How I Decide on Surgery for Myself
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- čas přidán 23. 07. 2019
- As a spinal specialist having performed thousands of surgeries, Dr Shim shares his perspective on when is the right time to pursue surgery.
For more information on this subject, please visit out blog at www.shimspine.com/the-most-im...
Music: Creative Minds by BenSound
Dr. Shim...thank you so much for your incredible advice. So valuable when I was most vulnerable. Your videos provide such good advice. I was being rushed towards surgery for my L4L5 herniation, while in great pain. Your videos provided me with the knowledge to ask the right questions, obtain a second opinion, and ultimately choose a surgeon that recommended waiting and allowing the back time to recover through meds and PT. I'm now on the road to recovery without surgery. Just so you know, your videos are literally a life changer. Thanks on behalf of myself and my extended family.
You’re amazing thank you for your honesty.
Such a great message. Thank you so much.
Thank you, Dr. Shim. This is very helpful.
Awesome video, thanks so much for sharing your experience
Wish more medical professionals were like this Dr.!!
Great talk thanks doc I hope everyone that is in this situation watches this
Thank you SO MUCH! NOW I will be trying more ways to deal with spine pain. You helped me so much.
Very well said. Had almost a 2 year encounter with neurogenic claudication (stabbing glute pain while walking) Was referred to a respected spinal surgeon. He basically gave me this same talk...I changed my physical therapy just slightly, kept modifying activities and ... now I can walk 5 miles almost pain free and even hike on moderately technical trails with 80-90 percent less pain than I had a year ago.
My surgeon said "you'll know when you need me" and handed me a card.
That is the Dr. You want. I'm 80 years old and went for a second opinion because I had my first episode. Was scheduled for surgery with l4 l5 rods and screws. Started PT and got better and better and decided to cancel the surgery. After hearing this I know I made the right decision.
Update: I can now walk up to 8 miles and hike a modest amount (5-8 miles) on moderate trails. NOT getting the surgery was the correct call for me, but I did have to endure many months of very slow progress and some behavior modification (deleting some exercises, modifying others ..like keeping my knees bent and in front of me when I do pull ups). The journey was frustrating at times but worth it.
@@charlottehayward5943 what is PT? can tell more precise how to make better?
Thank you for the information and honesty. I had already had this discussion with myself and concluded that I needed to commit to all the alternatives rather than the ACDF recommendation by the surgeon
Thank you, for YOUR honest opinion
Great talk! I was lucky enough to have a great spine neurosurgeon when dealing with cervical problems. I had three herniated discs and stenosis caused by degenerative disc disease. When I moved a certain way my entire arm and hand would just "shut off", basically go numb. I did physical therapy, injections, pain meds for almost 5 years before surgery. It got worse and finally came to the point that we all agreed surgery was necessary- my surgeon, my pain Dr, me and my family. My C5-7 fusion went well, fused well and gave me great resolution of pain. He told me flat out to expect more surgery at C4-5 and probably lumbar someday. Soo had first lumbar ESI today. MRI is not pretty, but I hope to avoid surgery and have these kinds of discussions with my new spine Dr.
Excellent channel. Deserves more viewership
Extremely well done, easily understandable and helpful. Thank you for taking us thru the thought process
Thank you.
Thanks a lot for your explanation.👍👍
Thanks a lot for giving a nice speech
Best advice ever thank you sir!
Thanks for your honest video. How to weigh the benefits compared to potential risks.
I like your lecture, doc!
Awesome information!! Thank you!!
Thank you, and good luck.
Terrific advice
Awesome Video. I’m passed
(I think) the pain desperation phase, but I can’t do much including walk more than 60 years comfortably. I don’t want surgery, but at this point, I don’t want to be this limited forever either. Excellent videos Thank you so much!
Thank you doc. very informative.
Thank you.
very good point on matching goals of patient and surgeon! Thank you.
Unfortunately, patients and surgeons often talk past each other, then talk with each other. It's like almost any encounter these days. Each has their own perspective. Few try to understand the others. Please make sure everyone has the same goal, and your surgeon understands yours.
Right on the point, if the pain is not paralising your decision making
This really helped! Thanks, i have to try everything first, that includes healing time
Always do what you can to heal naturally. If you have limb or life threatening things like cancer, or an infection, or loss of control of the ability to walk or control your bladder or bowels, then it is an emergency and you need action now. Everything else (about 98% of the time) should be given the opportunity to heal without risking options such as surgery.
Excellent information.
thanks for this. i have two bulging discs in lumbar, one moderately impinging the nerves on both sides, causing lateral recess narrowing, and one minor bulge impinging root centrally. sciatia is awful.
So helpful! Thank you!!
Do you have disck?
The most difficult part is a life of suffering after you've been cast aside by your neurosurgeon after you final visit
How true thankyou.12 mths after hip replace.still can't walk.they don't give fck
That's why I didn't do it. You gonna end up worse than before you got it.
Nice video.
I'm potentially staring at a third spine surgery. I'm beyond the point of conservative measures, especially since I'm having leg weakness (again).
Despite all of that, I'm not going to let anyone dive into my spine without a second opinion, one that is at a tertiary care center and performs 100's of surgeries a year.
This video is a great start for people, especially when talking about managing expectations.
thank you!
Very informative
Thank you. I had a herniation measuring up to 12mm L 2-3 disk last April. severe pain in front of left thigh. After months had an MRI end of June and then saw spine dr, and got referred for an injection which helped a lot- within one week the total numbness Id had in the leg and a lot of the pain got less severe. I did physical therapy from July through December 9 months later Im still having leg pain and dull back ache and had a follow up MRI two days ago that shows that it has gotten slightly smaller- ( now 10x6 instead of the 7 x 10 x 12 it was before ) . At my last visit the doctor mentioned possibly microdisctecomy surgery. But I am wondering if I should have pursued , or should still- pursue- first another epidural injection to calm the inflammation and help the area heal. And more physical therapy.. maybe with a new therapist. I have been committed to walking every day which does help somewhat. I will be seeing the spine doctor on Monday for my post MRI appointment . Id like to avoid surgery if possible but also am tired of being in pain
Thank you Dr.Shim,
this video helped me feel better.
I have an apt with a neurosurgeon this month on the 26th and I’m terrified. I’m just about to get married and Im back in school ( thanks to the pandemic ) but I went from 27 years old to 72 years old in 7 months ... I figured it was just my Piriformis muscle so I stretched and pushed through the pain, I increased my running and after a few weeks of trying to workout... I was diagnosed with radiculopathy and my MRI shows that my L4L5 is extruded 14mm ( and pressing on the nerve ) among two other bulging disc ( not pressing on the nerve) ...
I really don’t want any surgeries.
I didn’t know back pain was so excruciating, I learned so much.
Thanks again Dr. Shim.
Please have thoughtful discussions. Sometimes, knowing your condition and deciding how to cope makes things better.czcams.com/video/_OWB84wL8gE/video.html
Any updates After the Hype? I did the same thing at the beginning. thought it was just a muscle pull. Ended up not being able to stand or walk or even sleep constant pain 24/7. I did have the discectomy and it relieved all my pain other than some back pain. I ended up re rupturing the disc and had fusion the 2nd time. Now I really feel 80 years old although I can sleep, walk and stand and sit with very little pain but try and jog, ride a bike, motorcycle or any PT I am in pain. Good luck and keep us posted! I hope you found relief.
see my story above. At my worst, even .25 miles of walking gave me stabbing pain in the glute. I changed up my physical therapy just a bit, managed my activities...do 40 minutes of pt every day and now I can at least walk 5 miles sans pain..and powerwalked a 5K in 33:30 (probably a bad idea). Since I am 63 I probably won't run again, but you might. Give the PT time; do the workouts exactly the way they tell you to, and when it is possible, add miles back *gradually*; I mean 0.1 miles per week at first!
Also, try some treadmill stuff on an incline; that tends to allow for better posture for people with our condition.
How are You doing now
Very good points however is pretty easy decision when you don't have a choice and the nerve root is impinged and displaced
Thanks Doctor, wise approach to the video and helpful message. More please on 'complexity' and risks.
On outcomes and expectations: I'm wondering, for example, whether I'll ever be able to carry a heavy backpack again while hiking, following my L5 S1 laminectomy and discectomy. Can you give an idea?
www.shimspine.com/restrictions-necessary-post-discectomy/
@@ShimSpineVideos thank you very kindly.🤗
😊I agree with you 100%
Curious if Ablation or Epidural Injection would be better for Back and Spine pain following a non-union Lumbar L4-L5?
Decompression of nerves must and always resolves the pain that is the main goal
its 3 years now i tryed everthing my last MRI says disc herniation which is slighty more prominent than on the prior study,,,,,that, MRI ,2 yrs ago there is proximal left foraminal extension approaching the exiting left root ,,what does that mean ,can you help
I have L2 to S 1 degeneration disk bulge ect. I am a veteran and they want to fuse all of them. 10 years ago I blew out L4.
Doc can i ask what would be most appropriate operation for me
MRI
Interpretation
Straightened lumbar spine
Focal superior endplate notching at L3 vertebrae
Mild thickening of the posterior longitudinal ligament at the T12-L1 level indenting the ventral thecal sac
Disc desiccation and left central to foraminal disc protrusion at the L5-S1 level result in disc contact on the transversing S1 nerve root in the left subarticular recess as well as in mild left neuroforaminal narrowing
I have severe cervical stenosis over 3 years now I've had injections in my neck down my back to my hips also have lumbar stenosis for pain clinics not even theme giving any pain relief I have lost over three years of my life
Wish you were my back doctor !!
Hi Doctor Shim I am from Bangladesh hope you will read my message seriously and reply. I have done open surgery last 20 days but many people say that open surgery is not very good for spine it will take two to three years to return to normal life. Whereas microscopic can do all the work after three months and is very safe. Again they say microscopic or so far gold. A little clarification on this matter would be greatly appreciated
Thanks ,Dr I have been suffering from ciatic nerve, L4,L5,S1 pain since 12 yrs ago ,I tried everything, acupuncture, chiropractic, back injection to block the pain,massage, fisical therapy, medications and nothing help me,every 3 months I have the back injection and that is the most I scare ,I m a lupus patient, fybromialgia, degenerative arthritis in my lumbar,hips .do you think that I need the back surgery?THANK YOU FOR THE VIDEO WITH INFO.👍👍
I hope you are doing better now Miriam.
How are you feeling now miriam?
U may need insert in one of ur shoes go to charpractor and have them check ur weight when u step on scale thats what i did and never had sciatic or pain bu wearing 5mm in right shoes
I had a Discectomy 6 weeks ago. Totally worth it. I was peeing in a trashcan beside my bed for 11 days waiting to get my MRI. I would rather of given birth again. That only lasted a day. Excruciating.
What do you know about Tarlov Cysts? I have 3 on my S2-S3 with pain in rectum, coccyx and pelvic floor. Sent documents to the two main surgeons that deal with them in California and Dallas. Both say I need surgery to stop the nerve compression or my nerves will die. I am so scared the surgery can make things worse.
Did you get surgery ? I have same issue
sir i have a slip disc l5s1 grade 1 will it be cured without surgery and how pls help me with ur suggession im suffering from 3 years.... my back get stiff if i sleep straight on my back
U shouldn't have to do surgery go charpractor and injections and u should be good grate 1 doesn't require surgery
How long can you wait until she is permanent? I have numbness 24/7 in my middle and index finger for 5 weeks straight. I also have weakness from what seems to be the deltoid. My arm feels less stable when raising it above my head. My severe intense nerve pain however has steadily improved after the first 3 weeks of severity. The nerve pain was all over the bird from axillary and chest you entire arm feeling like I had a tourniquet on it and lots of intense pains. The last 2 weeks those pains have decreased in intensity and duration. Surgeons are saying that the he longer I wait the more risk to loosing function from he weakness I’ll have being permanent and I feel pressured 5 weeks in to make a decision by the end of 8 weeks according to them. I cannot find information anywhere as to how long it can take to heal numbness and weakness symptoms. They are saying they don’t think PT will help me. I begin PT this coming week but will be week 6 since my injury. The first 2 weeks of pain I couldn’t even sleep it would wake me up and get me out of bed into a hot bath and nothing seemed to help and it had my blood pressure sky high but I’ve seen huge improvement in the pain but no improvement in the numbness and weakness I’m having. So at what point is surgery the best choice to preserve function and get back to living and working out and working as I am a surgical nurse so I lift limbs and sleeping patients all day! I would so appreciate a response to this!!!!!!
How are you now? Have you made any improvements.? I had similar injury like you. It took me 4 months to recover and heal but can take up to 3 years.
I also had numbness in scaitic for 6 weeks but no pain want to go for operation pls reply
I am a football player 29 suffering from disc bulge ...can i resume my career as a football player again
I was 27 year when i find i have disck in l5s1 without scitica. The doctor that time told me you have to take care or you have the surgery in future. After i heal and the pain go i start my life again and i forgot doctor recommendation. Now iam 36 the disc come back again with scitica. Right now my life changed and i need may be surgery to recovery. This is my experince.
Sorry iam not native english, Just i want you to be safe from future. Your health is more important than football or any thing else
God help you
Hey patients of mine - this is what #EvidenceBasedMedicine looks and sounds like. Jane Sleeth Physiotherapist @LuminoHealth @TelusHealth Optimal Performance
Dim shim1%
3:16
1:14
My Neurosurgeon flat out told me last week, if you were my wife sitting there I would say do not do the revision of fusion and fuse the next level. I took that as I need to wait and see if the pain gets worse or I can live with it.
Your neurosurgeon was telling you how he would treat a family member. You should consider that strongly.
@Charles Wetherspoon Thanks Charles I guess time will tell.
Adr above the fusion with a disc like lp-esp would be the absolute best option.. "Hybrid" is the term.. it should help stop adjacent segment disease
Did fusion help you ? Was told it was my choice if I wanted a fusion
@@jackattack9799 I had the revision fusion at L4L5 in April of 2023 they went in from the front. It feels much better now, but I am still having some issues with leg pain and I assume it is from the L5S1 disc that has never been addressed. Much better but honestly feel like if he had knocked out both disc in April I would be close to 100% now.
Ok, I’m breathing now. Thank you. Exhaust ALL NON-SURGICAL options first. Family discussion. Are you ready to live with worst-case results?
Once an Orthopaedic surgeon told me if I could move for 5 metres I wouldn't go for surgery.
As long as you do not have a life or limb threatening condition, you can certainly wait. If you continue to improve, you may not need surgery.
If I can walk 5 meters and am hurting worse, surgery could be an option. I did PT for my l5-s1 bulge/tear and I caused more pain more often than not
@@jeremyvbk67 I would go get the surgery done. Stop fooling around
@@davidlindgren7605 Wish insurance worked like that in the US. You gotta go thru too many steps and months of pain before surgery even is an option
@@jeremyvbk67 listen buddy, I don't really agree with you. I said get the surgery because you said the PT caused more pain than benefit. To me, that's a red flag that surgery may be your best option, and if so, PT could be a waste of time and money. If you haven't had an MRI, I suggest you get one pronto, because without that, you're just guessing about the extent of your injury. I had a disc herniation, did one session of PT with lumbar traction, that only caused more pain, so I said "no more, PT." It's called listening to your body. 10 years ago I had a neck disc herniation. Did PT, but didn't help and only caused more pain. I then had surgery which fixed my problem. I'm now getting a discectomy in three weeks for which my surgeon said there is 0% chance the insurance co. will deny it because the herniation is so big. Insurance companies can be bastards. Mine initially refused to pay for an MRI until I tried PT. B.S! So I went and paid for one on my own which proved the need for an MRI. Insurance companies love to try to deny tests and procedures because it saves them money, though there is small component of trying to discourage unnecessary surgeries, which is valid, but when the signs indicate surgery is the best option, they need to step up and pay for it. If they don't, they can be sued for breach of the insurance contract. Your best bet is to get a surgeon to recommend surgery, which should be easy since you have increasing pain. But start with getting an MRI, and don't let the bastards deny you getting one. The MRI will give you the best idea of how bad your situation might be and whether surgery is worth considering.Don't let anyone tell you have to go through months of pain and conservative therapy. Sometimes surgery is the best option and should be done right away instead of PT first. Good luck!!
DO YOU LIKE KIMCHEE??? I NOT LIKE QUITE SOUR, BUT ALRIGHT WITH RICE AND BEER
thanks for this. i have two bulging discs in lumbar, one moderately impinging the nerves on both sides, causing lateral recess narrowing, and one minor bulge impinging root centrally. sciatia is awful.