New Here, need some answers guys

[Justin]

Hey Sandy,

I'll have a read through your post later today...I'm running around like a mad man now...

I didn't want to leave you hanging.

[Terry Allen Blackburn]

Sandy:

I hate to say this but your age may be a factor in what you are experiencing. If I remember correctly, you have some mitigating things medically, at your age, that will interfere with the healing process. The other thing is that you surgery is still less than one year ago. It took me all of twenty months to feel Top Shelf after my four level ADR surgery. It was definitely a roller coaster ride. You might want to check with a physician about the possibility to get injections done in your spine to help alleviate some pain. I had facet injections and SI joint injections every three months after my ADR surgery which brought me considerable relief. These never worked prior to the surgery as I was so badly damaged. After the surgery, while I was healing, the injections worked just fine but, took a few weeks to start working after I received them each time. I went for a whole year without any but went through a bad patch before Christmas time. I was able to get SI joint injections and I am back to being much better. I was also on Lyrica for a year and a half after the ADR surgery, at about 400 Mg. This helped immensely with the nerve pain. I still think you need to give yourself proper time to heal.

Also, please check out the possibility of some injections.

Hang in there.

Terry Newton

[Justin]

Sandy, my replies are in bolded text...

Originally Posted by SandyW

Now, I don't understand my MRI from 12/2007. Didn't ask enough questions, knew I didn't want fusion. Am going to see spine doctor at Cleveland Clinic finally for a much needed follow-up (Dr. B had to refer me) and want to be able to ask some intelligent questions. Looked up terms, got some thoughts from other site, but need the explanation from the "experts."

"There is some mild straightening of the normal cervical lordosis without focal subluxation. Overall spinal canal diameter is somewhat small, suggesting an element of congenital stenosis.

There is generalized multilevel disc desiccation and degeneration, mainly involving C3-4 through C6-7.

At the C2-3 level, no focal disc protrusion.(Had a discogram in Germany prior to surgery, no pain whatsoever, Dr. FM said dye went in and out, could the procedure have caused the disc to rupture? Decision made to do 4 adr's instead of 3.) There is some mild left-sided degenerative foraminal stenosis.

Sandy, no expert here. I'll help answer your questions: in my opinion, I don't believe the procedure caused the disc to rupture. As you are aware, a needle is slowly inserted into the disc in which contrast is injected during a discogram. This causes an increase in pressure in the disc (chemical irritation, etc. etc.) resulting in pain.

Your discs are similar to "pin cushions." This is a really poor example, but it's an easy one..the annulus fibrosis is the outermost portion of each disc, in which fibers are wrapped around each other many times (picture a wicker basket) and the center of the disc is the nucleus pulposus--it's similar to a jelly-like substance that is held in place by the annulus fibrosis that encircles it. During the discogram, when the needle is inserted into the disc it "pokes" through/around the annulus fibrosis fibers. IMHO, this would not result in an annular tear, especially since the technique of discography has been greatly improved over the years. (This is not to say it has never happened in the past.) Also, the size of the needle (or gauge) that is used is very small.

With the dye "going in and out" like you describe, it sounds like the tear in this disc was pretty big. This means your disc was unable to "hold" any pressure from the injection. A smaller tear would be able to hold more pressure/dye and in theory less dye would leak from the disc at a slower rate. However, this varies depending on the grade (size and location) of the tear.

I notice it states "At level C2-C3, no focal disc protrusion." This is why discography is done--discography is not used to look for herniations per se, but it is used to look at what is termed "internal disc disruption." This means it is looking for tears that are not easily visualized on xrays or an MRI.

If you took 10 people off the street at random and gave each person an MRI, most of these patients would have some degree of protrusion (herniations) / cysts that are asymptomatic. Thus, not all protrusions are problematic -- especially as we age.

I hope this makes sense...

At the C3-4 level, there are endplate osteophytes and some degenerative changes in the facets. The sac measures 9 or 10 mm in AP dimensions. (What is AP and what does 8, 9, 10 mm dimensions mean?) There is asymmetric osteophytic foraminal narrowing more on the left.

AP is anterior posterior: this describes the way “the picture” passes through your body – here it is going “in” your neck (front) and then “out” (back) of your neck. Anyway from the literature I have read, stenosis is defined as AP dimensions of less than 10 millimeters.

At the C4-5 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac which measure 9 or 10 mm in AP dimensions. There is some osteophytic foraminal narrowing, greater on the left.

At the C5-6 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac, which measure about 8mm in AP dimensions. There is asymmetric osteophytic foraminal narrowing, greater on the left.

At the C6-7 level, there are endplate osteophytes indenting the anterior aspect of the sac, which measures about 9mm in AP dimensions. Exit foramina are only slightly distorted.

At the C7-T1 level, no major abnormality." (was there anything in MRI that said adr?, I didn't ask, just took advice, fusion or replacement, although film showed disc's making indentations on spinal cord, anything that might suggest why I have more pain now than pre-op? Not sorry I had adr's, couldn't stand the thought of fusion, but am wondering why the pain)

Sandy, there was no mention of ADR on the MRI. The MRI usually only reports on how your cervical spine and surrounding structures “look.” Based on this MRI, then your surgeon(s) decide what the next step in treatment is based on these films, other tests, your medical history, etc... It does sound like there was some compression of your spinal cord before surgery (so it sounds like you had issues that needed to be addressed one way or another—I’m going out on a limb here, as I don’t have your films in front of me).

There could be a whole host of reasons for continued pain. It gets tricky, as you know…I’m still trying to work up why I have constant bilateral leg pain after 4.5 years of pain-free life post-ADR.

I wish you the best and I hoped this helps…keep us posted.

[Maria]

Hi Sandy,
Nothing to add except welcome to this site and hope you find some answers you are seeking no matter what course of action that is taken (invasive, non invasive, combination).

[SandyW]

Justin,

You'll make a good doctor xxx and ooo's!! When I google medical terms, I just get more medical words, that I don't understand, explaining the medical term I didn't understand - like who's on first .

Is there a medical site for dummy's where they explain things like you do??

the annulus fibrosis is the outermost portion of each disc, in which fibers are wrapped around each other many times (picture a wicker basket) and the center of the disc is the nucleus pulposus--it's similar to a jelly-like substance that is held in place by the annulus fibrosis that encircles it.

I think I'm putting together some decent questions for Dr. McLain at Cleveland Clinic (he looked at my 2007 MRI and didn't say much when I said NO FUSION. Said he couldn't take me in their Mobi-C trials, wouldn't discuss Dr. B, said talk to Delamarter). I don't want him to think I wasn't satisfied with Dr. B, but since I didn't ask Dr. B these questions, I want McLain to give me some answers. (I've already said McLain wouldn't see me post-op until Dr. B called him).

WHY WASN'T THE SMALL SPINAL CANAL MENTIONED BY EITHER DOCTOR? It's pretty evident on the film. And Justin, the film does show the discs causing indentations on the spinal cord.

I would like to have a CT or a good MRI to see if there is anything, like facets, bone spurs, small canal that could still be causing the pain? Did Dr. B remove or clean up any of these things during the surgery, or did he just do a discectomy and place the prostheses? I don't want to say what my mind is thinking about if this is causing the pain. Cross that bridge when I get there.

I also have pain around the thoracic area that I didn't have before, but that might just be the bottom cervical vertebrae still healing. QUESTION?? I KEEP READING ABOUT AN 8TH CERVICAL VERTEBRAE????

I also have numbness in my right palm, little finger and ring finger that I didn't have PRE-OP. I've read that this might come from disc at T1-C7??? or maybe my elbow (chiro found weakness in finger strength, manipulated elbow, strength better, not numbness, weakness returns)

Post-op have tried chiro several times (high velocity) but stopped because pain was too intense AFTER the adjustment not during, lasted too long, caused my throat to swell and caused hoarseness. Tried massage therapy, but same thing - felt good at the time, set me back several days. No short term improvement from either.

Am hoping that my pain is all musculature (traps-scapulae) and maybe trigger point injections, time, patience, water therapy, stretching etc., etc. will help.

AND MARK NO DISRESPECT TAKEN FROM "OLD AND MULTIPLE LEVELS."

HOWEVER, I refuse to accept this. I AM STUBBORN, MAY GET DEPRESSED FROM TIME TO TIME, BUT I WILL BE LUCKY. THERE ARE A FEW MORE LIVES IN THE "OLD CAT" THAT HAVEN'T BEEN USED!

Thanks everyone for your help, it's all appreciated and encouraged! Will let you know what I hear on the 22nd. Sandy Wade

[Terry Allen Blackburn]

I would be very cautious about having chiropractic care after ADR surgery. I believe we were told; "No adjustments for at least a year after the disc replacement."

It sounds like you have some decent answers to your issues.

Justin is going to make a fine physician. I have every confidence in him as he has been there. There is no greater experience than first hand. He has developed empathy for patients as he has been one. I am proud to consider him a friend.

Terry Newton

[Justin]

Originally Posted by Terry Allen Blackburn

I would be very cautious about having chiropractic care after ADR surgery. I believe we were told; "No adjustments for at least a year after the disc replacement."

It sounds like you have some decent answers to your issues.

Justin is going to make a fine physician. I have every confidence in him as he has been there. There is no greater experience than first hand. He has developed empathy for patients as he has been one. I am proud to consider him a friend.

Terry Newton

Terry, thanks for your kind words. I've had my share of ups and downs on my road to becoming a physician, but I know this will serve me well in my career. I'm aspiring to develop your outlook on life and also in the way you are so eloquent with words. You, sir, are a dear friend.

[Justin]

You'll make a good doctor xxx and ooo's!! When I google medical terms, I just get more medical words, that I don't understand, explaining the medical term I didn't understand - like who's on first .

Is there a medical site for dummy's where they explain things like you do??

Thanks Sandy for your encouraging words! I'm a "dummy" myself, so I have to dumb things down so that I can understand them.

I think I'm putting together some decent questions for Dr. McLain at Cleveland Clinic (he looked at my 2007 MRI and didn't say much when I said NO FUSION. Said he couldn't take me in their Mobi-C trials, wouldn't discuss Dr. B, said talk to Delamarter). I don't want him to think I wasn't satisfied with Dr. B, but since I didn't ask Dr. B these questions, I want McLain to give me some answers. (I've already said McLain wouldn't see me post-op until Dr. B called him).

It's understandable that surgeons don't want to follow another surgeon's case. They are very hesitant to follow the "difficult" cases as well. Unfortunately, part of this is a direct result of our sue happy society.

WHY WASN'T THE SMALL SPINAL CANAL MENTIONED BY EITHER DOCTOR? It's pretty evident on the film. And Justin, the film does show the discs causing indentations on the spinal cord.

Some people are born with a small spinal canal (congenital spinal stenosis). This is not problematic in 100% cases, but some patients do have issues later in life. It also sounds like you needed surgical intervention one way or another.

I would like to have a CT or a good MRI to see if there is anything, like facets, bone spurs, small canal that could still be causing the pain? Did Dr. B remove or clean up any of these things during the surgery, or did he just do a discectomy and place the prostheses? I don't want to say what my mind is thinking about if this is causing the pain. Cross that bridge when I get there.

Sandy, with your ADRs you're going to need a myeolgram to visualize your spinal canal. The ADRs will distort the MRI images with artifact that will be hard to read.

I also have pain around the thoracic area that I didn't have before, but that might just be the bottom cervical vertebrae still healing. QUESTION?? I KEEP READING ABOUT AN 8TH CERVICAL VERTEBRAE????

Are you thinking about 7 cervical vertebrae and 8 cervical nerves?

I also have numbness in my right palm, little finger and ring finger that I didn't have PRE-OP. I've read that this might come from disc at T1-C7??? or maybe my elbow (chiro found weakness in finger strength, manipulated elbow, strength better, not numbness, weakness returns)

Post-op have tried chiro several times (high velocity) but stopped because pain was too intense AFTER the adjustment not during, lasted too long, caused my throat to swell and caused hoarseness. Tried massage therapy, but same thing - felt good at the time, set me back several days. No short term improvement from either.

Personally, I would avoid HVLA (I know we actually talked about this previously, so I know we are on the same page). With your age and surgical history, you should avoid adjustments to your neck from a chiro.

Am hoping that my pain is all musculature (traps-scapulae) and maybe trigger point injections, time, patience, water therapy, stretching etc., etc. will help.

Yeah, it could be muscular in nature. After such an invasive operation like ADR, it takes time for things to settle down, as your cervical spine has been adjusted to a new position (more disc height) nerves are stretched out, etc...

AND MARK NO DISRESPECT TAKEN FROM "OLD AND MULTIPLE LEVELS."

HOWEVER, I refuse to accept this. I AM STUBBORN, MAY GET DEPRESSED FROM TIME TO TIME, BUT I WILL BE LUCKY. THERE ARE A FEW MORE LIVES IN THE "OLD CAT" THAT HAVEN'T BEEN USED!

Thanks everyone for your help, it's all appreciated and encouraged! Will let you know what I hear on the 22nd. Sandy Wade

Sandy, I'm stubborn too. My wife with agree with me on this one. Funny thing is we are both stubborn. Anyway, I know it sucks, but you've got to be patient. The previous trauma your spine endured and the way it adjusted to compensate from the trauma took years to establish. ADR is a quick surgery, but the human body takes time to recover to "new anatomy" and "elective trauma" (ADR surgery). Your body doesn't know that you had elective surgery: it sees trauma as trauma and it takes time to heal and get to a new baseline.

Good luck and keep us posted about your appt on the 22nd.

[SandyW]

Thanks to everyone for all the answers. I went well-prepared w/clipboard and my list of questions !

Almost a total waste! The doctor (head of the spine department at Cleveland Clinic which is rated #3 in the U.S.) said - "I told you so!" (not his exact words, but almost) and he "wouldn't touch me with a 10 foot pole!"

He felt that any doctor who performs a multiple disc replacement (3 or 4) was being irresponsible and he would never submit his patients to unproven, experimental surgeries, something that the German doctors do regularly. Remember I saw him in January prior to my surgery. At the time he said, no fusion. I reminded him of this and ask if No fusion, No ADR, then What? (didn't ask this last Jan) His answer, "cope with it, find a way to manage it, work around it, etc., etc."

I ask for a diagnostic test to see if there was anything that might be causing the new numbness and more pain. His answer was no, he wouldn't ever recommend more surgery, I'd had enough surgery. (my anxiety level was rising even though I had taken an ativan.) He did follow up by testing my movement and strength and said these were excellent and said there were no mechanical problems with the devices. He said that Dr. Bertagnoli reported that my pain was much better when I was released. I agreed, but said that I was on oxicontin and after the initial pain from surgery I felt pretty good considering my age and 5 hours in surgery. But I thought that after 9 months I had hit a plateau and maybe there was something else causing the pain. Again, his answer was "I told you so." (I know, exaggerating, but he might as well have said it.)

He continued with no surgeons in the U.S. are doing multiples and (you'll love this) and they stopping lumbar ADR's. I replied with, "your own personal doctor, Dr. Delamarter who you highly recommended, has done 3 cervical levels" and I just talked to a gal who had a 3 level with Dr. Chapman in Seattle. His answer! "Well he's a German."

Our last exchange was (I was trying not to @# him off), "you really are a very, conservative surgeon." His reply, "yes, I am and very proud of it." Didn't want to end with his combative reply, so I quickly asked about his Mobi-C trial. He said, "I've completed two, one 1-level and one 2-level which ended well. I am very strict in picking my candidates. I believe for the good of my patients, I let others make the initial mistakes." Whoppee !! so much for trying to leave on a pleasant note.

(Sounds like, Dr. Bill Dillin, that Mark mentioned. Also understand this is probably the reason Cleveland Clinic gets the high national ratings - learn from others, make fewer mistakes. I thought teaching hospitals were supposed to help in researching new problems?)

As he was walking out the door we were both still asking questions, followed him down the hall asking about other non-invasive measures, he finally offered to recommend me to other departments for some follow-up studies, call him when I was ready to start. Guess I accomplished something.

Why are some doctors such *&#%@#??

Well, we are heading south next week. Hopefully with some warm weather, the company of good friends, water exercises, maybe a little golf, I'll return feeling much better. As I've said before, I'm stubborn and I will not accept that I have to suffer from pain. But I'll try to be realistic and take my meds if needed and seek a good PM doctor.

Thank you everyone for your support. It makes a huge difference.

Sandy ** p.s. I'm very fortunate to have a spouse who has gone thru chronic pain and understands it. Unfortunately, I was not as kind to him during that time. I've learned my lesson.