Newbie: Advice needed!

[RayRay]

I am new to the forum and would like some advice on treatment options, ect.

I have been living with a herniated L4-L5 disc for approx 20 years. I also have a dark and degenerated L5-S1 that does not seem to cause me problems and several other slight herniations on other lumbar discs. Only L4-L5 and S1 show dark disc material, others are fairly healthy. I am 46 years old, active ( skiing and biking) when not in bad shape as I am now.

Over the 20 years I had a good neuro surgeon in the US that was a strong proponent of conservative therapy " If you have control of your bowel and bladder, we will not cut!"

I had some tough episodes that sometimes included siatica and some brutal back spasms, the worst was in 2000. That took me approx 6 months to get better and involved me laying on my belly at work with my laptop. Getting in and out of my car was brutal, but I marched on. The episodes in between were minor tweaks every 3-4 years with spasm and hunched over walking for a few weeks the typical result.

Exercise seemed to be the key for me. If my core was right, my pain was absent.

Last fall I began a new chapter. I now live in Germany just outside Frankfurt. I saw my General Practicioner GP and he gave me some relaxers and when I improved I went to Physio. I did very well and skied in Zermatt in February..I skied hard and had no problems.
In late march I began to run again, ( though my old US doc strongly advised against any high impact stuff like running) I started to feel sharp pain in my hip and attributed it to periformous muscle. I had no spasm at first. soon I began to wake up with a crooked, spasm back. I went back to my GP and we started with Muscle relaxers again with the idea of going back to Physio. Soon after I got out of the shower one morning before work, sneezed and hit the deck with intense pain. The disc seemed to blow out the back left. GP got me and MRI and I had a nasty 9mm herniation that was now causing siatica and mucho pain. 5 weeks of 2 hours of sleep in a position that made me look like spiderman climbing a wall.

I visited a surgeon in Munich Dr. Hellinger because I understood he does minimally invasive procedures which I believed would be better than open microdiscectomy. My consult was fine. He reccomended I get the disc herniation removed and said he could do it with a lateral indoscopic procedure (ala Yueng). Procedure would be an Inside out using his Discfx tools. Sounded decent, but I told him I wanted to continue to try conservative. He said, fine, keep my number handy and good luck!

I started to progress ever so slightly but Recently it has felt worse and my GP sent me to have another MRI. Latest one shows more degeneration and more pushing of disc material into the nerve canal. A visit with the nuero surgeon at the BUG Klinik in Frankfurt resulted in him saying we need to do a microdiscectomy now. I said no since I have pain and limited mobility, but no nerve damage or muscle weakness. He said try an epidural cortesone injection which I did on Monday morning. No improvement yet, but has not been 3 days yet so I will see.

OK sorry for all the background, but here are my questions:
1. Am I crazy to think I can avoid the knife? Is an operation enevitable?
2. Is there a spine Klinik here in Germany I should be visiting? One committed to "Less is More" and minimally invasive procedures?
3. Would an operation to remove the herniation allow me to get back to my former active self or am I on the slide to hell?
4. What else can you advise..Thanks Ray Ray

[Keano16]

1. Am I crazy to think I can avoid the knife? Is an operation enevitable?

Dr. Hellinger, as far as I know, is a world class neurosurgeon. You will not make mistake if you decide to go into procedure with him.

2. Is there a spine Klinik here in Germany I should be visiting? One committed to "Less is More" and minimally invasive procedures?

In Germany there are several good clinics. Stenum, AlphaKlinik (ATOS), Beta Klinik...

3. Would an operation to remove the herniation allow me to get back to my former active self or am I on the slide to hell?

If procedure wents fine, and it is performed by good doctor, then you should not have problems. Surgeries success rate is around 85%, and keep that in mind.

4. What else can you advise..

Just go for minimally invasive approach. If you are still in contact with Dr. Hellinger, tell him to consider PLDD on you. It can be a perfect solution for your discus hernia!

EDIT: I mentioned PLDD because new article about it was recently published, and Dr. Hellinger is one of the authors (including Dr. Choy the founder, and some others).

Good luck and keep us updated.

[jessmith07]

Dr. Bertagnoli is doing this procedure, and I believe it's only available in Germany:


http://www.badmintoncentral.com/foru...6&d=1162338603

[dshobbies]

Hi RayRay and welcome to the forum,

You asked some very important questions. I believe the reason your doctor originally suggested avoiding surgery is because it can lead to further degeneration. This isn't a given, just a possibility but it happens often. I do not know the statistics.

A weakened disc, herniation, discectomy... compromises the disc which puts an extra burden on adjacent segments which can cause degeneration of those segments. Of your two adjacent segments, you already know S1/L5 isn't all that healthy but L3/4 is.

My personal experience ... S1/L5 ruptured in 1994. No other discs were involved. I had a disco/lami and felt great for 8 years. In 2002 I had the same procedure on L4/5. By 2004, I had 4 degenerated levels.

Very many others have the same story to tell which may be reason your doctor wants you to avoid surgery. However, living with disabling pain is no way to live either. Suggesting that you take a first drastic step of an ADR surgery is overkill but you have to understand that a discectomy may compromise your disc which may eventually lead to further degeneration.

Only you can decide when enough is enough. You know your two discs are not healthly and herniate easily. Should you decide on surgery, IMHO it is definitely worth trying a lesser invasive procedure first, as long as you understand the risks.

My personal recommendation is Dr. Bertagnoli in Straubing and Bogan.

However you proceed, I wish you luck and hope you find the relief of pain you seek.

Dale

[trkdoc714]

Ray,

You're in the right country to have a back problem at least! I know there are going to be a lot of recommendations on surgeons. I'd give a hard look at Dr Ritter-Lang from Stenum Hospital. He performed a 2 level ADR on me at the end of March this year. I'm back to work full time and doing almost everything I feel the desire to do. I experience only minor back spasms if I over do it.

I'm still amazed at the rock star status of another German surgeon. He's shown a pattern of abandoning patients and blaming other reasons than his poor surgical decisions for the failures. I'm totally surprised that some of his failed patients defend him with such vigor.

That was one of the reasons I chose Dr. Ritter-Lang. He comes across as a down to earth human being. He freely admits to his mistakes. He gets maligned because he won't blame himself for failed devices or patients that don't follow post-surgical instructions (the guy that went diving a week after a 2 level cervical ADR procedure comes to mind).

I refuse to promote Dr. Ritter-Lang as god-like. He's a human being like the rest of us. He took care of me with great care skill. I'm four months post-op and I'm almost 100% of what I was like prior to my injury. I'm extremely pleased with my choice.

I hope you continue to research and make your own decisions. It's your spine and no one else's. Don't let yourself be pressured into any procedure with any surgeon that you have been sold on.

Good luck to you. I hope your back problem can be resolved with as minimal a procedure as possible.

Bob

[mmglobal]

I wish I could have recorded a conference call I had with 3 clients yesterday. One had ADCT (similar to stem cell treatment), one had cells harvested, one is planning on doing it next months. One was a lawyer who had done a TON of research. One was a PhD in Biopharmacology who works in developing arthritis meds. The 3rd one is an MD. It was a fascinating 90 minutes.

I was very excited by the emergence of stem cell treatements, adct, and so many other disc repair technologies. I really thought that we'd be further along by now. I think that most of us are too far down the degenerative cascade to be good candidates for these treatments. Annulus repair technology along with the capability to regenerate or replace the nuclues will solve a lot of these problems, but we are not seeing them used together yet. Hopefully the next few years will bring this to us.

Mark

[RayRay]

Do you know if insurance covers these stem cell treatments? I have Bupa and I am planning on asking them if they will cover a stem cell treatment related to my upcoming surgery.
My understanding is that when they harvest some of the disc tissue from me they can send it along with some of my blood to a lab here in Germany and then re inject it in three months in order to improve this disc highth.

One additional question I have is do the cells acctually repair the annulus or simply the soft inner gel like core?

Apologies for the non medical lingo!

[trkdoc714]

Ray,

I'd very careful before trying this procedure. The FDA trial in the US has just started and it really hasn't been proven to succeed anywhere in the world. Even the spine brokers are hesitant to put a success rate on it yet.

As it stands, insurance companies won't cover it until it's been proven to have a better or same success rate as traditional procedures.

This is your spine. Keep researching and ask true medical professionals questions about your findings. They will be your greatest source of unbiased information.

Good luck,

Bob