DEAR DR. GOTT: I’m a 57-year-old man happily living with my wife of 34 years. Although I watched my diet, exercised, and have no family history of cardiovascular disease, I had a 90 percent cardiac blockage in 2009 and ended up having a heart-catheterization procedure and stent insertion. I saw the signs early and now take 40 milligrams of simvastatin.
Because I had paid my deductible and co-insurance, I saw a back surgeon about my back, which had been giving me problems for years. After X-rays, a CT and MRI, he determined that I have a vertically herniated disc between my fourth and fifth vertebrae. He said I need a spinal fusion, which would involve going through my abdomen. He gave me prescriptions for pain but didn’t prescribe physical therapy or other alternatives.
I’m hoping I can avoid surgery by exercising and watching what I do. I gave up golf and began exercising at a health club, swimming, lifting weights, and walking on an incline treadmill. I limit activities that aggravate the pain.
Recently, I met a man who had spinal fusion in the same area. I asked him what caused him to go ahead with the surgery, and he replied it was because of a drop foot on his left side. My question is, can I live with a herniated disc and not have surgery? Is there another type of doctor I can see who would have an alternative?
DEAR READER: Spinal fusion is the permanent connection of two or more vertebrae in the spine that eliminates any motion between them. This is accomplished with screws, rods or plates to hold the vertebrae in place and promote healing. Fusion is performed in a small portion of those people with recurrent herniated discs or such severe herniation of the disc that it pushes on the nerves, causing problems. The specific technique used is largely dependent on the surgeon’s experience and comfort level with a specific approach. Unfortunately, as I have said countless times, nothing is without risk. In this case, infection, bleeding, blood clots, blood-vessel injury around the site and pain at the site where the bone graft was taken can occur. Beyond this, once fusion is accomplished, stresses of the spine are shifted to adjacent areas, which can accelerate wear and tear in those joints on either side of the fusion. This, too, could result in chronic pain. There are methods of making several smaller surgical incisions as opposed to open surgery through one large incision. This procedure is rather complex, requires great skill, and is not available at all hospitals. Despite the procedure, you may have less pain following surgery, but it’s unlikely all your pain will disappear.
If you don’t want surgery, speak with your orthopedic specialist. Take your films, and get a second opinion from a highly qualified physician. Check in with a naturopath. If your original specialist has already recommended fusion, it may be that you will not experience relief without a radical procedure; however, if there are options to delay what might be inevitable, ask for recommendations for physical therapy, acupuncture, chiropractic manipulation, a pain-management clinic and/or massage therapy. Even without intervention, your condition likely will not lead to neurological deficits or result in a progressive worsening condition; however, it is a possibility. If and when you feel your quality of life has been sufficiently compromised, consider the procedure once again. Who knows, perhaps in a year or two, less invasive and more advanced techniques might be available. Research is always ongoing.
Readers who would like additional information can order my Health Reports “An Informed Approach to Surgery” and “Managing Chronic Pain” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
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