Dr. Nelson discusses options

With disc replacement becoming more unrealistic, I scheduled another appointment to talk with Dr. Nelson about my options....

After a brief physical exam (bending frontwards, backwards, walking on tiptoes and heels, etc.), we had a long talk.

Of course, his first recommendation is to do nothing and manage my pain with medication, etc. This would be the preferred course of action if I could live with my current pain and lifestyle. However I'm thinking that is no longer a realistic option -- most of my evenings involve sitting in a chair with an ice-pack on my back, sipping whiskey and popping vicodin -- not a good way to live. Okay, I'm exaggerating a bit for effect, but this is not far from the truth and is definitely the direction things are headed. Chronic back pain is significantly affecting my quality of life, and it seems to be slowly worsening.

We talked at length about medical tourism including disc replacement in India or Belgium. Nelson had concerns with quality of care and possible later complications. He related how he worked for a time in Germany under a well known surgeon, and Americans would fly over to get procedures done, and he observed that the local doctors seemed to have a slightly condescending or less-caring attitude towards these people, which is not what you want. He couldn't believe that surgery in India could be as safe as here in the U.S. He mentioned that we have a big medical bureaucracy here to protect patients, and sometimes that is a good thing.

As far as the later complications, I told him that the foreign doctor would work hand-in-hand with a local doctor, such as himself. He seemed extremely reluctant to consider such an arrangement, especially since he does not do ADR himself. He mentioned potential serious liability concerns. I asked him if he would go to India to get a procedure done, and he said no. All in all, Nelson's thoughts make a lot of sense, and they certainly reinforce my hesitancy towards medical tourism.

We talked some more about disc replacement. He said neither fusion nor ADR can guarantee a result. He said ADR is not proven to be superior than fusion. Recent U.S. studies show them to be about equal. The longer-term European studies are suspect, since their methods are not as rigorous as their U.S. counterparts. He again expressed concerns about the anterior approach required for L4/L5 which could be dangerous even life-threatening, especially if something went wrong and a revision was needed. If ADR could not be proven to be better than fusion, then why take the additional risk?

He said I would be a good candidate for fusion. My main concerns with fusion are fear at having this metal implant in my spine with rods and screws, plus the possibility of adjacent level degeneration. Nelson says a reasonable expectation for success would be a 50-60% improvement in my pain. He said he had never had a patient express regret for doing the surgery.

I told him let's move forward as if we were doing a fusion. He said the next step is to get a better MRI, since mine was 6+ months old. So we are scheduling that.

Almost on the way out the door, we had a brief discussion on psychological causes of pain. He suggested I might look into an anti-depressant such as cimbalta(sp?). He also said another patient had some success with a book called The Mind-Body Connection, or something like that. I agreed to look into this. However, upon further thought, I really don't think depression is leading to back pain. The back pain is leading to depression.