Good evenng!
but I, and other members, have found that the biggest problem during research was the total inability to directly compare MISS and conventional procedures! This was/is due to the very big ELEPHANT in the room, the elephant that no one wants to take about!!
((The total lack of clinical, scientific, outcome and research information available, regarding all of the NHSs spinal decompression procedures!))
Can I ask you what is the first paper I posted ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899820/pdf/586_2009_Article_1155.pdf ) if it was not a direct comparison of the two techniques? Not only is it a direct comparison of the two techniques, it is summary of all the direct comparisons of the two techniques from the last 25 years!
I would say that there is plenty of peer reviewed research on this subject.
I strongly believe that the study was fundamentally flawed,
Let me explain using this analogy:If you walk in to a Vauxhall car dealership and ask the salesperson, which people carrier is the best?
a Vauxhall Zafira
Or
a Renault ScenicThe Salesperson may well offer you a balanced opinion, but the obvious potential for bias to cloud the opinion, is clear for all to see. The clear conflict of interest is also obvious, this is why we tend to use independent comparison web sites like WHICH and TOP GEAR.
But because we are talking about our beloved NHS, we disconnect our critical analysing skills and simply go with Doctor knows best!
Sadly Treebeard, it for these reasons, we are going to have to agree to disagree about the authors intents. Sorry!!
The paper is a dutch one - I don't know the opinion/reputation/vocation of any of the six authors, or what the situation is in holland with regards these procedures. You are talking as if this was a fix up by our NHS...? As far as selection criteria and statistical analysis it seems robust to me.
The link to the abstract of the German study that you supplied on your last post
([url]Full-endoscopic interlaminar and trans... [Spine (Phila Pa 1976). 2008] - PubMed - NCBI[/url])
was very interesting indeed, it is the clearest indicator yet of an increasing European acceptance of MISSs parity with conventional procedures. Better still, was its conclusion that in some respects, MISS is superior in those areas you pointed out in your last post Treebeard.I still have some concerns regarding the lack of obvious direct comparison in this study, but its methodology appears to be much better than the first one you posted.
The methodology is completely different and cannot be compared - this paper is an actual clinical trial - the first one was a review paper looking at lots of clinical trials (including this one!) in order to get a better overall picture!
I suspect you prefer this one because it tells you more what you want to hear...;) Here is another dutch paper I've just found which apparently shows even better results for MISS than the Ruetten paper - [DLMURL] http://www.touchbriefings.com/pdf/3224/godschalx.pdf [/DLMURL]
(However, not as scientifically robust as the other two papers)
Maybe it is I that am also looking for information that I want to hear... My wife has just been confirmed with needing surgery and has been told that it is not suitable for endoscopic as the herniation is too large (Again, I don't know what the situation is in Austria as to how available/used MISS actually is). She flies back tomorrow.
On a last note I would be interested (via PM instead of clogging up this thread) on anyones experiences and opinions on the Centre for Spinal studies and Surgery at the Queens Medical Centre, Nottingham University Hospital, and in particular a Mr. Bronek Maximilian Boszczyk as this is who was recommended by the specialist in Austria.
Thanks again, and Good night
🙂
Maybe it is I that am also looking for information that I want to hear... My wife has just been confirmed with needing surgery and has been told that it is not suitable for endoscopic as the herniation is too large (Again, I don't know what the situation is in Austria as to how available/used MISS actually is). She flies back tomorrow.
Don't be misled. Every disc herniation can be treated in minimally-invasive fashion.
Regards
Evening Treebeard
Let me see if I can clarify these points.
((Can I ask you what is the first paper I posted))
This one Treebeard.
<a class="go2wpf-bbcode" rel="nofollow" target="_blank" href=" http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf "> http://www.ncbi.nlm.nih.gov/pmc/arti...ticle_1155.pdf ))
I am not sure what you were referring to in the next bit, ending in over the last 25 years but I would just like to say that I am aware that there are many studies, peer reviewed papers and so on, but when I have dug deeper in to the quality and sources of them, what becomes clear, is that potential patients are rarely, if ever offered clear, simple, understandable and direct comparisons between comparable decompression procedures.
This makes it impossible for uninitiated, non medical patients to become fully informed and aware of available choices prior to deciding on a treatment course. Surely you would agree that this cannot be right?
((I would say that there is plenty of peer reviewed research on this subject.))
I respect your belief Treebeard, so all I will say in response to the above statement is to kindly you to ask for the following information from your Wifes Austrian and/or NHS Spine Surgeons.
Q) Please may I have all available information regarding the safety & efficacy rates, trial results and any other published paper for the proposed procedure))
If you receive enough information for a decision to make, then I offer you & your wife, all the very best of wishes for your prefered procedure!
(The relevance of this Treebeard, is that these are the criteria used to hold back the introduction of MISS into the NHS)
((The paper is a dutch one - I don't know the opinion/ reputation / vocation of any of the six authors, or what the situation is in holland with regards these procedures.))
I understand the first one was a Dutch study and the 2nd one German. I honestly dont have an axe to grind as to where studies are done or papers produced, I am just insistent about the transparency and scientific quality of them.
((You are talking as if this was a fix up by our NHS...? As far
as selection criteria and statistical analysis it seems robust to me.))
The combined power and influence of medical manufacturers, drug companies and medical personnel cannot and must not be underestimated when understanding how new treatment introductions are allocated and supported. This is in addition to any localized internal politics and shortcomings!
((The methodology is completely different and cannot be compared - this paper is an actual clinical trial - the first one was a review paper looking at lots of clinical trials (including this one!) in order to get a better overall picture! ))
I did not compare these 2 publications Treebeard!
((I suspect you prefer this one because it tells you more what you want to hear... Here is another dutch paper I've just found which apparently shows even better results for MISS than the Ruetten paper - [DLMURL="http://www.touchbriefings.com/pdf/3224/godschalx.pdf"] http://www.touchbriefings.com/pdf/3224/godschalx.pdf [/DLMURL]
(However, not as scientifically robust as the other two papers))
I think this last statement is a little unfair Treebeard!
I made to clear, that I still had reservation about the Reutten paper. This was because, as with the Dutch paper, the source of the conventional procedures stats, were not made clear in this abstract! Also, as you, yourself pointed out, the Dutch abstract was just a paper review and the Reutten was an actual trial, and I believe that this is why Reutten offers a more accurate and up to date picture. I am not a sycophant!
I sincerely hope your Wife has a good flight home tomorrow Treebeard, Im sure it is a worrying time for you both.
Best wishes and kind thoughts
SPINELF
Is it really worth the £10000 to have the minimally invasive technique?
Hello Treebeard
My post is a little late to your original question, its been a while since I last came onto this site.
First I am sorry to read about the problems your wife is experiencing, I can empathise having been a back sufferer for some years. Having read through all the posts I am afraid I am not as scientifically aware as Spinelf or Keano, but I can give you the benefit of my experience.
My back went in October 2007 and despite being in a lot of pain I was told it was muscular and given a raft of pills to take. It was not until January 2008 when I had a scan (I only got that because my husband threatened to knock out the GP) that I found out I had a significant herniation at L4/L5. Despite the word "significant" which generally indiates that it is not going to get better on its own my GP sent me home with more pills, finally signed me off work (I am a police officer!) and told me to have bed rest for three months. A week later I was getting out of bed to use the loo, felt a searing pain and the disc sequestrated.
The piece of disc which left its rightful place took out my L4 and L5 nerve. I was in agony and totally lost the use of my left leg. It was the worst pain I had ever experienced and the total paralysis of my leg was very frightening. Having been fobbed off by the NHS for weeks they decided to rush me into hospital, but again it took my husband to threaten violence to get my GP to see me without an appointment and to send me to hospital. I had no idea what was happening to me and had not had the time to research my condition or the alternatives.
I just wanted the pain to go away and to be able to walk again. I had an emergency discectomy to decompress the nerves. The pain relief was instantanous, however despite only having a sequestrated disc for 24 hours I was left with global weakness of my left leg and a foot drop. Due to nerve damage I now have SI dysfunction as my glutes are no longer strong enough to support my pelvis and on top of this my gait and balance is poor because of the drop foot.
The surgeon who removed the disc particle did such a good job that I was back in hospital the following year having revision surgery! I now have vertually no disc left at L4/L5 and in addition I sprang a leak (full thickness annular tear) at L3/L4 which the NHS said could not be treated unless I had my back fused.
I was wise enought to know that a fusion should always be the last resort and so I embarked on some research. After some searching I found Mr Knight. I checked in with those on this forum who had the treatment and in February last year I had MISS at level L3/L4 to seal up the disc wall, I have fully recovered from that and although the disc is degenerated I have not had any further problems with it. L4/L5 had a further disc protrusion which Mr Knight dealt with at the same time as it was on the same side as the leak above. I also had my nerves liberated from the various structures they had become glued to following open back surgery (scar tissue had stuck them down), as a result I had some improvment in my foot drop, sufficient for me to be able to walk without a splint.
So having had both open back surgery x 2 and MISS I can put my hand on my heart and say YES it was worth the money.
One of the important things to weigh up is the amount of scar tissue which can form following open back surgery, with MISS it is very limited if at all and Mr Knight is a very skilled surgeon. He can do multiple levels if the problem is all on the same side and he can fit it into his surgery time slot.
Of course there is an other alternative to MISS which Mr Knight suggested to me as I have a degenerative disc in my C spine which causes me problems and which he cannot help with - that is disc replacement. I can suggest Mr Shackleford who works at Warrington Hospital or privatly at the Spire in Warrington. He has a very good track record and is in high demand for disc replacment, he also does multiple levels. It gives you something else to consider.
I am sorry that I cannot help you with random studies and data - its all above my head, but I hope my input has helped. Good luck if you havent already decided on a course of treatment.
Bonnie10
Wow.. Bonnie!!!
You have gone through it all ..haven't you!!
Just had a bad situation with my back last week and had my 1st Osteo session ..was due to go in for the 2nd on Monday.. but the therapist had to cancel due to a course..
I was going to wait.. but today was another agonizing waking up session ..was on the floor unable to get up or lay back down without Mark, my husband ..it was pain i have never known before ...so done my research and going to sort it 1st thing on Monday.. without waiting around ..
Reading your painful journey I am appreciating more ...just how important it is to get things dealt with sooner..and also finding the right treatment with the person worthy of our trust !!
Thank you for sharing ! 🙂
with warm wishes
Vathani
miss-laser-spinal foundation
Just to put my two pence worth in.
After 3 previous conventional lumbar surgeries i also attended the Spinal Foundation, Unfortunately for me the ElDF procedure did not work and i still had quite alot of scar tissue left causing me problems
But what I will say is this, you will at least get an honest assessment and probably far more information than you were ever given before. I realize i had been blatantly lied to by other surgeons ( including a leading Neurosurgeon at Addenbrookes, the arrogant "son of a ........"- boy i would have a few words to say to him now).
You will find Mr Knight very thorough and will try his best for you. I think that is all you can ask.My search for a solution continues.
Keep searching fellow spineys !!!
Hi Biker, welcome 🙂
I totally agree with your post, sorry to hear you couldn't be helped though. I am in a similar situation but I still visit MK for yearly check ups to see if the situation has changed and what my prognosis is. He has got to the root trouble of my pain and no other person even looked in the right area 🙂
Hiya Cassie, Hiya everyone!
Hi Biker, welcome 🙂
I totally agree with your post, sorry to hear you couldn't be helped though. I am in a similar situation but I still visit MK for yearly check ups to see if the situation has changed and what my prognosis is. He has got to the root trouble of my pain and no other person even looked in the right area 🙂
I am sure that you are all getting fed up of me banging this particular drum, but as the variety of surgical options in the UK is so limited, I feel it is increasingly important to talk about the truth.
For 7 years, I have experienced the same painful condition of my right sided L5/S1 level, which is worse when I am standing and bending backwards! All of my lower lumber, hip, glute muscles, hamstring and calf muscle pains, spasms and symptoms have not changed in those 7 years. 6 MRI scans and reports have confirmed a disc bulge exists at that level, and I have 'repeatedly reported' symptoms which concur with the accepted knowledge of the autonomic and peripheral neurological pathways! All the clues are there!
But because the MRI scans do not show my disc compressing any nerves 'whilst I lay flat on my back' the Surgeons refuse to make the connection that 'when I am in the standing position' it would probably compress further under loading and close the apparent gap and will probably complete the compression of the nerve or nerve root. But no!!
Mr. Knight has operated on me and successfully removed my sciatic pains, during that operation, he saw the L5/S1 level nerve impingement, and as it turned out nucleus pulposis leak! with his own eyes, via an colour image Endoscope! He reported this in a post op GP letter. No NHS Surgeon will accept this diagnosis, even though Mr. Knight is the only person to have operated on me and seen inside my spinal canal!!
The blatant lies that Biker refers to in his post also happened to me and Im sure many other members too! In consultations with me, Surgeons have altered proven physiological facts, given me totally spurious clinical outcome figures, fundamentally reversed their own diagnosis to suit their required outcome, ignored neurological evidence & invented imaginary surgical procedures!! All of these lies and more, just to prevent me receiving NHS funded treatment at The Spinal Foundation.
So determined are they to stop me, they hint and suggest that Mr. Knights procedures were experimental or unsafe and that Mr. Knight himself is somehow an unworthy Surgeon!! I could not get them to give me any evidence to support these outrages suggestions.
Neither could they supply any evidence to prove that 'their own procedures were Safe, Effective or Appropriate!!!
Mr. Martin Knight is the most thorough, knowledgeable and considerate Consultant I have ever met in the 24 years of my back pain history!!
The only reason I am unable to go back to MK to clear my remaining lumber level, is purely funding costs, which I am less happy about, otherwise I would be there like a shot!! I am currantly considering more cost effective surgical options in Croatia with the help of Keano16!
Ranting over!!
All the very best to all of you still suffering
SPINELF
Martin Knight
If anyone requires and information with regards to Mr Knight etc please don not heistate to contact me. I had a procedure done with him in Oct 2006. Any questions or advice...
Regards
Lisa Sinden
Hi - Would be interested to know of your experience.
Thanks
Discography
What do you make of this Spineelf?
[url]2009 ISSLS Prize Winner: Does discogra... [Spine (Phila Pa 1976). 2009] - PubMed - NCBI[/url]
CONCLUSION:
Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.
The quality of any trial in all its parameters, the integrity of those involved, and the paymasters can all influence the results.
If this is of the highest standard it shows that intervention can be damaging. But it appears those who need intervention for their back pain are so desperate for relief that intervention in any form that may relieve the pain is necessary. Whether this process has anything to do with Martin Knight I have no idea, but by reputation he solves more people's problems than most.
I do so urge those with disc problems to look at their diet and follow something [url]like this[/url]. An acid-forming diet can ravage the body, particularly bones and cartilage as it is pro-inflammatory. The current Western diet is pro-inflammatory - it is a recipe for disaster. We are looking at the distinct possibility of the younger generation dying before their parents because our food is so unhealthy in general. One only has to look at the health of the Chinese since they have started to adopt the 'progressive' Western diet trends - it is progressively unhealthy 🙁 - they are suffering increasingly from diseases that have become so common in our society.
As a small example, a Dutch friend who lived many years in Indonesia found that even though the local population was so poor, they increasingly demanded the 'posh' white rice - it is what richer people ate. So the rice was polished in one factory and the brown bran was sent to another factory where the vitamins and minerals were extracted and sold in pill form to the Western companies who demanded quality natural vitamins! Meanwhile the poor people started to get sick and couldn't afford to pay for the expensive Western medicines to 'cure' them, many becoming crippled by their illnesses. It was impossible for them to understand that the simple change from wholegrain to white rice as their staple food could make so much difference to their health.
It seems almost as impossible to get people in our society to understand that so much damage is being done to us all by consuming those oh-so-convenient processed foods at cut-down prices, and then telling us we don't need vitamin or mineral supplements because they might poison us :eek:. Statistics and trials of all sorts can be skewed to suit the wanted results, as is being uncovered all the time.
Eating the right foods can change how you are. The body has an amazing ability to heal itself given the right tools - that is, the right food. And, yes, stress plays a major part too. It is imperative to find ways of dealing with this and it will be different for each individual. There are almost as many ways to sort it out as there are illnesses - but it is a necessary part of the healing process - so please find a suitable way to destress!
Wishing you all the best of health.
What do you make of this Spineelf?
[url]2009 ISSLS Prize Winner: Does discogra... [Spine (Phila Pa 1976). 2009] - PubMed - NCBI[/url]
CONCLUSION:
Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.
To be fair, it's nothing new, although pretty scary to see it written down bluntly, but of course the invasion of a discographic examination will cause problems, after all they are invading the disc and injecting dye into it, but the idea is that the benefits of diagnosis and determining if the disc is leaking outweigh the negative aspects. Usually the disc targeted is going to be operated on anyway.
What do you make of this Spineelf?
[url]2009 ISSLS Prize Winner: Does discogra... [Spine (Phila Pa 1976). 2009] - PubMed - NCBI[/url]
Hiya Billieboy and welcome.
At face value and going by the abstract, I find it very interesting!
I can imagine that there could be an introduction of degenerative conditions, caused by invasive procedures like this!
I would imagine that their next step would be to analyze the chemical components of the Discographic Contrast Injections, to see what could be causing this persieved deterioration!
Do you know if they are working on that Billieboy?
Having read the abstract, I do have some concerns with the methodology, mainly the fact that the ages of both groups were not displayed and as many back pain sufferers deteriorate naturally after their late 20s early 30s, I feel that this omission is unsatisfactory.
Also, the abstract states that, Seventy-five subjects without serious low back pain illness underwent a protocol MRI and an L3/4, L4/5, and L5/S1 discography examination in 1997. I think that to give this control group who had no serious low back pain an invasive procedure such as discography, was at best questionable, whether or not they were willing.
But that aside, I welcome studies such as this, as it does offer us sufferers with at least some incite into the risks of spinal procedures. My sadness is that Standard spinal decompression procedures offer no where near this amount of detail for us to peruse.
Thanks and best wishes
SPINELF
Just by short observation. Carrage (author of this article) is one of the world leaders in analysing and researching discography... By his work, many of world leading spinal surgeons have QUESTIONED but NOT ABANDONED discography as valuable diagnostic method.
In addition Billyboy, I remember reading somewhere that Discography was being restricted in some parts of the NHS, maybe due to what Keano says about Carrage's work? Either way it does seem to me too, that there are 'at best' conflicting studies regarding the benefits of the procedure. As for me, I'm not keen on the idea!!
Cheers
SPINELF