The trouble with researching back problems and possible solutions is that you unearth an ever-larger can of worms. Today I was pointed to 2 articles (the most recent this month) in New York published newspapers which have discovered that many spine surgeons are investors in manufacturing companies making the screws, rods and artificial discs which augment the final bills for patients hugely. Typically a single screw in a fusion operation can be billed at 1000$ when it costs only 50$ at most to make. That on top of other research which throws light on the doubtful voracity of the results of so-called clinical trials which ignore bad outcomes from dozens of failed operations which then allow a particular device to receive a good rating. Take a look!
http://www.backpainsupportgroup.com/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=1;t=012149
http://www.backpainsupportgroup.com/cgi-local/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=1;t=012150
It never rains but pours!
I’m appalled that my GP seems not to have read the consultant radiographer’s report on my 28th Dec 2008 MRI lumbar scan (which I only caught sight of yesterday) at the end of which he records that close to one of my vertebrae he can see a soft tissue lesion 5mm in size which he suggests is probably a neuroma and should be “looked into further”. It is currently deflecting a bunch of nerves. A quick look on the net tells me that neuromas can be cancerous or benign so I’ve written to her and requested the finding should be referred to my local NHS hospital pronto!

Received further emails from patients suffering from the effects of ADRs which went wrong- just what I needed to hear! One from the very clinic I am considering! In one of the cases it looks as though there were many contra-indicators available before the op but the clinic paid them little or no attention at the point of persuading the patient to go for ADR. How can you be sure that the clinic don’t just have their balance sheet in mind when they advise a client?
Saw for the first time the full consultant radiographer’s report from my Dec 28th MRI scan and it makes depressing reading! Apart from the technical terms which go over my head- what is hypertrophy?- it is clear that my backbone is a mess—distorted with scoliosis, 3 bad disks with the rest going bad! It’s a wonder it works at all! I have sent a copy to Pro-Spine in Germany for their comments asking for their comments on the poor state of my facets and whether that suggests ADR may be inappropriate. It will be interesting to see their reply. The more I question them the more chance they will smell a rat- “We don’t want any of those internet-savvy patients who might give us a bad name!”

This is the Dec 28th MRI scan of my lower back showing the state of three adjacent discs- i.e. narrowing

I've been reading messages on the 3 leading forums to do with ADR and have had a few private messages (tend to be libellous stuff which they wouldn't risk putting up on the forums) from individuals telling me of disasters- people who have spent their entire savings, others who have been driven to re-mortgage their houses- to pay for surgery and revision surgery. It's all a little depressing and I am rapidly reassessing my options and have this over-riding thought "Is the risk of failure of going under the knife not simply too great to conclude that it would be in any real sense worth-it?" People are telling me of individuals who have gone to Germany and bitterly regret the decision- not only are they now broke but their backs are in a much worse condition now than before! They live in constant pain, are barely able to move from their beds and some have contemplated suicide. All very disturbing.

Others have urged me to look very carefully at the issue of facets- the boney, spiny, antlers- two of which are attached to each vertebrae and moderate the twisting motion of the spine (they cleverly, gently resist you twisting too much). The evidence is clear that these facets, and most particularly their pre-op state hold a major key to the chances of post-op success. Seems that narrowing of the height of discs (my problem) will have over the years have almost certainly led to a deterioration in associated facets. Much pre- and post-op back-pain can be blamed on facets.

Another area of concern lies in patients reporting that the mere fact of surgery triggered over subsequent weeks, months and years other types of pain and at different sites (often in their legs) which was sometimes much worse (if that were possible) than the original back-pain!

Sorry for all this negativity but that's how I feel this morning.

I am comforted by just one thought. I am not lying on the floor in agony needing pain-killers and a decision about surgery- I am grateful for this as it allows me time to consider whether I should simply do nothing. Sounds easy- doesn't it? But then the questions keep coming. If I delay ADR surgery, I have been advised that I may be considered too old at say 65 for this operation. It is possible that my back will deteriorate beyond the point at which ADR is an option. Thus I may miss the only chance of restoring my back so that I may play golf again.

I am off to the GP this afternoon to ask if is possible for her to "prescribe" on the NHS an X-Ray bone density scan which is a requirement of the German clinic who would not proceed if the reading showed I have crumbly bones. Possibly she will say that this test (as opposed to the more usual quick ultrasound test used in the UK NHS not acceptable to the Germans) would have to be ordered through an NHS consultant in which case I would need to get the test done privately.

The options;-

1. Do nothing- means no more golf but by nursing my back and avoiding too much time in a sitting position I can live with the backache I currently suffer.
2. Have a fusion involving bone grafts across 4 vertebrae (on the NHS ie free)
3. Have a 3-level ADR (artificial disc replacement). I have a quote from one of the top clinics in the World in Germany (Pro-Spine) at a cost of c.£35K

The decision is complicated by several factors not least of which is what is the probability of success for options 2 or 3 (I gather from various web forums that one third report significant improvement, one third report no change and one third report deterioration i.e. there is a 1 in 3 chance I will wish I had not had the operation looking back say 18 months after either op!

But what if I do nothing? The best scenario is that my back might stay in a state which is liveable-with (not too painful) especially if I nurse it carefully.

Many people say that if you can possibly avoid it DO NOT GO UNDER THE KNIFE.

Introduction

Here I am in the middle of the biggest dilemma I have ever faced- to go under the knife or not! I have been advised I have scoliosis (a warped back) due to progressive deterioration of my discs. Three are narrowed, dehydrated (hardened) and no longer do the job nature intended. Now the cause is almost certainly due to 35 years competitive tennis (I had a wicked serve which involved an arched back and at racquet impact sent a shock through my spine concentrated on the lower back zone) followed by 15 years golf (got down to a 12H/C) often 3, 18 hole rounds per week and would hit drives c.275yds. It's all my fault- but I wouldn't have changed a thing even if I'd known what would lie ahead. I've had to give up golf (gave up tennis in 1987) and need to decide what to do now about a back which is slowly deteriorating.