How do I make the most of my first appointment with a spinal surgeon who is new to me? What to remember to ask? All suggestions welcome!
My spinal surgeon retired, then the pandemic hit, and only now I’ve got myself an appointment with a new surgeon on November 1. He’s at the same practice as the last surgeon and “Delaware Today” named him “Top Doc 2020”.
I’m way overdue. I have worsening disability with my hands and arms, especially the left, with weakness and tremor, plus pins and needles, burning sensations, et cetera. My neck hurts every day and sometimes all day. It’s decrepit (noisy) and sometimes makes big jarring clunking sounds. I had an anterior cervical diskectomy and fusion (ACDF) of C5-6-7 in 2008 (also L5S1 diskectomy, also T2T3 disk herneation with extrusion, also multiple injections and PT sessions). I’m bringing my numerous MRI, CT and XRAY reports, and they have electronic access to the images.
Highlights from my MRI a couple weeks ago:
IMPRESSION:
Interval progression of degenerative retrolisthesis of C4 onto C5, possibly associated
with mild dynamic (flexion induced) cord compression. Mild spinal stenosis at C4-C5. Interval progression of severe bilateral C5 neural foraminal stenosis.
Solid C5-C7 ACDF, with stable residual spur at C6 and chronic myelomalacia affecting left ventrolateral cord at C6.
I’m guessing the “severe bilateral C5 neural foraminal stenosis” is most responsible for the disability. But the cord compression, spinal stenosis, and chronic myelomalacia seem very worrisom. I’m guessing more surgery is fairly likely (any bets?).
Make sure you explain your current most troublesome symptoms, along with any change/progression of those symptoms. Let your surgeon know what your current interventions (home exercises, physical therapy, medications, other treatment stuff like TENS unit, etc) are and aren’t doing for you. Let him know your biggest concerns (pain/lack of sleep/loss of function, etc. whatever they are). Get his opinion as to what might or might not help, in terms of what he has to offer (recommendations for other meds, studies, treatments, interventions).
A good surgeon will only offer surgery if they think the benefits for you will significantly outweigh the risks. Remember, surgery may not make you better, but it sure can make you different.
If surgery is offered/recommended, make sure you have an understanding of what the most likely outcomes are. Most surgeries are done to improve function, or to stabilize the situation. Pain relief may or may not be expected, depending on the type of pain you have.
I wish I could get that much info from my guy. He says my stenosis is bad and I should be in a lot more pain. Really useful info right/s? I had a spinal injection with a steroid and things got much better and continue to improve but I feel like I’m waiting for the other shoe to fall. I’m also on Pregabalin which helps a lot.
Well, hopefully you’ll wait a long time. It’s fortunate you got benefit for steroid injection and pregabalin. Frankly, that’s close to optimal outcome. Your doc should tell you whether or not they think surgery will benefit you.
I’ve seen so many “failed back surgery” cases (particularly low back) that I’m leery of rushing patients (or myself) to surgery when other treatments are helping things. I’ve got advancing cervical spondylosis myself but I’m benefitting from conservative therapy at present.
I am not at all eager for surgery. The stenosis became a problem right after finishing up physical therapy on my 2 new knees about a year and a half ago, and then a problem again earlier this year. So it’s been years now that I was physically limited and I’d like to try to get my life back in order before the next problem. The outcome for surgery doesn’t look good enough to risk more time out of action. On top of that my father was a little nuts and unnecessary surgeries for minor problems left him with a difficult end to his life, definitely want to avoid that path.