Aaron, thanks for posting. This will be an interesting dialog. As you know, I am newly VERY interested in t-spine issues because I'm dealing with them too. It's nice to see you hear, but I'm sorry you are still in it. Call me some time.
Regarding my case, I was very surprised by how discouraging the surgeon's (that I've spoken with) comments have been about thoracic spine surgery. I thought I'd be a perfect candidate for XLIF, but the top XLIF surgeon in the world (Pimenta) told me, "Mark, stay away from spine surgeons!"
Hopefully the extreme lateral access approach developed with Nuvasiv's XLIF procedure will make most VATS surgeries obsolete. However, I think this may be one of those procedures that requires an above average surgeon with plenty of XLIF experience, to stay out of trouble.
Ask your doc what he's referring to with the less invasive option. (XLIF??)
Regarding success rates, this is the same type of thing that I'd hear about my lumbar spine. One of the surgeons I saw said, "I won't do a multi-level fusion for pain. If you had a fracture, tumor, etc... I wouldn't hesitate, but I won't do it for pain." IMHO, this is what we here from only the most conservative surgeons. The other extreme, when they will not hesitate to do a fusion while they told me, "come on and do a 2-level 360 fusion and you'll be playing soccer in a year."
IMHO, success rates vary greatly from surgeon to surgeon. Excellent technician vs a just lousy carpenter makes a big difference. Even worse are the surgeons who have the capability to be the excellent technicians, but let other factors make them careless and sloppy. Even the excellent technicians have poor outcomes. They can be poor diagnoses, or you could be unlucky enough to have something that even the best diagnostician cannot properly sort out. And then, most surgeons I've dealt with have told me, "some people just don't get better. We can't explain it, but it happens."
Lumbar discography is controversial. It is much, much less controversial than it was just a few short years ago and most of the naysayers, IMHO, are completely missing the point. (I'll explain further later.)
Cervical discography is still quite controversial. The volume of the disc is so much less than a lumbar disc, many doctors believe that false positives are far too easy to generate and don't trust the test. This is even more true with thoracic discs for the same reasons... even smaller volumes.
IMHO, lumbar discography can still be unreliable. I've seen false positives and false negatives. I've seen perfectly done tests yield completely ambiguous results. I've seen poorly done tests that yield results that seem determinative, but are unreliable because of the way the tests were done. (Remember that I've personally had 3 multi-level lumbar discographies, with and without sedation. I've had multi-level cervical discography without sedation. I've been in the OR, usually holding the patient's hand for > 50 discographies. Without the in-person experience, I've been involved in > 500 cases.)
All of the problems associated with discography allow the non-believers to question the validity of all discograms. Having seen the problems with discography, I believe that they are not the be-all, end-all test that must always be believed. Discography results simply add to the available information and the EXPERIENCED doc will have a sixth sense that lets him know how much weight to give the results. This is why it is important for surgeons to do their own discography, or at least know the doctor who does the disco very well.
A few surgeons use interoperative discography that gives them a great deal of data that allow them to do a more effective decompression (even though it lacks the pain response of a normal discography.)
Regarding, "will the tear heal": from my experience (and tapping so many surgeon's brains about this issue), some will and some won't. There are some physical reasons that some may not heal. These include the size of the tear or the incompetence of the rest of the annulus / severity of the DDD, the possibility for "interpositional" disc nucleus tissue that remains poking through the tear. The interpositional tissue can keep the tear from closing and also "wick out" the caustic disc juices that can cause a lot of nerve pain.
From the extensive dialog we had regarding Diane's case, paraphrasing what the doctors told us: "while many will have the disc herniation be reabsorbed and the tear close on it's own, the early responders are the lucky ones. By the time you get to be 2 - 3 months out if you are not improving, your chance of being one of the lucky ones are very low.
BTW, I have a disc bulge at T7-8, but we don't believe that is implicated in my pain syndrome.
Good luck Aaron... please keep us posted. All the best,
Mark
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