another meeting with Dr. Mark Nelson

meeting to discuss options....
last time we met, he encouraged me to avoid surgery, if at all possible.
avoiding surgery is no longer an option at this point.
i'm going to ask him about fusion vs. disc replacement
time to make a decision and get my back fixed

Discussion:
I briefly updated Nelson on my current status and told him about my upcoming surgery with Delamarter, without insurance approval. Then, I asked him about Abitbol and his recommendation. Nelson said that the dynamic rod doesn't make sense. He said that the chances are extremely slim that the composite material could exactly match the body's natural movement. And if it doesn't, then you're going to have it wanting to move around which can eventually loosen the screws which are into the vertebrae. He said it is better just to go with the tried and true. He said the orthopedic history is filled with "engineers gone wild" as they attempt to find the latest and greatest technique or mechanical implant to fix the problem. He thought that semi-flexible or dynamic composite rods were destined to go on the scrap heap of orthopedic history with many of the other inventions. I asked him if he though disc replacements would also go there, and he said he thought there was a good chance that they probably would.

So, we talked about fusion. He mentioned the oft-quoted 50% success rate (shoot for a double, then we're thrilled if we hit one out of the park). But he said that his German surgeon mentor taught him to be a realist and that it was better to undersell the possibilities rather than promising the moon and the stars and not being able to deliver. He said that success rate is better for a 1-level fusion, and he wanted to make sure that I really needed a 2-level. He said it is a virtual certainty that my L5/S1 disc needs to be fixed (fused), but he is less sure about my L4/L5. In order to better ascertain that, he recommended either another discogram (somewhat problematic and risky since you're poking the disc with a needle, plus the results are not always reliable, plus my disc height is so bad that it can be difficult to get a good reading). Or revisit my facet injections.

He recommends I see Dr. Robert Scott for a facet block at L4/L5. If that is successful in relieving my pain, then we know that I need a 2-level fusion. Alternatively there are nerve-blockers which can help relieve facet pain; however they are basically short-term (~ 3 months) band-aids. If I don't get any pain relief, then that doesn't really tell us anything either way. I have decided to schedule this procedure, and we'll go from there.