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344210 tn?1196072483

Hep C+ with pending spinal fusion

am a 45 yr old female who suffers from severe to crippling pain due to a back injury.  I am here to get some advice on Orthopedic Surgeons vs. NeuroSurgeons to do the spinal fusion that 3 different doctors have suggested I have done.  I have always been a very active... [More] person, but for the past 4 years my life has almost come to a complete stop in my daily activities.  I don't take any pain medication for my condition because it only masks the pain and when you stop taking the pain meds it makes you sick.
I have Hepatitis C and have been referred to a Hepatologist for consult, testing and treatment.
I recently found out that I have a severe arrythmia as well as hypertrophic cardiomyopathy.  Six weeks ago I had to have a ICD implanted.  My ICD has pacemaker capabilities but was actually implanted to prevent sudden cardiac death.  My Cardiologist says that this is only part 1 of the fix for my heart problems and that I will be looking at more cardiac proceedures down the road.  Since the implantation of my ICD I have not had any problems with the device but often wonder if my spinal fusion can be performed because of my other health issues.  My back pain is so severe that I have basically been bed ridden for months.  If I turn a certain way I scream because of the pain.  I'm here to see what kind of advice I can get for my back pain.  My Neurosurgeon feels that I should treat the Hep. C first and then have the fusion, but I don't think that I can stand to live with the back pain until after the Hep C treatment.  The Neurosurgeon will not see me again until after the Hepatologist does his consult, exam and possible treatment.  I have not taken anything for pain for months now because my Neurosurgeon says it's best to let the Hepatologist determine what the best pain medication for me.  I cannot take Tylenol because of my Hep C, and cannot take an Nsaids due to my stomach ulcers.  I'm here to try to get some good advice as to how to get my life back for I am just to young to be suffering from such severe crippling pain.  Please look at the results from my last MRI.

I have been suffering from severe pain in my lower back for a few years now.  I have recently had an MRI.  The impression on the MRI was as follows. !. L3-L4 disc level showa a 3 mm posterior disc protrusion present. Moderate Hypertrophic facet changes are present. 2. L4-L5 disc level shows a 3mm posterior disc protrusion present. Moderate Hypertrophic facet chages are present.L5-S1 disc level shows a 7 to 8 mm central disc protursion present.  Sisc dessication is present.  Hypertrophic facet changes are present.  Lateral recess stenosis is present, left greater than right.  The possibility of a focal left posterior disc herniation at the l5-S1 level measuring 4mm in thickness cannot be excluded.  There are findings that are suggestive of an annular tear at this level.

I have been to two Orthopeadic Surgeons who have told me that I am a candidate for a spinal fusion.  I then chose to get a second opinion from a Neurosurgeon, he also informed me that I would need a spinal fusion in order to resolve this problem.  I have been told that the only fix for my back injury is to have the spinal fusion surgery.

Speaking with the 2 Ortho surgeons they say that they are the Dr.'s who should fix this problem.  As a Senior Claims Examiner processing California Workers' Compensation claims, I feel that the best Dr. to do a spinal fusion is a neurosurgeon, due to the fact that they are more knowlegable about working around the spinal cord.

Both the Ortho Surgeon and the Neurosurgeon say they can do the surgery.  I suppose my biggest question to you is if you can advise me on which surgeon should I be more confident in to do this spinal fusion, an Orthopaedic Surgeon or the Neurosurgeon?  If you can tell me which surgeon I should go with and why I would sure appreciate some advice.  Thank you for your time.
3 Responses
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233616 tn?1312787196
I would also say post this on the orthopedic spinal cord side for more surgeon references.

Please know, I know this may be a very tough decision but if you are in that much spinal pain, having a liver that's well would still leave you prone if I'm understanding your description.

If your genotype is 1a, meaning you could have to do a year to a year and a half of tx.... and I am and found out today I'm not responding to tx enough, and if your viral load and biopsy indicate your liver is still at an early stage, then waiting at least until you have a shot at motion again might be wisdom.

Just saying this because 4 years in bed is not a very quality life, I know, from experience.

you are right, too much meds will mask back and other pains, but none will keep you from any motion.....no one keep hitting themselves with a hammer, and back/electrical pain is far more intense than that!!  So moderate meds is something you may just have to face.
If you go to opiates, easier on the liver, stay with the lowest possible dose, as all strong pain meds have heart implications. Like you I cannot take NSAIds .....currently I am on 2 Ultram a day, and occasionally 1/2 a vicodin ASAP at night if it's way bad...(a little tylenol they say is OK, although I have my doubts..) and the Ultram raises my liver enyzemes, so I will probably have to ask to some just plain pure dope soon. Still, it's not good to not move at all. Hope this helps.
Helpful - 0
233616 tn?1312787196
I have 6 discs 2 gone 4 ruptured, and a bent spinal cord....the pain thing is a connundrum. but moving rather than staying in bed, your heart probs can be from be bedridden, so at some point you need to consider that pain control is not the same as "getting hooked".

saying this is not easy, I also hate pain pills, but without something, I would not have even been able to sit up many days much less walk.

for some reason they say my injury cannot be fixed or fused.
but since yours can, please get this done before hep c treatment unless your Liver specialist say tx is urgent....as blood loss during HCV treatment is not wise, this I do know.
Helpful - 0
167895 tn?1189755825
I had a cervical fusion 1 year ago.  Definitely get a good Neurosurgeon.  UCLA Comprehensive Spine Center is top notch.

Tim
Helpful - 0
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