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accurascope procedure at north american spine institute

Started by Don on 06/10/2010 6:01pm

Has anyone been there and how are they feeling since surgery?

Do you find this discussion helpful?
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Drs.: how much do you know about these procedures? Have you observed them personally? Why did you make the decision to not learn these procedures for the benefit of your patients? Do you feel that more traditional open procedures offer better risk-reward for patients?

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The Doctors may have professional concerns regarding the answer to your question.

First the sacral approach to the lumbar area apparentally started with Doctor Rothstein a number of years ago. It is not taught in normal teaching programs. So they did not "choose" to not benefit thier patients. There is no peer review to prove a benefit.

There must be a reason that this is not being taught in Neuro or Orthopedic spine programs. Maybe there is not as much room for instrumentation as the video graphic shows, or maybe the heat generated by the laser injures delicate nerve tissue.

Lastly, this is not a choice between this minimally invasive approach or a traditionally open proceedure. There are many other minimally invasive proceedures avilable, with excellent track records, done in prestigious centers, not by someone with so many legal problems that they are moving to another state.

Drawing pretty pictures has little to do with the close tolerances required in surgery.

Great video, elegant idea, but wonder why it has no peer review aritcles, and has not been embraced by legitimate medicine, and further why the guy that originated it has 19 malpractice suits and is leaving the state.

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It's just a little frustrating to see how little documentation there is for anything, really. My Doctor dismissed pretty much all "minimally invasive" techniques out of hand. Apparently there isn't much proof of ANYTHING working particularly well. We're left to depend on the testimony of successful patients. All of these techniques - LSI, North American Spine, etc. - clearly work for some people, just like they definitely won't work for others. Everything I read about traditional surgery is bad, bad, bad; at least there is the hope of something better. They claim to be conducting research, at least.

One other thing, if they told you they invented the method of accessing the spinal canal through the sacral hiatus, they are lying. Pain management doctors have been using that approach for decades. It's not a Rothstein invention by any stretch. Google "epiduroscopy" and you'll see what I mean.

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Yes, the anesthesiologists doing pain management have used this for many years. However, the size of the catheter was much smaller and didn't envolve using the laser in this space. It seems that they have merely extended this, to enclude the laser, endoscope and suction.

There has to be a reason why mainstream medicine has not embraced this.

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Also, I wouldn't dismiss either open surgery or min invasive surgery.. I was at dinner the other night and two of our guests had had open cervical fusions several years before and swore it changed their lives for the better. Both had some limited range of motion, but one of them is and excellent golfer carring a single digit handicap.

I also know know of another person who did a min invasive proceedure for spinal stenosis that had bothered him for >10 years and he says that he is problem free.

Another friend who is now 76, had lumbar and neck surgery some 35-40 years ago and has had a miserable time with his lower back ever since.

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Morphine and vicodins is how I have been living for almost 2 years now. I have gotten off most of the meds as they really just make my head fuzzy and I couldn't even think and the pain was still there but not as intense. The more you take, the more you need. I have a business to run and could not do it on all those meds. Now I can at least direct people as to what needs to be done, where as on the meds I couldn't even do that. I do not want to live on meds forever and I am willing to try anything before open back Harrington rods and fusion. That just seems really bad. I do not know anyone that has done well with these procedures and that is why they wait until every thing else has been exhausted first, PT, cortizone shots, accupuncture, pain meds, inversion table, hot tub, heated pool, etc. I have been disappointed with all of these things, but I do not believe after 2 years+ of constant pain, it will get much better. I have rested as much as someone can rest. I do not have good insurance and most of my medical care is out of pocket. I have spent thousands and nothing has worked. I am so hopeful that this will work, even to relieve 50% would be pretty good. I am going to see neurosurgeon in Portland Maine on Monday and see what he thinks about this procedure and see what he would recommend for me. My pain doctor said Harrington rods and fusion, we asked why? he said that is all that is available around here. This is Maine we are behind the times in everything, but still love it. I will keep you all informed. I want people to know that I am a real patient and not someone who is selling this procedure. If I go through with this, I will update this site every week. I want people to know. I wish I could find this information about others. Not from North American Spine, from real people who's comments don't get edited first. I will be honest. I heard something on The Doctors the other day, 80% of oxycontin prescriptions in the USA are prescribed in Florida (that's 80%). That should tell us something. Medical care is not watched as closely as in most other states. I believe that Texas has lots of rich people with money and many with bad backs,,,,,,,, and guns, and if they were hurting people just to make money, they would be shot. Just kidding. I don't know, I just want to feel better and enjoy life again. My pain may be clouding my decision as someone suggested, but I have not been able to find anything bad about Texas Center or Dr. Reed. If someone knows something I don't, please let me know. If you think that this could not work, please let me know why you don't believe it could work. Many microscopic and laparoscopic procedures (gallbladders, appendix, etc.) work very well and the recovery period is greatly improved. Why not the back?

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Don,
Again, this is not achoice between NAS or Harrington rods. THERE ARE OTHER MINIMALLY INVASIVE PROCEDURES AVAILABLE IN OTHER UNIVERSITY SETTINGS.

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Salty Dog - No point using caps. When in pain, the mind hardly has the capability to make the right decisions. And everyone's EQ varies.

For me, when I am on a pain scale of 4/10 I can still think logically and decide whats good and bad for me. When I hit the 10+ last month and was in the ER/hospital for days, all I wanted was a surgery. Which I escaped.

Don - I might have skipped a few posts. So what does your MRI clearly state? Do you have a radiology report you can share here?

I hear you on the OxyContin part! My surgeon asked me to get into advanced PT when I was on a painscale of 2/10. It got worse. Ran back to him, says not his fault. Asked me to get the fusion done. He did not want to hear my story on what all I had to do to get to that low level a pain scale! I asked him for some med to atleast help me for a week, asked me to find a pain doc :) Needless to say, I changed my doc.

The new doc was very good, did an EMG first to ensure where the foot pain is coming in from and why and how badly the nerve was damaged. The goal was to see how much a fusion could help. So the EMG was useful! Rarely do surgeons recommend chiropractors, but this one did but just to try a decompression technique (no any of the other spinal manipulation options). I also got a weeks dose of robaxin and vicodin that helped me get back to a sane level.

I have stopped the meds now. I am on 2 alternative therapies now - acupuncture and ayurvedic treatment.

I don't know how much they will help, but without trying there's no point coming to a conclusion :)

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I came across a website for Minimally Invasive spine surgerywww.smiss.org in Ohio there is a doctor at Cleveland Clinic; this might be something to check out. Good luck to you

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Good site, thanks VP6886

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SMISS stands for Society for Minimally-Invasive Spine Surgery. Some of their members are world leaders in minimally-invasive spine surgery.

Minimally-invasive spine surgery is very wide term. It includes various surgeries and techniques like laser spine surgery, RF spine surgery, METRx (tubular) spine surgery, endoscopic spine surgery, other percutaneous methods, etc.

You should never write "Minimally-invasive surgery did not help me". You should always precise what exact surgery did not help. Accurascope is something new, and it should not be compared to other successful methods that are being used for past 20 years.

All best.

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http://www.beckersorthopedicandspine.com/news-analysis/1585-ohio-surgeon-faces-19-malpractice-suits-files-for-bankruptcy

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Google: Lawsuits North American Spine

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Googled it... every single site points to the same article that's already been posted. That sure sounds like one trial lawyer is trying to run someone out of business. It’s a little fishy that it’s all coming from one attorney. Can you say “vendetta”?

The AMA published a recent study stating “Claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. As noted above, the majority of claims are dropped and an even larger percentage are closed without payment.”

It’s also interesting that the same exact “complaint” text can be found re-posted on multiple websites. More than likely another Dr’s marketing shill. These guys must be helping someone, otherwise who are all these people on their videos and Facebook page? Who is paying for all those magazine ads? I just don’t believe that these companies like LSI and North American Spine are robbing all of their patients blind and not helping anyone. My guess is many other Docs are jealous, the trial attorneys want a piece of the action and the patients that don’t have good outcomes are quite vocal. For those of us who have tried all the conventional stuff – which has FAILED us thoroughly – new procedures offer hope, and for some, RELIEF.

Interested to hear if Don ends up going to Texas...

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Soccerbob, I guess you're right, NAS is your only alternative, in spite of all the MISS listings that someone offered earlier. That list covers the entire US and gives a bio. on each one, and ultimately the papers that they may have written.

Get away from all the marketing razmataz, and seek out credentialed surgeons, who do more than say they are doing research, they have already published their results, and have been innovators in their field. When new procedures are discovered, or invented the surgeon publishes this in medical journals along with results. Other surgeons review this and if it proves to be a good approach it replaces the old ways because it is proven to be better.

That is exactly how minimally invasive surgery for gall bladders, hernia repairs, repair of the aorta in aortic aneurysm. heart procedures etc.,has come about, not by slick advertising. This has been being donee for 7-8 years or more, and he has never published for peer review review. Didn't happen in the other examples, but hey, they published the results and problems as the techniques developed, not try to sell the technique. Medicine innovations should be conducted as science, not marketed like the next hula hoop. Human well being is at stake.

As far as malpractice suits are concerned, are you going to believe common sense, or the AMA.

Certainly, 19 malpractice suits raises red flags. How could you find 19 people willing to sue , who had good or acceptable results, in a such relatively short time period? Additionally, he no longer has malpractice coverage, and no assets to go after. That alone, deters additional suits as you know the atty is after the money. No money, no law suit.

Seriously, there are many minimally invasive surgeons out there, and most do not advertise. They don't have to! If you do good work, others will refer to you, just as in any other business.
I have a personal rule, don't go to Doctors or attorneys who advertise. If they're good, they don't need to.

This is why you're having difficulty finding someone. It's not like opening the Yellow Pages. You can call any Medical University in the country that has a spine teaching program and ask if they do MIS of the spine and then check them out further through MISS or other sources.

What ever you do, don't limit your choices to the marketing groups.

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Salty, thank you - good advice and I am researching all options, not just NAS.

It really seems like there isn't much research behind any of the MISS,honestly. Most of what I have found states that results are essentially the same as with open procedures. Medtronic admits on their own website that there is no good clinical data to support their Metrx stuff. ("The METRx System represents a new area in spine surgery, and the results of surgeries performed with this system have yet to be fully studied.") How long has METRx been around? 15, 20 years?

In any case I would not see Rothstein. There are several other Doctors at NAS getting rave reviews from patients, I may see one of them. I'm also considering Dr. Biscup in Florida. It's worth noting that he was complimentary of the NAS Docs and procedures.

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Soccerbob,

Ah, again that advertising is seductive. When we don't have data or solid evidencce, we quote "hundereds of saisfied customers" . That's like saying " garbage is good for you, could a million flies be wrong?".

All that I am saying is, the methods used by the "advertising factories" never seem to have anymore data than the old "snake oil salesman" selling his concoction that would cure what ails you and moving from town to town citing the personal plants in the audience. Ever go to see David Copperfied and have your seat preemptied temporarily by one of his plants?

Unless one of us becomes a spine surgeon, I doubt that we have the proper context to evaluate even the real research, much less testimonials.

An academic surgeon is not normally in the business of advertising and has been through the process of selection by that university, and therefore has been prescreened, not just shows up with a pretty website, out of no where.
There was a time when plastic surgery was an elite surgical subspecialty, on par with the skill levels for cardiovascular and neurosugery. Think so now? Advertising.

In the past, profesionels survived based on talent, now it may simply be by self promotion.

If the person is good, there aren't enough hours in the day to see new patients. operate, follow up, and teach. So why advertise?

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I think you may be giving the "medical mainstream" a little bit too much credit esp. when it comes to spine care. If traditional spine care worked so well, there wouldn't be so many of us looking for an alternative. For every procedure that comes out of university there are 3 that are rammed through by a device manufacturer and adopted by physicians on their payroll looking to make a quick buck. IDET, METRx, etc. Is marketing directly to patients any more or less ethical than buying off doctors to prescribe certain drugs or use new devices?

It's not like there's just one or two people who visit these centers and have good outcomes, there are quite a lot. If my choice is between something new and unpublished that makes sense and seems to have a lot of good outcomes, versus something that is very well documented to be a 50/50 coin toss, well... it's not an easy decision. I understand why you're dismissive but I think it's much more of a gray area than that.

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Ok, you convinced me. You go first.

Plucking herniated discs has good results, whether you do surgery or not, in the vast majority of cases. As one of the surgeons commented, you can't lump all procedures in the same basket, even all min invasive ones.

The most important thing, obviously, is to have a correct diagnosis. Otherwise the best sugeon doing the best procedure fails, and that has been the greatest problem in this type surgery. The worst looking MRI often has no symptoms and a person with normal looking MRI can have terrific pain.

I have a terrible looking MRI, but I feel that most of my difficulty is arithritic in nature, and until they do back transplants or some wonderful stem cell procedure, that actually works, I'm stuck with what I have, not in anyway comparable to your difficulty. By the way there are people out there offering sterm cell treatment of all manner of back and other procedures, with again, glowing reports from patients, but nothing more than that, to support their claims. Funny no one ever opps for "alternative" airline pilots.

That's all I got friend. Wish you the best.

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I am trying to find out if anyone has had the laser surgery at North American Spine Institute. I am seriously considering this procedure and need to hear more about people who have had the procedure and their opinions. I have sciatica and back pain. I have had the shots, physical therapy, aqua therapy, ortho opinions, chiropractor therapy and have been taking pain meds, muscle relaxers and lyrica for the past three months with no relief. PLEASE HELP anyone if you have any comments.

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Almost went for it, glad I didn't. My Orthopedic doc said if it was that great, why was UCLA not doing it? Hummm, I had no answer. Anyway, you better check the medical board of Ohio and you can do this online. You may be surprised what you find. Look, and be careful, it's your spine.

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I had the surgery for the lumbar spine and cervical spine 2 days later (8/24 & 8/26). It has been 1 month since surgery and the pain has been reduced by at least 50%. So far this has been good for me. There are some days that the pain level is better by 75% (I feel that the weather makes a big difference in my case). I have been going out to do some light duty work but trying not to push it, as this was surgery and it takes time. They told us it can take up to 6 months to feel maximum relief. If you had open back surgery, it would take at least one year according to past experience when I was much younger. So far I have no regrets and wished I would have done this years ago. I still take pain meds but only on an as needed basis. I was taking them every 4 hours before the surgery. I am still nervous about not doing too much as I want to make sure everything on the inside is healed. My doctors in Maine said it would not help me at all and it was a waste of money, but due to living in constant pain and on pain meds screwing up my head, I wanted to at least try something. I had very bad testicular pain (like being kicked in the nuts) and I also had watery diarrhea for almost a year and a half. The doctors in Maine kept telling us that this had nothing to do with the back pain. But since the surgery, the pain in the testicles is gone and the diarrhea was gone the next day. Sometimes because doctors who do open back have such bad results that they put off surgery for as long as they can, but the patient is suffering so much during this waiting period. I went to get second and third opinions, but there was never anything they could do or wanted to do because the results of the surgery they do is not good and could worsen the situation. There are always new things out there that have not spread to all areas of our country. Maine always seems to be a decade behind the time. This was the least invasive that I could find that maybe able to help me. During surgery they found things that the MRIs did not show. Scar tissue was removed from the nerves and herniations were sealed by the laser. They did inject me with cortisone shots while I was in surgery and I wondered when the shots wear off, will the pain come back. So far (after 1 month) not bad at all. I think the pain I am having is from the muscles that I am using have been locked up for so long is what the pain is???? I feel that I continue to improve daily. If anyone has any questions, please feel free to ask. I was very nervous about this procedure as I couldn't find any documentation either and I always said I would tell the truth about my experience (whether it be good results or bad). People deserve the truth to make the decision that is best for them. areldcss@aol.com I will post every month to give you updates. Don Arel, Lewiston, Maine

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Thanks for your honesty Don. I have read this thread from beginning to end - your evaluation of the procedure being the last post. Before I read this thread, I contacted NAS, sent them my MRI report & insurance info and was informed that I was a candidate for the procedure. Then I started reading this thread. I reviewed the horror stories behind Dr Rothstein's lawsuits and started having second thoughts about going thru with the procedure. But in looking at the NAS website now, Dr Rothstein isn't even mentioned as one of the physicians performing the procedures even though he does have a video posted on the site.

I appreciate your honesty and look forward to follow-up postings by you. I had L3-4 surgery last December and had relief for about a month when the pain returned during my PT sessions. Needless to say, I went back to my Surgeon who ordered another MRI and gave me an injection at L4-5 and L5-S1. That sort of worked for a day or two but the pain has returned. Needless to say the Dr now wants to perform surgery on L4-5 and L5-S1. I am very hesitant about that because the previous surgery was very painful and I can only imagine what it will be like if the Dr works on two locations in the same surgery session.

I hope your progress continues to improve.

Dave Wright :-)

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Dear Dave,
I too read the entire thread and was particularly interested with Don's progress, so much so, I emailed him to see how he is doing now, another month later. I did not hear back yet. It has only been a few days. I'll ask him to post if I hear (neg or pos).
I was rear-ended in a MVA 8 mos ago and have injuries to C6-7 (encroachment on nerve), T 9-10 (an extrusion herniation, and 2 bulging lumbar discs plus a torn L4-5 disc. I too sent my MRI reports to NAS and am told I am a candidate for all three levels. They say they can fix me in 2 procedures (thoracic and lumbar together where they will address 3 lumbar discs and one thoracic) and another surgery for the cervical issues. I would be in TX about 7 days. This sounds awesome to me! However, I am an RN and am very leary about the seriousness of the thoracic being done with the lumbar. I want to be out of pain SO BAD tho. I am doing epidural injections now. I have not had much of relief if any so far, but I have only had one lumbar L4 and one thoracic T9. I will advise that you keep up your search. There are others out there doing this surgery (not in my hometown of Roch, NY). I am looking for a skilled neurosurgeon (not anesthesiologist) who has hosp affiliation (that shows credentials). Also, I asked about NAS dealing with any boney issues and they do NOT do that (ie nerve encroached in the foraminal opening and that opening needs to be enlarged - they can't do that). Be "devil's advocate" and look for disciplinary actions, sanctions, and lawsuits on the surgeon you are leaning towards. I think it will help to have others help in that area. Wish you the best. Can anyone advise about good surgeons in the NE? I found one in Manhattan and 2 in Pgh. Would love to find one in upstate NY. Thanks for any help. (PS: have done all the conventional stuff: PT, water therapy, chiro, acupuncture, inversion, traction, laser therapy) with only temp help at best. Sherry

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Dear Dave,
I too read the entire thread and was particularly interested with Don's progress, so much so, I emailed him to see how he is doing now, another month later. I did not hear back yet. It has only been a few days. I'll ask him to post if I hear (neg or pos).
I was rear-ended in a MVA 8 mos ago and have injuries to C6-7 (encroachment on nerve), T 9-10 (an extrusion herniation, and 2 bulging lumbar discs plus a torn L4-5 disc. I too sent my MRI reports to NAS and am told I am a candidate for all three levels. They say they can fix me in 2 procedures (thoracic and lumbar together where they will address 3 lumbar discs and one thoracic) and another surgery for the cervical issues. I would be in TX about 7 days. This sounds awesome to me! However, I am an RN and am very leary about the seriousness of the thoracic being done with the lumbar. I want to be out of pain SO BAD tho. I am doing epidural injections now. I have not had much of relief if any so far, but I have only had one lumbar L4 and one thoracic T9. I will advise that you keep up your search. There are others out there doing this surgery (not in my hometown of Roch, NY). I am looking for a skilled neurosurgeon (not anesthesiologist) who has hosp affiliation (that shows credentials). Also, I asked about NAS dealing with any boney issues and they do NOT do that (ie nerve encroached in the foraminal opening and that opening needs to be enlarged - they can't do that). Be "devil's advocate" and look for disciplinary actions, sanctions, and lawsuits on the surgeon you are leaning towards. I think it will help to have others help in that area. Wish you the best. Can anyone advise about good surgeons in the NE? I found one in Manhattan and 2 in Pgh. Would love to find one in upstate NY. Thanks for any help. (PS: have done all the conventional stuff: PT, water therapy, chiro, acupuncture, inversion, traction, laser therapy) with only temp help at best. Sherry

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Well its been 2 months since the surgery at North American Spine. Things pretty much the same. 50% pain relief. Due to being a landlord, I climb 4 flights of stairs almost everyday and the pain increases with this activity. Walking is much easier since the surgery. I still feel pretty good about the lumbar surgery as I could not even walk without tremendous pain before the surgery. The neck surgery was not as good, I still have as much if not more than prior to the surgery. They did tell me that there is 6 months of healing to feel the complete benefit of the surgery and I am hoping that this gets better as time goes by. I am doing light duty work and work a few hours a week.

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I am a physical therapist and have seen minimally invasive procedures performed since the 1980s. Certainly over that period of time, the "minimal" has become even more minimal but the results results haven't changed. I remember comments by the surgeons in the 1990s who said when you can only see a part of the spine, you miss things but just going after what showed up on the MRI. As for outcomes from surgery, it is more than likely based on the selection process and not the type of surgery. If someone needs a nerve decompressed, decompressing the nerve no matter which procedure gets the job done. Recovery is more involved with open procedures but people do recover and do well for decades! Having said that, I would choose the minimally invasive procedures if I was older and had a concern about anesthesia--the "laser" and accurascope do not require general anesthesia and for many people this a huge consideration. I have seen patients that have been to the Laser Spine Institute, some of done great, some got no results--in summary, it really didn't seem any different from more traditional approaches. If I were having surgery, I would wonder why these less invasive procedures are not performed at teaching institutions. If they are so great, why not subject them to rigorous studies comparing the procedure to traditional approaches. There are sufficient opportunities to do that so it is surprising that is someone has discovered something so revolutionary that they would not want to publish their results and capitalize on the factually based outcomes rather than the supposed success stories on the internet. One problem with this procedure is that because it is an outpatient procedure, the "barrier" is lower similar to the IDET procedures that were supposed to be miraculous in the 1990s (they weren't). The problem is that more people subject themselves to less invasive procedures potentially unnecessarily. As the famous orthopedic surgeon Jack Hughston used to say, "there isn't a surgery that can't make you worse!" Proceed with caution is my advice. Fine a 2-3 good respected spine surgeons (orthopedic or neurosurgical) who have completed spine surgery fellowships and get their opinions on whether to have surgery. Take their advice. You might also consider 2-3 opinions from physiatrists and what everyone neglects is finding several really good physical therapists in your area and going for an evaluation from them getting different ideas about how they would approach your problem non-surgically. Sometimes when you are only looking at surgical options, you miss 85% of non surgical pain generators. Just my thoughts.

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To now more about NORTH AMERICAN SPINE. GOOGLE( north american spine complaints)click on north american BAD MEDICINE AND CHECK OUT THE COMPLAINTS. It's bad news.

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Thank you Don for sharing honestly how you are feeling since your surgery with NAS. I am glad you are walking better and I wish to hear that you are 100% better soon :) You are kind to come back and let us "seekers" know how it went. Silver Herb, thank you for your perspective of time that you shared. I've wondered the same thing about teaching hospitals. I live in a city with several teaching hospitals and we have noone doing minimally invasive surgery with microscopes much less endoscopes! I have been in pain now nearly 9 mos and am really wondering if the T9-10 extruded disc will ever reabsorb or if i should let someone go in there and cut it down some. I have been doing conservative therapy all this time and frankly am not really any better. I do get some temporary relief with pool therapy and chiro, but it never really is better. I am scared to do the surgery knowing I will be faced with this decision shortly. I appreciate the medical community seeing the worth of internal healing and supporting that with therapy. I just am not sure how long to let that go? My PT has a similar L4-5 lesion to me (lateral) and after a yr she is now considering surgery herself. I really wish I knew for sure if a torn disc or extruded disc can in fact heal, shrink, ect. My symptoms have interfered with my work (RN) and my home life (5 kids, husband, church life, travel, interests, ect). So you see how surgery tempts me to fix this thing. Lumbar has 2 bulging discs and cervical has some encroachment C6-7. All three areas could use surgery but I am seeking out the thoracic first. Thank you all for your comments and causing me to consider this in different ways. I am most appreciative.

homenet

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I am very sorry to hear that your local hospitals do not utilize minimally-invasive technique and equipment. Search more, its worth !!!!

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