It took me a while once I got home to wrap my head around all that he had to say today. Unfortunately, none of it was good- lots of not so good news, no good news and even worse news.
Anyway, he was going over the images again when I got there.....and we went into the exam room to talk and go over the xrays and other reports first......the good news is that there isn't a ton of movement between the vertebre, but then again, we aren't sure how accurate the xrays are since I can't bend forward or backward very far......that would be the not so good news......
Bad news- there is no fusion from my previous surgeries, although there is a very thin bridge between the 4th and 5th vertebre on the right side- it is very, very thin to use his description of it. More bad news, I have both osteopenia and osteoporosis through out my spine apparently. Even more bad news- the slippage of L3 over L4 has increased in the last month. It went from a first degree spondylolysthesis to a 2nd degree. Even more bad news- this means that it has increased the compression of the spinal canal some.
Really bad news- it appears that the dura ( covering of the spinal cord) is attached to the vertebre at L3, L4 and L5.....more really bad news- any surgery would most probably result in a tear in the dura, at all those levels. This would mean an attempt to repair the covering- and at least 5 days flat on my back , while they hope that it seals once they repair it. If not, I would be flat on my back until it did. The canal should be about
14 mm wide, mine at those levels is anywhere from 4 mm to 3.14 mm.
They are not sure if they would need to extend the fusion- in ordinary circumstances, they would extend the fusion from L4-5, but it would be from L2-to, at a minimum L5, but most probably to S 1 or S2......because I didn't fuse before, they would prefer not to have to extend the fusion but would try to decompress the spinal canal by removing bone from the canal area. If they had to remove more than 40% of the bone from either side, they would have no choice but to extend the fusion, which means a much more difficult recovery and rehab stay in a hospital for some time post op......even without the extension of the fusion, I may still wind up having to do the hospital rehab for awhile due to the extent of the spinal cord injury.
I asked him what he felt the likelihood of having to extend the fusion was in his opinion and he said that it is probably about 80%.....but that he would try to decompress the spinal cord first and hope that it was enough. More bad news is that what was once my disc between the vertebra is now laying in the nerve root exit and compressing that as welll on both sides at L3 and L4....there is also bony overgrowth from L2 down- and hardening of the vertebre due to the constant rubbing of the vertebre all over each other constantly.
Anyway, there's more, as always, but he said that I can choose to do nothing and hope that things don't get worse for awhile and have someone follow me , keeping an eye out for any worsening of symptoms- but that since I have so much nerve damage as it is, that being able to tell if there is a worsening of symptoms is going to be very challenging at best....
He said that there is a lot at stake, if I choose to go ahead with surgery, the potential for several things to go wrong is huge, and choosing not to go ahead also have huge risks. He would like for me to at least consult with two more surgeons, to see if and what they would recommend before we go ahead with surgery. He wants me to be sure, that no matter what I choose to do, that it is what I think is right for me.
I tend to agree with the idea of seeing a couple of other surgeons and seeing what they think given the reports and the risks involved. I am still not sure what the right decision is, and tonight hasn't really given me any clarity in regard to making one , one way or another.
I talked to my husband , and he would like me to see a couple more surgeons before making a decision. He likes these two doctors, likes that they are looking to do the bare minimum , rather than just jump to the bigger operation, but, like me is understandably scared for and about delaying things while I try to find other surgeons with comparable credentials and skills.
So I am still darned if I do , and darned if I don't......