My back is shot, I’m 54.. I fell years ago hiking and fractured L4. Over the years I’ve had two lumbar fusions and countless injections. I have recent imaging and have been getting multiple opinions on what I should / can do for chronic low back and leg pain. It’s getting worse, not better by any means.

Three surgeons in a row told me I was bone on bone at L1 & L2 with several pinched nerves likely causing the leg pain. They all three said the rest of my lumbar spine needed to be fused to the bottom of my thoracic spine.

I saw one last surgeon today that was *highly* recommended by one of the other three because he specializes in repairing complex issues. My wife takes off work and we drive almost an hour to see him. He spends less than 15 min with us and says I’m not a candidate for surgery, “it won’t help you” he says. He never even asked how I injured my back. This guy is supposed to be a hot shot and teaches how to do these surgeries.

So who am I supposed to trust in this situation? One of the three I mentioned above spent nearly an hour talking to me about my back. I’m certainly not dying for more surgery. I just want to be in a better state than I am now, preferably in less pain.

Man…that’s a tough spot to be in.
I don’t know the answer but I hope you can find some relief from ANYWHERE!
At this point relief is all you can ask for. I hope you find it!

Thanks man, I appreciate that

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Originally posted by KMitch200:
Man…that’s a tough spot to be in.
I don’t know the answer but I hope you can find some relief from ANYWHERE!
At this point relief is all you can ask for. I hope you find it!

Ask the other two docs what they think of the this doc who barely spent 15 min with you.
I’m not saying he’s wrong.
He’s probably brilliant because he clearly doesn’t have a bedside manner.
I spent the better portion of a summer limping because I went to an ortho specialist who said I should “just deal with it” at my age (<50).. my husband kept pushing me to get a second opinion, and when I finally did the next guy had me on the table within 2 weeks and fixed me up. Even let me watch them fix my knee. I’m walking without pain now.
Best of luck. Back pain is horribly debilitating.

What specialty was the specialist?

Your in a tough spot. I can't see a surgeon being excited about cleaning up the mess from two prior surgeries. He might be a great doctor but like an attorney only wants to take cases they can win. As far as not asking how the injury occurred is really a moot point. Sure it adds a personal touch but does not factor into the outcome for an old injury.

I also have bad disc in my lower back and was told to avoid orthopedic surgeons and see a neuro surgeon.

Way back in the late 70's I was in a tractor flip over accident that left me underneath a rear tire for over an hour. The major injury was a badly dislocated left shoulder. When I finally got to the ER they took a bunch of xrays and told me that surgery was needed and a doc was on his way. A year after that surgery my shoulder began popping out of it's joint. Talk about painful. I dealt with that for about six months and then decided I really needed to get it fixed and done right.

I started asking around for the name of a top notch Orthopedic surgeon. The same name kept popping up of a surgeon in the big city about two hours away. He had his own private practice and I made an appointment and drove over there.
He came into the examining room, introduced himself and asked me what was going on. I told him about the prior surgery and then he looked at the xrays I brought, walked over and looked at my shoulder, moved it around, prodded it a bit and then sat down and told me "I can fix this but we need to go back in". I just looked at him and said "let's do it". I bet I wasn't in his office more than ten minutes. He never asked how the accident happened and I never gave that a second thought.

I totally get that everybody is different when it come to selecting a surgeon but as far as I am concerned the only things that matter is I want him/her to be busy, I want him to know exactly what the problem is and know exactly how to fix it. That's it for me.

As far as your back problem goes, as you are very aware, there are many stories (most right here on the forum) about back surgeries that have gone awry and left people in worst shape that they were. My gut is telling me to listen to the expert.

Good luck my friend, please keep us posted as to how it all goes.

Did he explain why his opinion was drastically different than the other three?
Seems odd that his opinion would be that much different assuming they are all starting with the same facts.
The answers to these questions would drive my course of action.

I am in a VERY similar situation, though not as bad I think. I have bilateral pars fractures, spondylolisthesis and stenosis. Skipping seven years of background and detail, about a year ago I had two surgeons that wanted to fuse my L4/L5, and one who said it won't really solve my pain, and will create more problems down the line. All three are spine surgeons, yet they had different opinions.

Putting myself in the 3rd guys head, I think he's avoiding the risk that he'd make things worse not better. And given that I have to live with the consequences, I went with his opinion and doubled down on PT.

Possibly not applicable to you, but throwing it out there just in case. My new PT guy is taking a different approach than the first handful of PT guy's approaches. No more rubber band nonsense. We're using real weight and working muscles harder. Working to strengthen my core with heavy weight bridges and squats. Also Roman chair work. Lots of protein too. It seems to be helping, for the first time in years.

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He spends less than 15 min with us and says I’m not a candidate for surgery, “it won’t help you” he says.

It might depend on what went on during those 15 minutes.

Surgeons like to operate. If a surgeon that was recommended by another surgeon as specializing in complex issues says you're not a candidate, I'd weight that opinion pretty highly.

What I'd do in that situation is have ask the doc who recommended the specialist to get in touch with the specialist to get a doctor-to-doctor take on the specialist's opinion, and see if the two of them concur.

quote:

Originally posted by joel9507:

quote:

He spends less than 15 min with us and says I’m not a candidate for surgery, “it won’t help you” he says.

It might depend on what went on during those 15 minutes.

Surgeons like to operate. If a surgeon that was recommended by another surgeon as specializing in complex issues says you're not a candidate, I'd weight that opinion pretty highly.

What I'd do in that situation is have ask the doc who recommended the specialist to get in touch with the specialist to get a doctor-to-doctor take on the specialist's opinion, and see if the two of them concur.

This is pretty much what I was going to say. I too suffer from back pain and want to avoid any fusion as have my doctors. My issues were at the L5-S1 and I had to have surgery. Things were pretty good until a year later and now I have issues with the L4-L5. Have you tried the ablations where they burn your nerves? I get that done and it cuts my pain in about half for a year until the nerves have grown back and I get it done again.

quote:

Originally posted by joel9507:

quote:

He spends less than 15 min with us and says I’m not a candidate for surgery, “it won’t help you” he says.

It might depend on what went on during those 15 minutes.

Surgeons like to operate. If a surgeon that was recommended by another surgeon as specializing in complex issues says you're not a candidate, I'd weight that opinion pretty highly.

What I'd do in that situation is have ask the doc who recommended the specialist to get in touch with the specialist to get a doctor-to-doctor take on the specialist's opinion, and see if the two of them concur.

That's also good advice!

Also keep in mind, he may have spent 15 minutes in the room with you, but also 20 minutes reviewing prior physician notes and imaging. I know that doesn't make you feel very god, and I'd feel the same way, but they do a lot of background work often that is unseen.

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I also have bad disc in my lower back and was told to avoid orthopedic surgeons and see a neuro surgeon.

This is good advice-I received similar advice from a highly respected neurosurgeon who worked on me several years ago. My changes in the interim were due to arthritis, not trauma.

I am now on a walker at age 84, but at least somewhat mobile.

I wish you good luck!

Tillman

I'd suggest finding an excellent physical therapist who has a lot of experience with lower back injuries and post-surgical rehab. Have them do a thorough evaluation, including reading any records from your previous surgeries and looking at current images.

Then have them do a good diagnostic eval of what's going on now. The best diagnostic exams I had were from such a PT and from the surgeon's PA.

These PTs see patients across time who have different histories, whereas surgeons rarely get long term views into outcomes for different patients. Most docs are very specialized, so their view is narrow, and thus their opinion is narrow to their expertise.

Many tests can identify which disc is bad or which nerve is involved. A nerve conduction test will show which nerve is involved. The physical exam can confirm where the impingement is happening.

The consistent comment I got was that good candidates have good surgical outcomes, but bad candidates have bad outcomes. I'd want to get clarity on what makes my particular situation a good or bad candidate for different surgical options.

I don't know who you're to believe but I can share my experience.

I've had bad dandruff and skin peeling off my face throughout my life. I've gone to different doctors, different specialists. They tried prescribing all sorts of treatments from cortisone to accutane, etc. All these doctors spent time talking to me, looking me over, etc.

Three years ago, my primary care sees my condition and says I have exzema and referred me to a dermatologist. Okay, fine, I can try a new prescription with no hope but I'm used to it.

I make the appointment with the dermatology clinic. A nurse preps me the usual way, taking my vitals, etc. A Physicians Assistant, not a dermatologist comes in, walks into the room no more than 3 steps looking at me and mutters something that I didn't hear. I said, "What""

"I'm prescribing you something that will treat you."

"You saw that far away and saw I have eczema?"

"You don't have eczema. you have blah, blah, blah."

No more than 3 minutes for that whole exchange.

And, sure enough, my dandruff is gone and the peeling skin from my face is gone.

So in my experience, I guess when you're good, you're good. You don't need to talk or hear the history of how someone got to where they are. What matters is whether they can tell how you are and what will work.

But that's not to say you're to take the last doctor's advice as gospel either.

Thank you all for your replies..sorry to have not responded before now. I did not sleep well, which is usual and ended up sleeping late this AM.

A little more info I guess, I was a paramedic for 10 years..not that makes me any kind of expert but I’ve been around my share of MD’s. I was a medic when I fell and fractured L4.

I have a pain management doc as well, have used her for over six years. She’s never been keen on more surgery, which I understand.

What I do know is that this is getting worse and I don’t want to be 5-10 years down the road in my 60’s facing another fusion. If something needs to be repaired I’d rather deal with it now. I just do not get the other three, one of which has a similar specialty of dealing with jacked up spines, telling me I need the same fusion…while this dude says the opposite. The guy I saw yesterday that I’ve been torqued over said he only operates when he knows there’s a 80-100% chance of improvement. That sounds great but I have *never* heard of anyone suggesting those types of positive odds with back surgery.

Also..I’ve seen neuro & ortho surgeons. Life revolves around pain right now. Im lying down, icing my back 3-4 times a day. My right leg goes to sleep if I’m on my feet more than 5 min. It’s just getting debilitating.

Thank y’all again. For your input

Edit: I have a telehealth appointment with the surgeon that referred me to the guy I saw yesterday. He mentioned I was welcome to come back and ask any questions..that he’d help if he could. I’ll certainly ask why he thinks this surgeon gave me conflicting advice. Also, all three of these guys know each other, lol.

^^^^^^
If you are on Medicare telehealth ended October first. I know of some patients who are helped by a Spinal Cord Stimulator.
Surgeons should not be selected on the basis of their social skills.

Not on Medicare..yet. lol. Yep, I’ve had three spinal cord stimulator’s over the years. I never had a positive outcome with them. Thanks for the suggestion though.

quote:

Originally posted by ZSMICHAEL:
^^^^^^
If you are on Medicare telehealth ended October first. I know of some patients who are helped by a Spinal Cord Stimulator.
Surgeons should not be selected on the basis of their social skills.

I am NO doctor. But I would think that an expert surgeon could probably look at your X-rays or MRI and in 5 minutes determine if he could help your situation. They are experts for a reason. An expert in car collision doesn't need to know how the car was wrecked in order to determine how and how to fix it, I would expect surgeons would be the same.

You could also go see a different expert.

Well, shit, 80 to 100%.. from what you’re describing I’d accept 50 as long as I understood that was my best hope for improvement from the pain. I’m very sorry for your situation. It sounds awful, and I would do everything I could to try and improve it as well.