Wednesday, January 7, 2009

Good News

So just before Christmas my mom was in and out of the hospital with stomach and back pains that pretty much no one could explain. They gave her a TON of pain meds and sent her home. Later that week, she had an appointment with an orthopedic doctor who finally told her that she has a slipped vertabrae and would need surgery. However, she couldn't get an appointment with the surgeon until January 7th (today). Up until now she's been in and out of different doctors to get a back brace, more medications, etc. They all basically told her the same thing: her vertebrae is so far slipped that her spinal cord is in danger of being ruptured, in which case she could become a paraplegic in the blink of an eye. Her surgery would fuse the vertebrae on top and the vertebrae on bottom would be fused together with the slipped one after it was pushed back in. Needless to say we were all very nervous throughout the holidays and we're pretty relieved that she would finally be meeting with the surgeon today to schedule the surgery. This morning when she called me on her way home from the surgeon's office, I picked up and all she said was "I don't need surgery."

Now, while that is great news - we're a little confused and surprised and not sure what to think. How could one doctor tell us that surgery is a must and this doctor tell us she can be healed with therapy? Apparently, from what I understand, the vertebrae that is slipped is so far down her spine that the spinal cord isn't actually intertwined in the vertebrae so its not at serious as they originally thought. Now, this still confuses me, because isn't your spinal cord long? But whatever. I'm just excited that my mom is safe and that we don't have to sit through another surgery with her (she's already had two knee replacements - on the same knee!) Not to mention that this definitely frees her up for a certain surprise party that's in the works...

1 comment:

Lost in the Supermarket said...

That's a bit of a blessing that your mom won't have to undergo surgery. This from wikipedia about treatment options for spinal disc herniation (a slipped disc). In short, surgery should be used as a last resort before other options or if there is a neurological deficit (compromised sensation or muscle control):

Conservative treatment

Pain medications are often prescribed to alleviate the acute pain and allow the patient to begin exercising and stretching.

There are a variety of non-surgical care alternatives to treat the pain, including:

1. Bed rest and lumbo-sacral support belt.
2. Chiropractic manipulations
3. Physical therapy
4. Yoga therapy (specialized back care through modified Yoga poses)
5. Massage therapy
6. Non-steroidal anti-inflammatory drugs (NSAIDs)
7. Oral steroids (e.g. prednisone or methyprednisolone)
8. Epidural (cortisone) injection
9. Intravenous sedation, analgesia-assisted traction therapy (IVSAAT)
10. Weight control [32]
11. Spinal decompression

[edit] Surgery

Surgery should only be considered as a last resort after all conservative treatments (non-surgical therapy) have been tried, that did not alleviate the pain and heal the disc herniation.

Surgery is indicated if a patient has a significant neurological deficit.[33] The presence of cauda equina syndrome (in which there is incontinence, weakness and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression.

Regarding the role of surgery for failed medical therapy in patients without a significant neurological deficit, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "limited evidence is now available to support some aspects of surgical practice". More recent randomized controlled trials refine indications for surgery

* The Spine Patient Outcomes Research Trial (SPORT)
o Patients studied. "intervertebral disk herniation and persistent symptoms despite some nonoperative treatment for at least 6 weeks...radicular pain (below the knee for lower lumbar herniations, into the anterior thigh for upper lumbar herniations) and evidence of nerve-root irritation with a positive nerve-root tension sign (straight leg raise–positive between 30° and 70° or positive femoral tension sign) or a corresponding neurologic deficit (asymmetrical depressed reflex, decreased sensation in a dermatomal distribution, or weakness in a myotomal distribution)
o Conclusions. "Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis"[34][35]
* The Hague Spine Intervention Prognostic Study Group[36]
o Patients studied. "had a radiologically confirmed disk herniation...incapacitating lumbosacral radicular syndrome that had lasted for 6 to 12 weeks...Patients presenting with cauda equina syndrome, muscle paralysis, or insufficient strength to move against gravity were excluded."
o Conclusions. "The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery. "

Surgical options include:

* Microdiscectomy[37]
* IDET (a minimally invasive surgery for disc pain)
* Laminectomy - to relieve spinal stenosis or nerve compression
* Hemilaminectomy - to relieve spinal stenosis or nerve compression
* Lumbar fusion (lumbar fusion is only indicated for recurrent lumbar disc herniations, not primary herniations)
* Anterior cervical discectomy and fusion (for cervical disc herniation)
* Disc arthroplasty (experimental for cases of cervical disc herniation)
* Dynamic stabilization
* Artificial disc replacement, a relatively new form of surgery in the U.S. but has been in use in Europe for decades, primarily used to treat low back pain from a degenerated disc.
* Nucleoplasty[38]

Surgical goals include relief of nerve compression, allowing the nerve to recover, as well as the relief of associated back pain and restoration of normal function.

[edit] Emerging Treatment Options

The identification of tumor necrosis factor-alpha (TNF) as a central cause of inflammatory spinal pain now suggests the possibility of an entirely new approach to selected patients with severe pain due to disc herniation, protrusion, bulge, or disc tear. Specific and potent inhibitors of TNF became available in the U.S. in 1998, and were demonstrated to be potentially effective for treating sciatica in experimental models beginning in 2001. [39][40][41] Targeted anatomic administration of one of these anti-TNF agents, etanercept, a patented treatment method,[42] has been suggested in published pilot studies to be effective for treating selected patients with severe pain due to disc herniation, protrusion, bulge, or disc tear. [31][43] The scientific basis for pain relief in these patients is supported by the most current review articles. [44][45] In the future new imaging methods may allow non-invasive identification of sites of neuronal inflammation, thereby enabling more accurate localization of the "pain generators" responsible for symptom production.