They cut the vertebrae but did not chop any out.
Menzies, as an ex-Quack with quite a bit of anaesthetic experience, it might help if I tell you that having done a lot of GAs, epidurals, and spinals, my common quote was..."if I ever have to have surgery, it will be under LA as opposed to GA if at all possible". That's from a strictly safety viewpoint. However, if it takes a long time, or involves less that elegant positioning, such as my perineal puncture for prostate biopsy, as someone else said, being out is good.So I had the injection into L5/S1 and no relief.
Had a subsequent injection into L4/L5 and no relief.
Met with the surgeon today and talked for an extensive time on all of the options. Seems there is a minor issue L3/L4 as well but that is a ways out.
Without going over all of the conversation we are going with a fusion on L4/L5. Scheduled for July 23rd.
Understand the pressure a fusion puts on other local vertebrae, but he feels that a laparotomy will be a short term solution given the stenosis.
We did discuss doing both the L4/L5 and L5/S1 but he feels my issue is driven by the former. By focusing on one it will be minimally invasive, if we aim for both it will be open surgery.
I opted for the awake surgery. Epidural and no general anesthesia. Which will help with recovery.
Also enrolled in a study comparing awake versus general.
Going for the COVID test on the 21st and if clear will go under the knife on the 23rd.
12 weeks before I can cruise again. Around first of October. All calendars are based on cruising!
Tally ho old chaps!
Bruce, I think Menzies meant 'laminectomy' in this instance, which several others referred to as well. It is a way of removing bulging discs, by just taking out a piece of the arch (lamina) covering the disc and nerve from the back, and removing the jelly-like substance in the bulge, but does then reduce the 'gap' by reducing the disc volume, which tends to cause exiting nerve pressure later on, so not a good long term prospect. However, some procedures now either introduce a bone graft to prise the vertebrae apart, (interbody fusion) or even more recently place in there an artificial disc, after removing most of the disc, to re-establish the gap, and take pressure off exiting nerves, and sometimes that is done from the front, ie through the abdomen, and could therefore need a laparotomy.You tried the conservative moves,hope the fusion is a cure. Doing it awake is interesting,won`t you hear the trusty De Walt drilling pilot holes for the screws. I didn`t understand the laparotomy option.
In this case, Bligh's op helped stabilise the disc space and prevent further compression over time as the disc degenerates. 'Laminoplasty' means they trimmed away some of the lamina (bony arch) to make more room for the nerve exiting. However, as he said, this does not then compromise further interventions later, whereas just reducing the disc volume does.
