Question
Greetings Dr. Rahamimov,

I am a white female, age 57, about 190 lbs evenly distributed over a 5'7" frame. (More muscle than flab.) Used to ride bicycle and was very active.
Decent health, smoker, low B/P and low/med cholesterol reading. Very rarely ingest meat products. Have had 2 heart attacks in 1994, of which no evidence of heart disease was found. (By 2 different heart centres/hospitals. Director of Nuclear Med. at one hospital, concurred with me that it was a broken heart. Seriously.)
Was diagnosed 20 years ago with severe arthritis in lower back...and 2 years ago with spinal stenosis, degeneration of lower vertebrae and have a herniated disk at L4/L5. The spinal cord is reduced to 1/3 its size at that spot.
When I am not careful...I aggravate the disk which causes me to not be able to control bowels and or urine. Lose control of function in my legs and my pelvis all by itself shifts forward and I have to swing my legs in order to walk. Of course with much excruciating, crushing pain.
I am a work-horse and a trooper and I refuse to quit or lie down.
For the past year and a half, I tried to heal this disk myself. By hanging from doorways, and stretching, in an attempt to relieve the pressure on that disk.
I have had enough of this. I want to ride my bike again.
I will have my second visit to the neurosurgeon, in August. He originally told me, that when I have had enough, to come back.
He informed me that he will be removing that disk and will not be adding anything to replace it.

I need to know......

1....Is there anything 'new' out there instead of 'no replacement'?
2....Should I have something done about the stenosis at the same time as the disk...and what does that entail?
3....Can I have this surgery without a general anesthetic? Say, a local freezing with Demerol drip. I am aware that folks expire not from the surgery but rather from complications with the anesthetic. And I am scared of that...being over-weight, a smoker and having sleep apnea.
4....What percentage of people -- post surgery -- end up with another disk problem down the road?
5....Can you suggest any herbals or exercises to strengthen the vertebrae?

I so appreciate your time and your feedback to my concerns.

Sincerely,

HarbourCastle  

Answer
Dear HarbourCastle,

In reply to your questions:

1.Is there anything 'new' out there instead of 'no replacement'?

It is difficult to suggest surgical solutions without proper evaluation of your imaging studies. There are a few recent innovations which might be suitable for you, but for spinal stenosis the time-tried technique of decompressive laminectomy has proven to be the simplest and most effective. In certain cases we add today what has been termed "dynamic stabilization, which has the theoretical ability to prevent future degeneration of the disc, and even regeneration to some extent.

2.Should I have something done about the stenosis at the same time as the disk...and what does that entail?

The disc and the stenosis are two parts of the same problem, and they are usually treated at the same surgical session.

3.Can I have this surgery without a general anesthetic?

Local anesthesia can be more hazardous in certain cases than general. During surgery we need the Anasthesiologist to control blood pressure amongst other thing. This is not possible with local. It is true that general anesthesia has it's complications, but they are very rare.

4....What percentage of people -- post surgery -- end up with another disk problem down the road?

The need for revision surgery is related to proper pre-operative diagnosis, proper surgical solution, and luck. The recurrence rate in the literature is about 7-10%. My guess is that since this statistic is partially based on older techniques, the current rates will prove in the future to be lower.

5....Can you suggest any herbals or exercises to strengthen the vertebrae?

If you have osteoporosis, you can ask your physical therapist for exercise routines that help build bone. I have no knowledge in herbal medicine.

Sincerely,

Dr. N. Rahamimov