Lumbar surgery, the background
When I began having lower back pain last summer, I assumed it was temporary and would resolve with the help of some chiropractic treatments. But when I woke up on morning during the first week of August, and found myself unable to stand on my left leg, things got real.
Just a week earlier, I was driving on the highway through Tel Aviv when a siren sounded indicating incoming missiles from Gaza. Like everyone else on the road, I pulled over, exited my car and hunkered down against the dividing wall. I now realize that I never even blogged about last summer’s “Second Gaza War”. I was too wrapped up in managing a part time job with full time hours, looking out for our American interns whose parents wanted them home asap, and making sure my own kids didn’t freak out over the almost daily sirens and runs for the stairwell.
None of that mattered when my left leg became my worst enemy. Excruciating pain ran down my leg into my left ankle. I had 2 ER adventures where they made it clear that so long as I wasn’t incontinent, I was fine from their point of view. I had x-rays and bone scans, a CT indicated a herniated disc, and I figured the problem was pinpointed. After some nerve blocks that helped a little, I finally got approval for an MRI which took another 6 weeks to schedule. I had now been bedridden for more than 2 months. I was unable to drive and could barely make it out of bed much of the time.
The MRI was a revelation. I had a rare non malignant tumor in my lumbar spine, called a synovial cyst. It was huge and two surgeons and a neurologist who saw the results all said removal was the best option for returning to a fully functional life. I kept delaying. My husband didn’t want me to do it. He was afraid I would be in worse condition after the surgery. Conventional wisdom quoted me by ‘everyone’ was, “don’t touch your spine unless there are no other options”. So I took another month to think about it. The pain had become less intense, but more diffuse, spreading throughout my lower back and into both legs. I could walk and drive short distances, but by noon I had to lie flat on my back any chance I had in order to continue caring for the children. By this time I had lost my job. I couldn’t sit at a computer for hours at a time, and my mini iPad became my best friend.
I began researching options, and what surgery might entail. Since I don’t read Hebrew very well, I stuck with mostly American websites that provided information on surgical options for spinal synovial cysts. In most cases, it appeared patients required spinal fusion. Fusion surgery appeared to have a 95% “success” rate, from the doctor’s point of view. Most patients went on to experience severe pain along the spine since the fused area was no longer flexible, adding more pressure to the surrounding vertebrae.
In great trepidation, I went to an orthopedic surgeon who cheerfully told me that fusion wasn’t necessary, Yay! He suggested an Israeli developed medical device that makes fusion a thing of the past in many cases. While thinking about this new option that I hadn’t found in my online research, I decided to get a second opinion from a neurosurgeon specializing in spinal surgery.
I had the good fortune to be referred to Dr. Uriel Wald, a leading neurosurgeon with expertise in spinal tumor removal. After looking at my MRI, he felt that even the TOPS medical device wouldn’t be necessary. He wanted to remove the cyst with a much less invasive laminectomy.
I am now several months post laminectomy. It went well. I was lucky. If I had done it in the US, most surgeons would have insisted on fusion. Dr. Wald spent a total of 3 hours operating to remove the cyst that was pressing on my spinal cord and some nerves at L4-L5. TOPS would have meant much more invasive surgery. I still have some pain after a day with lots of movement, but much less than before surgery.
If I had to do back surgery again, or advise anyone else, I would tell them to get a second opinion from an Israeli neurosurgeon. Flight, lodging and surgery is less expensive than non-covered surgery in the US. For many Americans, even a co-pay could end up being more expensive.