The NurflugelBlog is a place where I can vent my spleen about pretty much anything that crosses my mind. Politics, religion, those annoying little indignities we all have to put up with - I have plenty to say about them.

Location: United States

Friday, August 24, 2007

The Second Opinion

I got a second opinion from another neurosurgeon yesterday. That was a very interesting experience. One of the more interesting things that he said was, "I bet you had a hard time finding a neurosurgeon that would give you a second opinion", which was true. It's a small community, and I don't think that they like to second-guess each other.

This surgeon works out of OHSU, which is a different hospital in the first neurosurgeon I went to. In fact, the first surgeon interned here. I figure that a different hospital and a different surgeon would provide different viewpoints.

So, the surgeon looked at the same MRI's that the first surgeon did, and repeated the same neurological tests that the first surgeon did; but came up with different results. He agreed that I had cervical spondylosis, but that I did not have significant myelopathy, which the first surgeon thought I did. The short of it is, the surgeon didn't think I needed surgery immediately. He said that I would definitely need surgery in the near future, but unless my symptoms changed or increased, that that near future could be several years away. I noted that he took great pains not to criticize the diagnosis of the first surgeon, even though he had a different diagnosis.

Aside from telling me things I liked hearing, I felt I had a better rapport with this surgeon as well. I just seemed to get along with him better than the first surgeon. One of the things I keep hearing is that patients really need to be able to feel good about their doctors, so I think I'm going to make him my neurosurgeon. I have an appointment with the first neurosurgeon again next week, when we will go over my list of questions, but I'm pretty sure I'll go with the second guy.

One of the interesting things that came up was that he had implanted the Prodisc-C while a in a fellowship in Seattle. I asked him if he had heard of Dr. Bertagnoli , and he very neutrally replied that he had, but did not elaborate beyond that. He made it quite clear he wasn't enthusiastic about the idea of what he called "medical tourism" - his main concern was that if any complications arose you were not close to your doctor to get them dealt with. That's a reasonable concern, and I can understand that. He didn't slam Dr. Bertagnoli, just acknowledged that he knew of him.

The short of it is, this doctor felt that it might be possible to wait a few years before surgery, thus allowing more implants to be qualified and available in this country and with FDA approval. As long as my symptoms don't change or increase, the longer I wait the more options I have. Who knows, insurance may even cover it then.

However he did say that if I needed surgery now, it would be fusion. He feels that fusion's supposedly 95% success rate is hard to argue with, and that with the currently approved implant (the prestige) I can't have two levels done. Apparently the prestige hardware is not capable of being used in adjacent levels - it just doesn't fit. that's also the same reason why you can't have one level fused and a prestige disc above it-again the hardware just won't fit together.

So, for now I have a prescription for some physical therapy, and I'm going to get an ergonomic evaluation of my workspace at work to help ensure that I do not place any unneeded strain upon my neck.


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