criteria for surgery?

[lazycrazyjen]

I'm just curious. I know every doctor is different, and every patient is different. But is there some sort of a guideline for surgery? I have a 6mm herniation  and pain, to some degree, every day. I have a dozen different symptoms that could all be attributed to this. I know I've been worsening over the past few years, and I've gotten way worse in the past six months.
I have had no progress with my current neurologist, and i've made an appointment with a specialist at mass general next month. I would like to be prepared for what he wants.
But what do doctors look for? I don't want surgery if there is a way to resolve this pain and discomfort without it. But I know surgery can fix problems too  (I haven't had a sinus infection in over four years since having my deviated septum fixed)

[selmaS]

  I have to agree with tink in that it is a case by case situation....some have surgery bcuz they say their Dr said their herniation was severe 12mm's when we all know it is not the herniation....so some r getting surgery bcuz of the herniation....I know my Dr told me I had CSF obstruction not only from my tonsils but from a partially retroflexed odontoid (it was not turned completely around) So that made the flow of CSF that much more diff...and was causing my drop attacks....my herniations were 4mm and 6mm but like I said we know it is not the herniation that is the only thing considered and if that is all ur Dr is discussing u need a diff Dr.....

I am still in pain..still have issues...not bcuz of the surgery or Chiari but bcuz of the related issues to it....make sure u find out what all u have b4 u look into surgery to see what is causing ur pain....my surgery was necessary and I need others...and I have pain as a result of other issues, had I not known about them going in I would think I had a failed surgery.....even tho I know I am so much better, no more drop attacks,....major HA's r gone too....I get them once in a while....nothing like b4....

do not rush into surgery this is not like fixing a deviated septem....this surgery can cause other issues to surface that u may not expect..like developing  ICP, seizures, epilepsy...etc....this is a major surgery the other one u had was not and there is no way to know how ur body will respond.

Find out what other possible issues u may have going on first.....know, if u have EDS, tethered cord, disk issues ,POTS, sleep apnea.....b4 ....JMHO

[tink_0427]

I don't think that there is a definite answer to ur question. From what my NS said it really is case by case as to whether surgery is recommended.
Here's how it went for me: 6 weeks after my youngest son was born (he'll be 2 in October) I had my first MRI, Chiari was present, however, both my Neurologist and I agreed my current issues did not match up to Chiari so we went into a wait and see mode. 11 months later, MRI #2, results the same, no change. 4 months later my headaches started getting worse and more dibilitating, I was getting neck pain/stiffness, shoulder pain/stiffness and back pain. My head started to feel heavy (like a bowling ball), I saw my Neurologist for a follow up and to inquire as to whether maybe my meds needed adjustment. While I was in the drs office waiting for her to come in, I got like a coughing fit. Coughed for like a minute and a half straight, I didn't think anything of it. Well mid coughing fit my Neurologist walked in the door and apparently (I didn't even know I was doing it) I was holding my head because to cough was excrutiating! She looked at me and said, 'Its time to be seen by Neurosurgery!'  She refilled my pain meds and my muscle relaxers and referred me to Radiology for another MRI and also to NS for a surgery consult.
That was the end of April, I had my MRI and saw my NS for the first time mid May. He explained the risks, the benefits and the possible drawbacks of surgery. He explained exactly what he would do, how long he expected it to last and how long he would estimate my hospital stay and overall recovery. He stated that he felt I was a good candidate for surgery but that it was ultimately my decision. I chose to have surgery. He ordered a complete back MRI and another brain MRI prior to my pre-op appointment. My surgery was July 10th and I feel that I made the right decision.
The last 2 weeks or so prior to surgery I felt worse then I har ever felt in my entire life! It was all I could do to ether up in the morning and go to work and one home as crawl back into bed! I honestly feel that was my bodies way of letting me know I had made the right decision and it was time to have the surgery. My herniation was  over 1 cm or about 15 mm, however I did not have any spinal column cysts an my back MRI came back fine so there was no need to open up my spinal canal during surgery.
I don't know if this helps at all or u, but providing as much information regarding ur symptoms to the new dr is always gonna be best...maybe between now and then u can keep a journal of any concerns, problems and ur day today pain?
Ultimately, for me, it was about quality of life. I was living off of pain meds and taking them like they were tic tacs so I could just function through my day. My NS told me that the amount of meds I take would have my liver and kidney fail by the time I was 50...I'm 35 now! That was a huge wake up call for me!!!
Good luck and let us know how it all goes!!