Spinal Surgery - Anterior Cage Alternative?
May 6, 2014 3:16 AM   Subscribe

IKYNMD - So a few years back I have a laminectomy, discectomy of S1, L2, L3, L4. I also have stenosis and scoliosis of the lower spine, with major issues in my neck due to everything being out of whack and balance. Also have degenerative disc disease all along the spine. So a few years after I had the first surgery, was told I needed to have an anterior cage to support my spine that was basically collapsing. I said no because of the fear factor.

Fast forward now I'm really weak - hard to stand, walk and numbness in hands and all around the lower lumbar area.

Still have the fear factor about everything. After care - success of it all and other elements.

I have a few questions but will narrow it all down to - have there been any other breakthroughs to stabilize the lumbar area OTHER than the anterior cage (which involves removing a rib and bone graft??) - that's less invasive and even more successful?

What has your personal experience been with this procedure?

Who is the top guy to go to for this procedure - on earth?

Where can I get some support - anywhere - on the web for people like me - that's topnotch, no BS, is active and informative?

Thank you!
posted by watercarrier to Health & Fitness (5 answers total)
For most of your questions the best answers will come from a face to face talk with a good surgeon. Hard to say who is the best on earth, but Norm Chutkan in Phoenix worked at my hospital until recently and is very highly regarded when it comes to complex spine surgeries. He has taken care of some family members and despite the fact that he is a surgeon he is not at all quick to operate and considers all the less invasive options.
posted by TedW at 5:52 AM on May 6, 2014 [1 favorite]

Do you have a doctor who provides care for your condition who isn't your surgeon? They would be a very good resource for finding out who is considered the "top" surgeon.

You'd be surprised how much people discuss specific doctors and surgeons on online forums -- if you can find one for people suffering from your condition, I would definitely try there.

Try searching Google Scholar and/or PubMed for recent publications about this surgery, improving outcomes from this surgery, etc. I recently had a fairly specialized surgery, and it's not too hard to find the names of the top surgeons because they are the ones who are constantly publishing about it.

Not only do you want a surgeon who is very good at this, but you want a hospital where it is done frequently. Pretty much without exception, outcomes tend to be better for procedures that are performed frequently at that hospital, regardless of who the surgeon is.

When you interview a potential surgeon, ask explicitly how many of these surgeries they have performed, how often they do them, and what their success rate it. For some reason people seem to think these questions are "rude," but this is exactly the information you need to assess if you should let this person cut you open. Keep in mind however that the "top" surgeon might have a lower success rate than the local guy -- not because he's worse, but because the most complex patients get passed up to the top surgeons.

I know nothing about this surgery in particular, but if you are in the Northeast, The Hospital for Special Surgery is an extremely good facility for spine and ortho in general.
posted by telegraph at 7:08 AM on May 6, 2014 [2 favorites]

Hi. I am the proud? owner of an anterior cage, between T12 and L2. Mine was installed at Westchester Med. Ctr (NY) after I burst L1 in a 40' groundfall, so - I didn't have much choice and/or shopping opportunities. However, I was told that the cage represented the state-of-the-art and was my best shot. I also have 2 plates and 4 screws around it. It's bombproof.

I did not lose a rib, but they displaced a rib to access the area, and that's been a sore spot ever since. My cage was filled with the crushed bits of my former L1 vertebra. I understand that in other cases, bone is sometimes taken from your pelvis (which is reportedly painful).

My aftercare was not normal, due to my other injuries (broken foot, could not walk).

My experience ... well, I didn't have alternatives. My back is still a sore thing and a work in progress. I would say I'm 80-90% of who I was before the accident; pain is often more a limiting factor than flexibility or strength. But for you, it may well represent great gains or stabilization of mobility.

Hospital for Special Surgery is a good recommendation, as are telegraph's other comments on finding a doc.

Keep in mind the usual caveats for spine surgery: in ~50% of cases, it isn't "successful" in that people have continued pain; google "failed back syndrome" to learn more there. Also, when you're googling, remember what my spine doc told me: the people who *have* the time to post to forums about their (bad) experience are the ones for whom it didn't work. The ones for whom things went well aren't posting to the internet - they're off living their lives. So - read very very sparingly. Don't wallow in back-pain forums. It's not a random sample.

DO YOUR PT!. I do yoga daily now, and it's mandatory.

Numbness in hands is thoracic/cervical, not lumbar ...?

The one question I would have if I were you would be: how does this cage fit into the long-term plan or prognosis for your back? Is it a game-changer, is it necessary to stave off dysfunction/injury, is it just another thing to do, is it a part of a long-term plan for you?

Best wishes.
posted by Dashy at 7:37 AM on May 6, 2014 [1 favorite]

Thanks everyone who was kind to reply. Dashy - wishing you good luck and thank you for your good wishes as well. The numbness in my hands has to do with ruptured disks in the neck area - got probs from top to bottom. This cage would stabilize from further movement due to the procedures and scoliosis - there's some pressure on basic nerves and arteries right now. Much obliged to all. Good health and blessings.
posted by watercarrier at 9:20 AM on May 6, 2014 [1 favorite]

I have a relative who is fused from L4-S1 since about 10 years ago. The nerve problems are gone - he can walk and move basically normally, no numbness - but the pain never went away. Never needed follow up surgery. He prefers having the cage, some pain, and no paralysis.
posted by mrbigmuscles at 9:24 AM on May 6, 2014 [1 favorite]

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