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Preventative Surgery

60 yo male in great physical condition. 5’6, 155 lbs, 13% body fat. I do a 2 hour full body strength workout at the gym twice weekly. 4 days hiking per week, 3 to 7 miles with 2000 altitude gain typical. Im actually on a 6 month training program for mountaineers climbing mt Everest. I’m planning on climbing a 20,000 mountain in the Himalaya next April.

A few months ago I twisted funny and hurt my lower back. The pain resolved within about two weeks. I was left with some numbness in my right quad that resolved in about another 2 weeks. In the meanwhile I did an MRI just to look.

Just to be clear I no longer have any pain or numbness. No symptoms at all. I feel great!

The MRI showed various disk issues. It turns out I have an L2-L3 disk extrusion. Not surprising for a 60 year old guy. The kicker is that my GP wont sign my medical release to go to Nepal until I saw a neurosurgeon.

The 1st neurosurgeon I saw recommended preventative surgery - a lumbar laminectomy and micro disksectomy. He also recommended that I terminate all my gym workouts.

Just to be clear I have no pain or numbness. In fact I was 100% perfect on the nuerological office exam.

I feel like surgery as a first option on a asymptomatic patient is going a bit too far. Other more conservative options were not even mentioned.

Right now I have a second MRI with contrast scheduled. If the first neurosurgeon still recommends preventative surgery, I will seek a second opinion.

Has anyone here done preventative back surgery, or even heard of such a thing?

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Comments

  • Nope! I think your instincts are serving you well! For what it's worth, the only preventative surgery I've ever heard of in my career (EMS, not a doctor) have been cardiac stents. I would discuss this with your PCP as well and ensure they understand how you feel. I can see their concern with you doing a hike like Everest, but any surgery brings further risks not to mention down time. I doubt your health insurance will pay for such a thing.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • L4_L5LL4_L5 Posts: 237
    edited 12/26/2017 - 1:07 PM

    Just curious...

    1) Why do you think conservative treatments were not even mentioned?

    Due to the level of the extrusion ... L2-L3?

    My neurologist said there’s much more range of motion the lower you go in the Lumbosacral spine.

    Because of this he said if you have a problem with L4-L5 or L5-S1 it’s more likely to heal via conservative treatment alone, versus a disc that’s higher up your lumbar spine, especially L1-L2 or L2-L3.

    But it also depends on the extent of the injury to the disc.

    2) Why do you think you were told not to exercise?

    Usually there’s certain stretches (core, glutes, hamstrings, etc) that are recommended for people with herniated discs.

    My guess is because of the unusual level of your herniation. But that’s just a hunch.

    I mean no offense by this but it sounds like the first neurosurgeon you saw wants to make a quick buck off of you (I’ve never heard of a preventative microdisectomy). That sounds a bit ludicrous IMO.

    The goal of surgery is to improve your symptoms and overall quality of life.

    But if you don’t deal with any pain, tingling or numbness as it is, I fail to see in what way you could benefit from going under the knife.

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  • I think on paper my extrusion looks severe. The radiologist who read my MRI stated there was “a large signal intensity behind the body of L2... suggestive of a large disk extrusion (7.4 x 10.7 mm)”.

    Beyond that fact I’m not sure why more conservative options were not brought up.

    The exercise limitation was for anything associated with my spine (sit-ups, kayakers, leg raises, etc.). My impression is that they didn’t want me to do any more damage.

    I’ve been on nearly the same exercise routine for about 14 weeks. I didn’t stop just slowed down and am more mindful of movements that seem like they may be a problem. I do quite a bit of core work. My back feels great actually. Better than it has in years!

  • L4_L5LL4_L5 Posts: 237
    edited 12/26/2017 - 6:54 PM

    My back feels great actually. Better than it has in years!
    That’s excellent to hear! Perhaps despite the size of the extrusion you managed to avoid nerve root compression thus far, therefore radiculopathy, at least at this point, isn’t an issue?

    I personally would proceed with great caution as far as surgery is concerned. Based on your current status it seems like it may cause more complications than it would resolve? That’s just my take.

    In the long run, it may be a different story. I would take it a day at a time, since your quality of life sounds pretty decent.

  • I’ve got mixed emotions on this case to be honest. On one shoulder is a lil guy saying wow 60 years old and living life! On my other shoulder, as a Paramedic with 30 years experience is another lil guy saying, wow here’s a 60 year old man with some back issues which may become worse and require rescuing while trying to climb Mt Everest! There are no easy answers! If your asymptomatic and not fixing to climb Mt Everest it’s one thing! But if you injure that area during your climb, not only do you make your situation worse, then you also risk the lives of the rescuers! Just something to think about.

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  • I've never heard of an insurance company that will pay for a preventative surgery. It's unheard of from reading these and FB groups to have one done without neuro symptoms or severe pain.

    I have cervical issues, and discussed a future surgery with my doc the other day. I asked if they'd do the next level, b/c it's half way there already. Nope. They don't do preventative surgery. (great, so two more in the books in the next few years)

    ACDF w/Corpectomy C3-6 12/8/14 ; Laminectomy C3-6 5/19/2016

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