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Old 09-19-2008, 09:06 AM
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mmglobal mmglobal is offline
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Cheryl,

Greetings from Straubing! I'm so sorry that you are having such a difficult time getting to someone who can help you.

It's interesting that while lumbar discography is becoming a more accepted norm, cervical discography is still lagging behind. I'm in the process of arranging cervical discography for several people in the US and I've discovered that a couple of places I've had it done have stopped doing them. It's relatively uncommon and not a huge part of their practice, so it it's controversial, they are demotivated and don't want to bother.

I believe that it is controversial BECAUSE it is rare and can be done improperly and can generate ambiguous or incorrect results. Those with little practice or experience with it will make mistakes and generate negative experiences and data. As with so many things, in the proper hands, it is a most useful tool. Done improperly or even interpreted improperly, it is problematic.

With the larger discs, larger canal area and more durable nerve structures in the lumbar spine; lumbar discography is less of a problem than cervical discography. With the smaller discs / smaller volumes in the cervical spine, I think it's easier to generate false positives. I have not heard of problems caused by cervical discography, but I'd be surprised if there aren't serious potential complications.

I look forward to hearing positive news about your appt. on Monday.
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Regarding my sitting in on Dr.'s appts: Thanks for all the kind words from everyone. I'm very proud of what I'm able to do. I've done this many dozens of times with clients from all over the world. It's been great to see when patients who've been dismissed by doctor after doctor and have not been able to get a serious look, actually are listened to and get their problems addressed appropriately. It is not normally needed (but can still make an important difference) in straight forward cases. In complex cases where there are multi-focal problems, patients are too often dismissed based on their demographic. Assumptions are made about secondary gain, drug issues, psych issues or other medical problems that overshadow new or previously undiagnosed issues.
"Your films don't look bad enough to cause the problems you are reporting."
I hear this too often in cases when the patient has additional spine problems or other health problems. If the patient was a 50 year-old CEO with no other health issues, the problem would be pursued aggressively. If the problem is in a 40 year old woman with prior spine surgeries, prior chronic pain issues, and who knows what else... the new problem is completely overshadowed and they never even get a fair look (by SOME doctors.)

In the past weeks and next few weeks, I have clients from Alaska, Utah, Georgia, Canada, New Jersey and No. Cal. coming to So. Cal. to see 5 different spine surgeons, 2 neurologists and a pain management specialist - simply because they are going to doctor after doctor and unable to get any help. I wish I could easily get all around the country to help folks like Cheryl, but it's not practical. (That's why my system of remote diagnosis is so useful! Usually, by the time the patient is seeing the doctor, there has been a review and a dialog, so the doctor is already engaged in the case and has been brought past the 'demographic dismissal'.)

I have to run... Bertagnoli will perform multi-level lumbar surgery on a client in couple of hours... next week brings a very interesting revision surgery with a completely new system to stabilize a tilted lumbar ADR. (Jeff - are you reading?) I'll write more when I get some time... this whole summer has been a sprint... I hope to get some time to relax and catch up soon.

All the best,

Mark
__________________
1997 MVA
2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
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