The decision about which surgery to do is a very difficult one. Often, there are financial implications as people cannot afford to go back to the well again if they need a second surgery. Or they feel that they cannot afford to be disabled longer if a less invasive surgery is attempted in order to try to salvage a disc or to keep from a more invasive surgery.
I am often dealing with people who have failed less invasive attempts and are graduating to more invasive surgery. Look at my history... 2 failed microdiscectomy/laminotomy procedures before my ADR. In my case, knowing I needed more surgery earlier might have saved me 2.5 years of my life, but also might have caused me to do the wrong surgery. (I came very close to doing a 2-level 360 fusion... then a 2-level BAK fusion with NO POSTERIOR INSTRUMENTATION. Both surgeries, I believe are less desirable options than the ADR surgery I ultimately had. (Note that I am not anti-fusion... for many of us, fusion still represents the best option.)
There is an interesting discovery process as we are hurtling towards surgery. Early in the process, the prospect of 4 more months of pain seems like a hefty price to pay.... and it is. However, 3 years from now, when you look back, it will seem unimportant whether you waited and suffered for 2 months, 6 months or 10 months. What really matters is long-term relief... getting the most appropriate surgery... getting the least invasive surgery that stands a good chance of solving your problem... getting a surgery that leaves you further options if it's not successful... THESE ARE THE CRITICAL ISSUES.
Obviously, I do not intend to understate how severely our lives are affected by our problems. Our careers are on the line. Some will lose their houses. Some situations are made worse or intolerable by our horribly dysfunctional workmen's comp and insurance systems. I still submit that getting the most appropriate treatment to minimize the prospect of spending the rest of our lives in chronic pain and in a fog of depression and medications is more important than our careers, houses, etc... (I know that this is easy for me to say and I had many advantages as I went through my 5-year ordeal: most importantly, a supportive spouse and a house with enough equity to allow me to get the surgery I needed.)
Also, these decisions are not black and white. Everything is a trade-off. It's easy for someone with disc herniations, good disc height, no instability, early in the DDD process to consider getting a discectomy/laminotomy. They stand a VERY high chance of success. Success may mean getting immediate and total relief and never needing another surgery; or it may mean partial relief and staving off additional surgery for just a few years... but that is still success.
But, if you have poor disc height, huge annular tears, advanced modic changes, instability, etc... you may be putting more at risk by trying less invasive procedures... you may be causing further damage to critical elements that may limit your options later.
Spine surgery is something that should be avoided. With spine surgery less is better. Decisions should be based on knowledge and an understanding of all your options... not just hearing what you want to hear from a doctor that wants to do surgery. When I returned from Germany last week, I rode to the airport with a cancer surgeon who just had apparently successful endoscopic surgery with Dr. Hoogland at the AlphaKlinik. He said something that I wrote down for my list of quotes:
Quote:
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Desperation is not a good consultant!
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One last note: When we are looking at the less invasive procedures, do what you can to preserve future options. I've had multiple clients who had minimally invasive discectomies but graduated to needing ADR. Sadly, they discovered that what they thought was a minimally invasive discectomy because it was done endoscopically as an outpatient procedure, actually removed all or too much of their facets and disc replacement was no longer an option. So, if you are having less surgery, which is best if you are a good candidate, make sure that you are with someone who has an eye to the future and will not burn your options unnecessarily.
Mark