I had a long discussion with Mr Mundil, the consultant neurosurgeon. We went back over the background, and how the pain affects my everyday life. He thinks doing something about the burning sensation in my foot should be quite easy to fix as it is a single point to target. My back might be a bit trickier though due to the wide are the pain affects, and thus multiple nerves might need to be tackled, but he feels it is achievable. He would want to see me in clinic before deciding though so that he can pinpoint the pain areas.
He explained that there are essentially two ways of inserting spinal cord stimulators. One is a less invasive procedure, where they put it under the skin on the spine. In my case that would probably be just above where my current scar is, so somewhere around C4-6 vertebrae. The other option is a more invasive procedure involving removal of a disk (or 2, or 3), shaving a gap on the spinal cord side of the disk and fitting the SCS there, so it is then fixed in place once the disk(s) are reinserted. Needless to say there are pros and cons of each option, but typically they both offer 50-80% reduction in pain.
We went on to talk about what sort of lifestyle I planned to lead, and in particular how active I am or intend to be, as that can have a significant bearing on which option to go with. I explained that, whilst I’m not exactly the most active person, I do enjoy swimming and cycling, and I had recently been kayaking, which had been great fun. He said that, if I intend to do “rigorous” activity such as this, then I would definitely need to consider the invasive option. Whilst things like the kayaking would be great to do again, it’s not exactly something I’m going to do regularly, so need to think about how important that sort of thing is. I realised when talking to family about my appointment later, that it had actually left me with loads of questions; for example is all swimming regarded as rigorous – what about pootling around a pool on holiday (swim-up bars are an essential feature of any holiday are they not?😉), or doing some gentle lengths? Is all cycling out of the question, or does rigorous mean things like off-roading? I talked about this with my doctor friend a few days later to see what her thoughts were, and in her own inimitable style she said the thing I should really be asking the consultant is “as a newly single man, is shagging regarded as rigorous activity?” 😮 Her thinking is that this should give me a good gauge as to where the other activities fit! 🤣 I’ll have to think about how I bring that up at my next appointment. 😀
He went on to clarify the pros and cons. The main pro for the less invasive option is simply that – it is less invasive, therefore less risk, quicker recovery etc. The main con is that, if I do undertake rigorous activity, the stimulator can move, and thus become less effective, or even completely ineffective. The main pro for the invasive option is that once it is fitted in place, it stays there, so activities – rigorous or otherwise – are extremely unlikely to affect its benefits. Of course, the downside is that, being a fairly invasive procedure in the sense of having yet another laminectomy, there are risks associated with it (although less risk than the surgery I’ve had so far as he will not be touching the spinal cord itself), and recovery will be longer.
He left it with me to think about before we have a face-to-face appointment. In the meantime he is arranging for me to have a full-spine MRI to see what state my spine and spinal cord are in now, and check there is a suitable location to put a stimulator if I decide to go ahead.