Hi jacklondon-ga, and thanks for pointing this question to me. As
usual, this isn't a substitute for direct medical advice, evaluation,
and treatment.
As you well know, lower back problems are a major problem. As I
suggested in my answer to gummerson-ga, surgery is usually avoided
until, as in your case, someone has so-called "localizing" symptoms
such as sciatica. When there is physical impingement on a nerve root
resulting in sciatica, epidural injections can potentially provide
some temporary relief, but obviously won't ultimately solve the
problem.
Based on your description, you are statistically more likely to have a
bulging degenerated disc at the L4/L5 level causing your symptoms.
The traditional surgery for this type of problem is laminectomy and
discetomy. In this procedure, a portion of the back side of the
vertebral body is removed and the herniating disc is removed,
relieving the pressure on the exiting nerve root. Here are some good
diagrams to help you get a better idea of the anatomy involved:
http://bioweb.uwlax.edu/APlab/Table_of_Contents/Lab_03/Herniated_Disc/herniated_disc.html
http://www.relievawellness.com/images/herniated%20disc.jpg
http://www.smartdraw.com/examples/medical-legal/herniated_disc_full.htm
http://www.constantinestudios.com/surgical5.html
http://members.kaiserpermanente.org/kpweb/healthency.do?body=multimedia/hw144271/hw144271-sec.html&topic=Herniated+Disc
You can view an excellent, very straightforward video discussion of
degenerative disc disease and the typical course at this site:
http://www.spineuniverse.com/displayarticle.php/article1321.html
In additional to Dr. Heary's comments, some surgeons also place
artificial disc spacers between the vertebral bodies, depending on how
much disc must be removed. Also, I think that Dr. Heary
underestimates how often back surgery can fail to relieve a patient's
symptoms, which in some studies has been as high as 35%. Also, the
time typically spent in the hospital after the procedure is less than
the 5 days that Dr. Heary quotes.
There are also some helpful videos and other information here,
including postsurgical recovery:
http://www.spineuniverse.com/displayarticle.php/article46.html
_________
You can find an excellent overview of lumbar disc disease and sciatica
at this eMedicine site:
http://www.emedicine.com/med/topic2902.htm
As this article states,
"Approximately 75% of patients who undergo a microdiscectomy have
long-term reduction of sciatic pain and, thus, are considered cured.
Reported results vary from 65-95%. Predominance of leg pain is the
best determinant of good outcome from surgery for lumbar disc
herniation."
"The overall complication rate is 2-4% for the surgery."
You may also find this eMedicine article helpful:
http://www.emedicine.com/emerg/topic303.htm
=================
More to the point of your question, who should perform the surgery,
there is quite a bit of controversy. Both orthopedic and
neurosurgeons operate on the spine. Some neurosurgeons have told me
that they feel orthopedic surgeons are far ahead in terms of advanced
spinal interventions to retain mobility and function. That being
said, there are also major neurosurgical programs, such as the one at
Northwestern, who do very advanced whole spine reconstruction
procedures. For this particular type of procedure, involving a focal
area of the spine, my own feeling is that neurosurgeons are more used
to dealing with the nerve roots and the various complications that can
arise (such as conjoined nerve roots, etc.). I do think, however,
that most determinations of this type should be made on a case by case
basis, since it is certainly true that not every neurosurgeon is more
skilled at treating the spine than every orthopedic surgeon.
Dr. Gorek is an excellent spine surgeon. You can read more about his
credentials here:
http://www.permanente.net/kaiser/pages/c5606-top.html
He is fellowship trained at Johns Hopkins and did his residency at
UCLA. Here is a list of his publications:
Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM. Constructs
incorporating intralaminar C2 screws provide rigid stability for
atlantoaxial fixation. Spine. 2005 Jul 1;30(13):1513-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15990665&query_hl=1&itool=pubmed_docsum
Kilgus DJ, Namba RS, Gorek JE, Cracchiolo A 3rd, Amstutz HC. Total
hip replacement for patients who have ankylosing spondylitis. The
importance of the formation of heterotopic bone and of the durability
of fixation of cemented components. J Bone Joint Surg Am. 1990
Jul;72(6):834-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2114407&query_hl=1&itool=pubmed_docsum
Markolf KL, Gorek JF, Kabo JM, Shapiro MS. Direct measurement of
resultant forces in the anterior cruciate ligament. An in vitro study
performed with a new experimental technique. J Bone Joint Surg Am.
1990 Apr;72(4):557-67.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2324143&query_hl=1&itool=pubmed_docsum
Turner WD, Vasseur P, Gorek JE, Rodrigo JJ, Wedell JR. An in vitro
study of the structural properties of deep-frozen versus freeze-dried,
ethylene oxide-sterilized canine anterior cruciate ligament
bone-ligament-bone preparations. Clin Orthop Relat Res. 1988
May;(230):251-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3365899&query_hl=1&itool=pubmed_docsum
_________
I have been unable to locate a Dr. Sacil at Stanford in any specialty.
In fact, a general search didn't turn up any neurosurgeon named Sacil
(as well as several variations). If you'd like to check the name, I'd
be happy to track down some information on this person as well.
_________
Here are some other surgeons to consider:
Dr. Alan Hunstock
North Bay Neurosurgical Associates Medical Group
121 Sotoyome Street, Suite 202
Santa Rosa California 95405
Neurosurgeon
Tel: 707-523-1873
http://www.spineuniverse.com/mdpage.php?doctorID=41
http://www.suttersantarosa.org/ProviderSearch/?sitecfg=46&action=providerdetail&masterid=15190&isLevelOne=1
Dr. Hunstock has over 30 years of experience and is an Assistant
Clinical Professor at UCSF, one of the best neurosurgery centers in
the world. He is also affilicated with Santa Rosa Memorial Hospital,
Sutter Medical Center of Santa Rosa, and Warrick Hospital. He
primarily works in a small private practice with two other
neurosurgeons who specialize in spine surgery.
Here are his publications, which are somewhat remote (i.e., he is
primarily a clinical rather than academic neurosurgeon):
Branston NM. Bell BA. Hunstock A. Symon L. Time and flow as factors in
the formation of postischemic edema in primate cortex. [Journal
Article] Advances in Neurology. 28:291-8, 1980.
Crockard A. Iannotti F. Hunstock AT. Smith RD. Harris RJ. Symon L.
Cerebral blood flow and edema following carotid occlusion in the
gerbil. [Journal Article] Stroke. 11(5):494-8, 1980 Sep-Oct.
Hunstock AT. Symon L. Intracranial rhabdomyosarcoma producing bulbar
palsy. [Case Reports. Journal Article] Surgical Neurology.
12(4):311-5, 1979 Oct.
_________
Dr. John M. Grollmus
Neurosurgery
http://www.suttersantarosa.org/ProviderSearch/?sitecfg=46&action=providerdetail&masterid=8528&isLevelOne=1
250 Bon Air Rd
Greenbrae, California 94904
Phone Number: (707) 525-0696
990 Sonoma Avenue #20
Santa Rosa, California 95405
Phone Number: (707) 525-0696
Fax Number: (707) 525-8404
Dr. Grollmus specializes in complex spine surgery. He has worked with
some of the top neurosurgeons in the world, including Drs. Spetzler
and Wilson. Here is a list of his publications, which are also
somewhat remote, consistent with his being a primarily clnical,
private practice neurosurgeon:
Grollmus JM. Wilson CB. Newton TH. Paramesencephalic arachnoid cysts.
[Case Reports. Journal Article] Neurology. 26(2):128-34, 1976 Feb.
UI: 943067
Spetzler RF. Wilson CB. Grollmus JM. Percutaneous lumboperitoneal
shunt. Technical note. [Journal Article] Journal of Neurosurgery.
43(6):770-3, 1975 Dec.
UI: 1194948
Grollmus J. Spinal subarachnoid hemorrhage with schwannoma. [Case
Reports. Journal Article] Acta Neurochirurgica. 31(3-4):253-6, 1975.
UI: 1181816
Hoff J. Grollmus J. Barnes B. Margolis MT. Clinical, arteriographic,
and cisternographic observations after removal of acute subdural
hematoma. [Journal Article] Journal of Neurosurgery. 43(1):27-31, 1975
Jul.
UI: 1141981
Grollmus J. Hoff J. Spontaneous spinal epidural haemorrhage: good
results after early treatment. [Journal Article] Journal of Neurology,
Neurosurgery & Psychiatry. 38(1):89-90, 1975 Jan.
UI: 1117304
Grollmus J. Perkins RK. Russel W. Erythrocyte sedimentation rate as a
possible indicator of early disc space infection. [Journal Article]
Neurochirurgia. 17(1):30-5, 1974 Jan.
UI: 4818571
Grollmus J. Hoff J. Multiple aneurysms associated with
Osler-Weber-Rendu disease. [Journal Article] Surgical Neurology.
1(2):91-3, 1973 Mar.
UI: 4772800
Grollmus J. Wilson CB. Pituitary transplantation in dogs. [Journal
Article] Surgical Forum. 23(0):445-6, 1972.
UI: 4671152
Wilson CB. Rand RW. Grollmus JM. Heuser G. Levin S. Goldfield E.
Schneider V. Linfoot J. Hosobuchi Y. Surgical experience with a
microscopic transsphenoidal approach to pituitary tumors and
non-neoplastic parasellar conditions. [Journal Article] California
Medicine. 117(5):1-9, 1972 Nov.
UI: 4638402
Wilson CB. Ehni G. Grollmus J. Neurogenic intermittent claudication.
[Case Reports. Journal Article] Clinical Neurosurgery. 18:62-85, 1971.
UI: 9015634
Gauger GE. Grollmus J. Scanning electron microscopy o dural repair.
[Journal Article] Surgical Forum. 22:405-6, 1971.
UI: 5121422
________________________
You may also find some of these articles from a Google Scholar search
(spine, surgery, sciatica) helpful:
http://scholar.google.com/scholar?as_q=spine+surgery+sciatica&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en&lr=&safe=off
Here is the same search, limited just to articles written from 2000-2006:
http://scholar.google.com/scholar?as_q=spine+surgery+sciatica&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=&as_publication=&as_ylo=2000&as_yhi=2006&as_allsubj=all&hl=en&lr=&safe=off
========================================
I hope this information is helpful in your decision making.
Ultimately, of course, the decision is up to you. Part of the
decision making process may involve considering which of the surgeons
you feel the most comfortable with. There's no harm in meeting some
of them and getting multiple opinions. I recommend taking a copy of
your MRI with you. You may find that you feel much more at ease with
one surgeon over the others, making your choice much simpler. I
believe that you would do well with Dr. Gorek, but I would also
consider some of the neurosurgeons I listed.
Again, if you are able to clarify the name of the neurosurgeon
suggested to you (Sacil?), I would be happy to provide you with some
additional information. Please feel free to request any clarification
prior to rating.
Best,
-welte-ga |
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