HydroCision or equivalent

[iflycozy]

I am a male, 43, never had a broken bone in life and now have MRI confirmed herniated L5-S1 disc pressing against nerve with shooting pain down back if left leg only thru buttocks, hamstring, calf and bottom of foot. Family guy and scared but all non-surgical option now lead to discectomy. Research seems to show least traumatic surgery is orthoscopic discectomy with HydroCision or waterjet equivalent. Does any neurosurgeon do that kind of surgery in or near central Kentucky? I can sit, stand or walk for 2 minutes maximum before having to lay down flat in back. Already missed 2 weeks of work. Sciatic pIn since April and getting worse. There are few neuros in CA, like David Ditsworth, Stanton Schiffer and Larry Khoo, but none in Ky. Please help me. I don't want regular "minimally invasive surgery" with any bones being drilled. Posted August 5, 20210. Matt Bunch 859-797-3164. Emails to me at matt@bunchlaw.com. Thx.

[mmglobal]

Matt, welcome to the forum.

What do you fly?

I wrote about hydrocision fusions here (I know that you are looking at discectomy, not fusion, but you may find this interesting):

http://www.ispine.org/forum/ispine/1...-data-too.html

I don't think that the "bone drilling" approach will be substantially different than other endoscopic discectomy techniques. You still have to get the scope and tools to the discectomy site.

IMHO, the key is finding someone who is REALLY good at whatever technique you choose. I would choose endoscopic over open if I needed a discectomy. However, I'd rather have an excellent open discectomy than a mediocre endoscopic.

I have observed surgeries with a surgon who had 400 procedures under his belt. He was ALL THUMBS compared to the guy who developed the procedure. I would have thought that 400 was way more than enough, but this really demonstrated to me that there can be a HUGE difference with the same procedure between one surgeon and the next. This can be true even when both have high numbers..

Good luck! let us know how it goes.

Mark

[iflycozy]

Mark: thx for the post but how can I ( a regular patient ) find out about all thumbs doc? Who is the best in the endoscopic field, or at least the best close to KY? I have no way of knowing bur I'll travel if I have to. I built: N9825W First Flight.

[Keano16]

The thing is - hydrodiscectomy, PLDD, nucleoplasty, IDET, etc. are all "blind" procedures.

The "bone drilling" approaches sound aggressive and invasive, but the truth is that there is really few drilling there. Sometimes, it makes sense to drill and go inside the disc with the endoscope.

Not sure who is near KY, but try SpineUniverse specialist search tool. Concentrate on specialist's CV's. Look where they were educated and with who.

Leaders in MISS field in USA are J. Chiu (California Spine Institute) and Anthony Yeung (Desert Institute for Spine Care). There are definitely some more good MISS surgeons, Mark can note some of them.

I also give my vote to anesthesiologist, dr. Atif Malik at Advanced Pain Management. He has completed few MISS fellowships, especially with Thomas Hoogland...and he has great results with endoscopic surgeries. Look Advanced Pain Management Services ? Home

[Job13]

RIP Freedom of Speech

[Keano16]

hmmm...

To be honest, I am really not sure why you quote me about IDET and Yeung by this occasion.

I have just mentioned IDET as a fluroscopically guided "blind" procedure, and thats it. I have not recommended it to anyone. Dr. Yeung and many other surgeons tried IDET as a serious alternative to fusion and ADR, but only in theory. In practice, situation was different, results were not good any MOST of surgeons abandoned IDET as an alternative for internal disc disruption.

7mm endoscope (you call it cannula in IDET procedure, but you are wrong) is not used during IDET. IDET is blind procedure that does not utilize endocope. It utilizes needle, and trough that needle coil is inserted.

Endoscope is used during endoscopic spine surgeries, and it creates a hole in annulus like you say, but in the end, when you look at all the facts why this hole is created - it all makes sense. However, all this procedures have contraindications, complications and failures. That is normal...

In theory all methods are great, including micro-discectomy. Its simple, they cut you, take out the herniated part of your disc, they close you, and thats it!!! However, like my friend neurosurgeon often says, in spinal medicine, two plus two is not always four.

[Job13]

RIP Freedom of Speech

[mmglobal]

To my knowledge, Yeung has not done IDET for years.

Another endoscopic pioneer, Stanton Schiffer up in Pleasanton still does IDET and gets good results with them. His patients are braced when upright for 3 months post-op. I asked him what kind of success he would get following the protocol without the IDET procedure. Many people would have success with this.

Job13 was just responding to Yeung's name posted with her personal experience. That is what we are here to share and benefit from. I'm happy to have the brisk discussion.... we don't all have to agree on anything.

All the best,

Mark

[Keano16]

Originally Posted by Job13

The quote is simply to point out what I am referring to. You are too sensitive I just said that what I felt during the procedure was scary at the least and I, personally, dont recommend IDET. I didnt say you recommended anything.
Best regards!

Ok, no problems. I think most of us are aware of pretty bad success rate with IDET. Regards

[iflycozy]

Thx. for all of your posts. Back to original, who are the better known MISS doctors in or near Ky? I've tracked down about 8 or 9 in MA, CA, TX, AZ, MD, but none in Ky, Oh, In. etc. Thx. Matt

[Keano16]

Ok, as I suggested to you, I tried SpineUniverse specialist search tool and I've found River City Orthopaedic Surgeons - Louisville, KY - David P. Rouben - Michael T. Casnellie - Orthopaedics - Medical Imaging - Physical Therapy. There are two MISS surgeons working there with pretty interesting CV's. Explore them...

[mmglobal]

I'd contact Tony Yeung's office. Info on Sciatica.com. They have an interest in promoting their technique because they market and train on their system. Ask them for info re: SED trained surgeons in your area.

Good luck,

Mark

[mmglobal]

I'd contact Tony Yeung's office. Info on Sciatica.com. They have an interest in promoting their technique because they market and train on their system. Ask them for info re: SED trained surgeons in your area.

Good luck,

Mark

[mmglobal]

You might want to do that with some of the other top docs mentioned. They may be in similar situations.

[mmglobal]

Matt, take a look here:

NAvion N4584K

I'm flying the orange NAvion... all the pictures of other aircraft without 84K are taken from it, All pictures of the red and white one on the Bay Tour are taken by Dr. Bertagnoli from the right seat. The red and white NAvion is a multiple show winner with an IO540 and a bunch of speed mods. It is like a brand new 1948 aircraft.

Cudos on 25W... that's an amazing achievement to build your own plane. How many years? Are you an A&P?

All the best,

Mark

PS... let us know what you decide about your back.

[ksptds09]

The doctor that I know of in KY is Dr. Harold Rutledge in Lexington, KY.

I had an IDET done almost 7 years ago by Dr. Derby, who is like one of the creators of the IDET, when I lived in California and Dr. Rutledge was recommended to me by him as the person in KY who also does IDET's. Nobody on here should be knocking the IDET unless they've had it done, experienced it and thoroughly researched it. If you researched it, you'd see it has almost an 80% success rate. Far better than a fusion or any other procedure you could have done.

I had mine done January 2004. I was prescribed 6 months of part time physical therapy but chose to do 9 months as a "just in case" measure because my injury had occured 5 years prior to the procedure and my leg muscles had become so weak.

In the past 4 years, I haven't had a single episode or painful moment. I can walk, run, ride roller coasters, ride horses and sit on crappy airplane seats again wih no problem. Half of these things I was told I probably would never be able to do again but I've done them and I've done them without experiencing any pain. It does take about 2 years after the procedure for you to have little to no episodes of pain. Discs take a long time to heal but you will notice results within a couple weeks after the surgery and you won't have pain unless you do something you're not supposed to do for the first few months. I only had maybe a handful of painful days in the first couple years and those only occured when I sat in bad airplane seats for more than a couple hours.

I have recommended the IDET to everyone I know. I was only 24 when I had it done and was told it was either an IDET, fusion or do nothing. I was too young for a fusion because once you remove the discs and fuse the vertebrae, you are almost guranteed to have the verterbrae above and below it, fail, thus you will eventually need another fusion. Fusions are generally not recommended for anyone under 40. They told me if I had a fusion, I would be in a wheelchair within 10 years so after a lot of reading and long conversations about it with my orthopedic surgeon, I opted for the IDET. At least with an IDET, you still have your discs.

The IDET is also NOT a "blind" procedure. The IDET and the discogram are performed on a live X-ray type screen. The doctor can see the actual discs he's putting the needles in to. You are also awake during both so you, yourself can see the monitor and see the discs, the verterbrae and everything they are doing.

It may sound like a painful procedure but you won't be as sorry as you would if you chose a different option. Every other option has a higher failure rate and at least with the IDET you still have your discs and if it doesn't work, then you can consider the more aggressive option and have a fusion. I'd do it every 10 years if I had to. It has restored my health to about 95% and given me back the quality of life that I had before the surgery. It was also about half the price of any other procedure.

The IDET is not an aggressive procedure either. Your discs are merely shrunk but you still have enough of it to provide the cushion you need. Taking out the disc completely as you would in a fusion...now that's aggressive.

[mmglobal]

ksptds09, WELCOME to the forum!!! Thanks for posting.

I'm curious as to what post-op protocol Dr. Derby was using after the IDET. Some doctors I know who still do IDET have the patients in a brace whenever they are upright for 3 months. (and they are supposed to avoid being vertical whenever possible.)

It's so wonderful to hear of such a complete recovery. While I'm not a big IDET fan, I know several people with your kind of success with it. Whatever works!!!

I wish I’d had a chance for thermal annuloplasty before I started having traditional discectomies back in 2000. While we’ll never know what might have been, I wonder if I’d have so much metal in my back if I’d been able to discover a different path.

Thanks again for posting. Such wonderful success stories are always great to hear. I wish you continued success.

Mark

[Maria]

Like Mark says.. whatever works! Glad to hear you had such wonderful results. Sure wish my traditional discectomies had left me in that good of shape!

[ksptds09]

Yes, I was in a brace for maybe a couple months? I don't remember the exact amount of time but it was at least a month. After that I did 3 months of physical therapy. I opted to continue my physical therapy another 6 months just for my own piece of mind and they said it wouldn't hurt. I'm pretty skinny and don't have much muscle mass so I wanted to make sure my back was extra strong.

I think if you have a good Doctor like I did, the IDET would have been the best decision you've ever made. Dr. Derby was recommended to me by numerous orthopedic surgeons when I lived in California.

I opted for the IDET since it allowed me to keep my discs and still allowed me the option to have the fusion if the IDET were to fail.

I believe there are still studies in the works where synthetic discs are being used in place of metal. I'd looked it up as a "just in case" measure years ago but haven't kept up with it since I've gotten better.

[Maria]

Just wanted to add that even tho my two discectomies were long ago they were different in surgical approach/technique and there was a HUGE diff in terms of results.

First discectomy in '89 was big open surgery on L5S1 and I had a good recovery. Surgeon had been doing it "that way" for years. 2nd discectomy was in '92 and it was a percutaneous discectomy and I wanted this surgery tho I think the surgeon (and surgery) was pretty new at that time. I was told too much disc was sucked out (very blind procedure back then) and it failed miserably and gave me much more pain/many more probs.

Ultimately both levels rebulged. Like Mark I wish there had perhaps been a way of sealing off the area the instruments were introduced into as perhaps the rebulges wouldn't have occurred and added to my pain/probs. Then again the 2nd surgery was just a flop from the get go...

So I pretty much back up what Mark and Keano both state in terms of getting someone who's really good and experienced at whichever approach/technique/surgery is utlized as that likely is what help optimize your surgical outcome/recovery. This doesn't mean that any outcome is guaranteed just hopefully a better possibility of good outcome.

[iflycozy]

In 2010, I had my back surgery from Dr. Gabriel Jasper in Brick, NJ. Surgery was a medical success. If interested in my notes, I'll email them upon request. matt@bunchlaw.com. Matt Bunch, Kentucky USA