. I've been scared to death of fusion and using a laser to blast away the bridge seemed logical. It has now been explained why this doesn't work out very well and that's good enough for me.

I appreciate the posts. Thank you.

Russ

Chiming in on a couple of points already made (BTW I'm a general surgeon). Class rank is one of the last things to look at in choosing a good doctor. Probably one of the best ways is to talk to a doctor or someone in the medical field who is a friend. I have seen so many docs who the patients think are wonderful, but really aren't that great. There are some great docs out there who get a bad rep because of one bad result in the wrong person, and likewise some real butchers who have great reps because they have such a wonderful bedside manner.

Someone suggested going to a major market. To even have a neurosurgeon around, the market has to be fairly sizeable.

Similarly, class rank is based largely on grades. My medical school gave us pass/fail for the entire 4th year. That means that 2/3 of their grades came from the years of only using textbooks. The 3rd and fourth years are more hands on. Finally, the place where we really learn is residency, and that doesn't even have grades attatched to it at all.

Another amusing point is how many patients ask me about "laser surgery"; I guess they mean laproscopic (minimally invasive). I never even use a laser. I call it "Ninentendo Surgery"

I want to thank everyone, especially the medical professionals, for their posts. I hope everyone understood that I was not asking for medical advice over the net, just trying to get some questions answered about how to choose a Doc for this surgery. My "last in the class" remark was "tongue in cheek" as evidenced by the " " symbol.......my remark was not intended to imply that the person that finished last in the class isn't qualified......just that some are obviously better than others in the field. Since it's my neck on the line (literally!).....I'd just as soon have a Doc from the "better" end of the of the group!

I live in NE Oklahoma and, as far as I know, the surgery will be done in Tulsa. Thanks for all the info, feel free to offer any additional advice....either here or via personal message!

Lots of good surgeons in Tulsa area. Good luck.

Square Shooter

I do have a question for you......I am Extremely sensitive to many drugs and would like to know how this will affect my surgery.......every pain med or muscle relaxer I have ever tried absolutely puts me out!

Just to let you know how bad it is......I attended my Grandfather's funeral yesterday and had to ride about 6 hours ......riding that far causes lots of pain, but I didn't take any pain meds until 5:30 yesterday afternoon on the way home....I took half a Lortab 7.5-500 then, and a whole tablet at 9:30 and went to bed......my wife finally woke me at noon today and it took me a long time to wake up!I rarely sleep past 6:30-7:00.........

1/4 of a 10mg cyclobenzaprine tablet puts me in la-la land.....slurs my speech and makes me stumble around like a drunk! Even 12 hours after I take 1/4 tablet of that stuff I am still whacked!

How will the anesthesiologist deal with that???

Gonehuntin,

I would opt for a major medicial center...There knowledge and skill level should be at the cutting edge...No pun intended...

The best in the future..

Mike

I am the same way. Very sensitive to drugs. The surgery is mimially invasive. Skin incision and dissection of the subcutaneous tissue. The muscle masses are separated not cut, therefore, very little pain is involved, usually. Since there will be donor bone for the fusion, no pain from the bone harvest site which was the worst part of the pain experience anyway. Usually the patients wake up with very little pain compared to the nerve pain they were experiencing from the compression just a 1.5-2" skin incision. Take the anti-infamitories if your surgeon will let you have them, and get on with it.

I'm not really concerned with the pain after the surgery.....I'm more interested in knowing how the anesthesiologist will deal with the drug sensitivity.......

That is simple. You will probably receive a standad general anesthetic. The drugs we use are in the classification of ultra short acting. The way we keep you under control is adding drug as needed to keep the desired level going. Anesthesia is a timing event. You keep giving drug intil a little before the surgeon is done and you let it wear off. If needs be, a reversing drug can be given to promote rapid awakening. I don't recommend this as it can leave you very uncomfortable. I always tell my patients that I will try my best to leave them comfortable and relaxed for the immediate post op period. After all if you get a few hours of sleep on top of your procedure is that all bad? You don't have to take post op pain meds at all if the drowseyness really bothers you. Personally, I prefer to sleep it off. You aren't going anywhere anyway so what is the big deal? Just discuss your conscerns with the gas man and he will accommodate you as best he can. Remember , less than 0.0005% of all anesthetics turn out bad and most of those are due to pre-existing morbidity. You are far safer under an anesthetic than in the car that brought you to the hospital.

OK, I've read, re-read, and re-re-read this thread with great interest! And, like GonHuntin, I'm not looking for a diagnosis or specific answers. About 20 years ago a rodeo bull wreck broke my left cheek and eyesocket. It's repaired (the wife thinks I'm cuter than before!) but for the last 15 years I've had chronic pain from what the Doc called bone spurs . . . he described it as the bone covering rippling up and calcium growing in to fill the void, on the large vertebra at the base of the neck. Last time I saw a doc about it was 10 years ago and then they said that nothing could be done (I've done the therapy, cortizone injections, acupuncture, massage, etc. with no luck). As time goes on the pain worsens. Right now it's 24/7.

My question to the Docs here is . . . are the advances in the field over 10 years enough to warrant me going back through the battery of tests. They told me then that surgery is never done just to stop pain so it wasn't even considered.

General opinion appreciated!!!

Have a great day!

JDS

jds,
In 10 years, a lot has changed. Both your bone spurs and the diagnostic and surgical techniques.

Don't kow for sure what is going on, but guess it is near the C7-T1 area, and might involve more than just bone spurs. Have you ever had an MRI?

Intractable pain is an indication for surgery sometimes. The medical student/general surgery belly surgery mnemonic for indications for surgery was HOPI: Hemorrhage, Obstruction, Perforation, Intractable pain.

Spinal surgery is more conservative regarding surgery for pain only. I have seen too many "failed backs" after 3 operations and still in chronic pain needing narcotics from me.

I don't think even the neurosurgeons could say much unless you give them more info to work with through cyber space.

First of all a plain 5-view C-spine X-ray and maybe T-spine if that is what is involved, after a physical exam by someone like me.

If it has been 10 years since you saw your family doc about the problem, that would be a good place to start.

Hello Sir,

I have had an MRI but again, many years ago. I use to make every doctor appointment religiously but after nothing worked over and over again, I just figured I'd give up and live with it.

It's weird how the pain has moved over the years. At first it was a burning sensation just to the left of the vertebra (you are correct - it is in the C7-T1 area). As time went on it radiated to the lower shoulder blade area, later moved up to radiate to the middle shoulder blade area, to the upper, then into the side of the neck, and then the back left side of the head. The only spot that has never changed is right next to the vertebra and it never stops!

All of this for a 3 second ride on a bull!!!

I guess I need to go back to the Doc . . . it might stop the wife from nagging me! . . . I just hate to have to go through all the steps again (PT, therapy, etc.)

Thanks for the info. Sorry to GonHuntin, I didn't mean to hijack your thread.

JDS

I offer this as well: Several years ago while training up for some moto racing I took a good spill and the result was among many other interesting breaks, a compression , or set of compression fractures of my T-3 through T-6 verts. Spent a few months in a vest sized cast and then came the rehab...

...all is well today, still ride'n hard, running, etc....But...

A comprehensive fitness plan post recovery MADE ALL OF THE DIFFERENCE!!

Whatever route you take, make sure that your PT is the best you can get. Mine was excellent and got me back in condition and have been going strong ever since.

Good luck!

Jeff

Sorry for the delay in answering this....I was at a spine surgery conference in Phoenix last week.

I am a neurosurgeon who does this type of surgery pretty frequently.

In finding a qualified surgeon, your best bet is to go by word of mouth by both patients and other physicians.

I also encourage you to consider a second opinion, which at least will allow you to hear a second physicians opinion about what is wrong (i.e. are both C3-4 and C5-6 significantly diseased to warrant surgery), and provide you with more information about what to expect.

Anterior cervical surgery is one of our safer procedures, with much more gratifying results than most of the lower back (lumbar) surgeries that we also do.

Surgery to operate on both levels (with a fusion and a titanium plate) should take about two to three hours. You can go home either later the same day, or the next morning.

Send me a PM if you have any other questions.

Garrett