One Year Exam

10-29-03: Surgical evaluation with XXX

XXX is one of the best microdiscectomy doctors in the bay area who only does spine-surgery. I run into him quite often in the Workman Compensation work arena here in the bay area, where he is often used as an AME evaluator. In his technique, he uses a small drill to drill a hole in the lamina without removing it completely. He does all of his work through this hole. Sometimes, if the anatomy is right, no hole is needed at all. This technique is suppose to cut down on the post surgical scar tissue formation.

My current complaints are: great trouble with lifting, repetitive bending, prolonged sitting, and of course, my inability to do any form of exercise - including my beloved road bike, golf, running etc.

Today's Exam Findings: 2cm loss of left calf thickness, moderate weakness of the left ankle evertors, and mild weakness of the gastrocnemeus (calf muscle). My left achilles reflex has returned from the dead and is now normal! The kemp's test did not produce back pain but made my lateral foot go numb. All other ortho tests were normal. Sensory exam showed a loss of sensation in the left lateral foot.

Recommendations: He told me that if it wasn't for the fact that I have had the best week I've ever had, he would have recommended a microdiscectomy. (which greatly surprised me for he is known for being super conservative) He thinks that I may have finally turned the corner. He wants me to give it 3 or 4 more months and to try three more translaminar ESI's. He thinks with a little luck - I might make it out of the woods yet. He also wants me to try some stationary bike at the gym and some very basic leg exercise. No stomach or back extension (which have always flared me up) exercises.

IDET & Nucleoplasty: As for the IDET, he said the same thing my long time neurosurgeon friend had told me back in the spring. IDET will turn the disc into "mush" and force you into a fusion. The Jury is still out on the Nucleoplasty but why take a chance with damaging the integrity of the disc? He went on to tell me the story of a patient he had recently performed a fusion on (from the anterior approach). This was a patient who had had an IDET 1 1/2 years prior. Her disc had collapsed and she was forced into a fusion. The IDET did initially give her 6 months of relief, then a relapse. When he began to remove the disc, he was stunned to find that the disc had literally turned to a mushy - cat food like substance! Another IDET story from hell: Last year he had a patient that was a candidate for the IDET. She was a marathon runner. She tried the IDET and developed severe foot drop! She was devastated although he reported that some of the power has returned. She will never run again and is now worse then me and headed for fusion. He has also wrote about some local studies on IDET in an AME report on one of my patients. In one study IDET seemed to help and in the other it didn't help. I may post this later.

Final Comments: I told the doctor that I was worried about having a discectomy, for the research (especially the work done by Stanford's head of Neurosurgery - Eugene Carragee) currently indicates that my small 3 mm contained herniation do absolutely terrible with microdiscectomy. He told me that its the central contained herniation's that cause the problem, NOT the ones in the lateral recess or beyond. He then stated that Microdiscectomy is designed to eliminate sciatica and "is not very effective for relieving axial (center) lower back pain." He said I would most likely do very well since 95% of my pain is in my left foot, calf, and butt. My axial MRI and CT clearly show compression the S1 root; which perfectly matches with my positive neurological examination. You can see my CT and MRI on the "My MRI EMG CT" page.