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coflex v. fusion

Started by engr_x2 on 02/21/2017 8:31pm

I spent the last decade plus looking at multiple approaches to my back problems that started with numbness in both thighs. I wasted six years before thinking about any "medical procedures" and so I hope this post will help others that are similarly dragging their heels. --Over this wait time, I did lots of PT, daily core strengthening, and a daily visit to the Jacuzzi tub.

An MRI done three years ago showed severe stenosis at L4/L5. I was also warned of the possible on-set of Cauda Equina Syndrome and since I travel a lot, didn't relish the thought of emergency surgery overseas. Went through the 5-step insurance protocol for surgery and investigated several alternatives. Bottom line is that I just had Coflex inserted at L3/L4 and L4/L5 with limited decompression surgery (Coflex is only for L1-L5 in skeletally mature patients) . The constriction was something over 90% at L4/L5 and after 4 weeks of recovery so far, everything is on the upswing and the opioid use is on the downswing. But the most important thing I wanted to communicate is the tortuous path to finally get this more up-to-date treatment. ..for the US at least (albeit used ~10-15 years in Europe). --But it was worth it.

I do research for a living and so used the same approach to make the decision whether or not to move ahead with the Coflex procedure/limited decompression surgery. I considered steroid injections, standard fusion, and the so called x-stop. I read some very good studies on various approaches and Coflex v. fusion (use Google Scholar ...and don't let the fancy paper titles scare you) and they are even somewhat readable once you wade through the jargon (..which I have heard others say is a technique to keep people from communicating effectively... ). My conclusions were as follows (Please note that I am not a medical professional and these conclusions were for my personal decision only!!)

(1) Steroid injections are OK, but studies show that they remove the pain reflex action and patients think they are "fixed" when in fact they are not. So patients tended to abuse their backs thinking everything was OK and ended up doing more damage. So the recommendation from that study was to minimize the number of injections and if there is a structural problem as indicated on an MRI, fix it with surgery instead of masking it with injections. Patient outcomes were better in the long run. But because of insurance protocols, I did have two injections. One lasted 3 months, the second about 1-2 weeks. (2) On fusion, I am a fairly aggressive downhill skier in my 60s and so I was concerned with transferring the stress that would now be concentrated above and below the fusion and eventually taking out those joints also. (BTW-skiing perfectly should not hurt your back ....but I have yet to meet a "perfect" skier). The effect can continue to propagate and require even more fusions. Having talked to four surgeons, none could guarantee that this effect would not happen. In addition, they usually remove the back side of the vertebrae (the so-called spinos process) which concerned me that the spinal cord would be less protected as nature intended. (3) X-stop was no longer available at this time. I talked to the inventor and personally, I did not see any difference between this device and fusion (except for procedure) as it did not have the "springiness" of the coflex device. The x-stop and similar devices are intended to limit range of motion which I did not want.

---So I went with Coflex. Although there is some restricted rotational movement along the spine, the "springiness" is maintained at each vertebrae in the up/down direction. So that unlike the fusion procedure, the stress the entire spine takes stays distributed.

Coflex is not a silver bullet that fixes everything and it may not help everyone. The original pain disappeared right after surgery. But recovery is slow (6-10 weeks) with many ups and downs.... especially as nerves/muscles realign and pain signals start getting through again, but I am very hopeful on the final outcome. Like I said, 4 weeks have elapsed and am weaning off the opioids and hopefully can start PT in another couple of weeks. ---And am still convinced that I made the right decision even though I still have my “peak pain” days ….just as my surgeon said would happen. --Next year, I hope to hit the "steeps" and "chutes" ski slopes again, but my surgeon says I may want to hold off on the Volkswagen size moguls on the infamous "Face" since I am not getting younger. –Oh-well, but life does have to change somewhat as we age.

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