My t-spine

[mmglobal]

It's time to bring you all up to date on my saga. I've been mostly absent for a while as I've been getting worse and worse for the last few months. It's been frustrating as my early success following my cervical ADR surgery in April was so dramatic. All of the symptoms we did the surgery for are completely gone or dramatically improved. Unfortunately, I have new symptoms that have progressed from annoying, all the way to nearly disabling. The new pain is down below my shoulder blades, centrally located. Until last weekend, it remained a deep aching pain that got worse through the day and worse with uptime. Also, any time spent working with my hands in front of me (like washing dishes!) really provoked the pain and muscle spasms.

It seemed as if the reconfiguration of my spine with my 4-level surgery might have provoked things. I'm taller following my surgery and I have always carried my head too far forward and now it's on a longer lever arm. I thought that things were simply muscular. A couple of weeks ago, I got facet injections T2 - T8, both sides. The results were quite dramatic as 1/2 hour after the injections, I was able to sit up and work at my computer. This was the test for me because going into the injections I was way flared up and unable to do that at all. I was comfortable for another 45 minutes, then as the injectant was wearing off, I was back in pain and unable to sit again.

A very thorough hands-on exam revealed scalenes and pectorals all very short, hence pulling me into the poor posture I described above. That gives me hope that it is muscular and that PT; strengthening the weak muscels, lengthening the too short muscles, might be effective. Last week, I started PT and gentle pool sessions. Following that I'm way flared and the pain has transitioned from the ache, to more severe axial pain.

I saw my GP today to get referral back to pain management and spine surgeon. He also ordered a new thoracic MRI. I have one from February that showed the T1-T2 herniation. My fear is that the blown T1-2 is just the start of a series of thoracic spine issues. There are other disc problems that might have been provoked by PT. I don't know what to think about all this, but it really sucks to be back into pain management and trying to function when I'm so impaired.

All imaging of the hardware implanted this April looks great. It will probably be a few weeks before the referral is processed and I'm on calendar for the MRI. (ain't managed care great.... plus $250 copay for MRI!) It will be interesting to see the advantage of the ProDisc-C Nova's and the more MRI friendly titanium plates, but still with cobalt chrome joint surfaces. We'll see.

All the best,

Mark

[Bill1961]

Mark,

I'm sorry to hear about your difficulties. If the facet injections gave you relief why would you not consider radio frequency ablation as the next step?

For what it's worth I went thru a tremendous amount of muscle spasms and pain with in the scalenes, SCM, Rhomboids and Levator that seem to have manifested after my 2nd PT for shoulder surgery (I had shoulder surgery, then 4 weeks later had (2) ADR's, 2 weeks after ADR started PT for shoulder). The Spasms also created Trigger points.

I was also told about forward posture, shortened muscles etc.. being my problem. I exercised and stretched diligently and have got everything fixed except for the Levator which feels more like atrophy than Spasm. I had an RFL 2 days ago at C3,4,5 we'll see how that works for the Levator

I would more than gladly share my details and experience with you if you think it may help you.

[Bill1961]

Forgot to mention. Even with Titanium you'll get deflection on the MRI at the levels where the artifact is. The other levels will be OK.

I had a CT and MRI post ADR. The CT is better but still some not so clear views around the spinal canal at eh ADR level.

[mmglobal]

Bill.. if it looks like a rhizotomy will help, I'll consider it. I have a very tough time believing that my problem is facets and don't know what to think about the positive injections. After exhausting other non-surgical options, if more diagnostics reconfirm the facets, I'll seriously consider the RFA. The doctors that do the ablations seem to consider them a 'freebie'... (no-risk procedure?) I know many people with successful ablations and don't know any horror stories. Even so, I don't think there is any freebie and will only consider them when other issues ruled out and diagnosis reconfirmed.

I don't expect the MRI to be pristine around the Novas, but look forward to seeing the difference between a regular ProDisc and the Nova artifact on MRI.

Call me when you can.

Mark

[steve55]

Mark, thanks for posting an update. Man, that stinks to have new issues. But of all people, you are the best qualified person who is able to sift thorugh all the medical mumbo jumbo and get to the bottom of what is causing this.

Pain sucks so bad, especially that deep between the shoulder blades pain. Although I have been through alot this year, I count my blessings that I am pretty much pain free so far. Keep us updated!!

[Maria]

Hey Mark,
Sorry to hear you've got more probs. I wondered about this long and hard w/myself even w/the lumbar surgery just because I feel my body has adapted to it's weirdness over time (that is contracted muscular/ligamental type of configuration).

I've also found that an injection of Toradol can bring me out of some terrible low back pain which I guess are simply spasms (muscular in origin). I'm beginning to think that long ago back when I was out of work for weeks at a time and in bed lying down to recover that a shot of Toradol would have shortened this whole stupid spine situation..

Oh well, hindsight. Just glad for what I now know and am able to have/do re the spine.

Hope you will get relief with whatever you're going to try. Managed Care sucks absolutely and even with a PPO and Medicare there are authorizations, copays, deducs and more stuff than I want to hear about re insurance.

Whatever happened to the "good old days" in medicine where the doctors ruled vs. insurance co's???!!!

[dshobbies]

Mark,

I suspected you weren't doing too well. I can't tell you how sorry I am. You've been through so much. Here's hoping pt helps as much as you hope.
Do you think waiting as long as you did had anything to do with these new symptoms or it is just a lousy back?

I'll call soon and we can talk. Please take care of yourself, Dale

[sahuaro]

Mark:
I am so sorry that you are experiencing such a horrific degree of pain.
The pain I experienced on waking from surgery was thoracic, not cervical, and it was bad, so I think I have an idea of what you are experiencing.
I hope this is something related to muscles or ligaments rather than spine
and I hope the MRI is helpful in ruling out further spine issues. Also be sure that your doc rules out shoulder (rotator cuff) issues.

[ans]

Mark, I'm very sorry to hear this and hope you have non-surgical method to produce a positive/pain-free outcome. Best, ans

[Maria]

Mark,
is there any scoliosis in your thoracic spine?
Re working out and flare ups~ I wonder if ight post your work out muscle relaxers might help or perhaps you're already on them every so many hours.
I do hope your t-spine stuff won't require anything too invasive. The PT all sounds good. What about in water?

[jentop]

Mark,
It really sucks that you're in so much pain. Your comments about it hopefully being muscular make sense to me. I also can relate to the fears about the thoracic spine issues too. (As you may recall my thoracic MRI in Straubing showed T1-3 discs with very small bulges-"nothing to worry about" according to the radiologist.) What kind of PT exercises do you think set things off? I have not done any PT, but am considering it. I am now 8 months post-op (ProdiscC 5/6,6/7 for those interested)and have for the most part been good, until the last week, now the pain is all too familiar. Mostly aching, progressing to pulsating pain at night or when laying down and just in the back of my neck and occipital ridge. I'm thinking that it's a combination of muscular/ligamentous but I have been experiencing the weird vibrational sensations some too. Still, I really feel positive that it was all the right decision and this too will resolve. BTW, ProSpine wants my 6 month followup questionnaire and films.(Apparently they had a staffing change, so it's a bit overdue) If they'd asked a week earlier, it would have been much rosier. Are the films necessary or just for their research/data points? I'm about sick of all the radiation etc.
Okay, I'll stop whining now. I'm sending positive thoughts your way. -Jen

[fortitudine]

Hi Mark,

I have been doing aqua aerobics for years as well as some yoga. I attribute my relatively pain-free spine to those activities as the films all attest to lots of nasty deterioration.

As I am temporarily housebound due to foot surgery, I have hired a yoga trainer to keep me fit. He told me something interesting yesterday, which relates to your comments about posture: he said that physiotherapists do things to you to help you get better and give you isolated exercises, but that yoga forces you to do all the work and build new habits. I am pretty convinced he's right.

I hope there's a happy and non-surgical outcome to this latest challenge!

Hope

[sahuaro]

The observation about yoga is quite interesting. I've been wondering if the changed mechanics of the spine after ADR (or fusion, for that matter) have been studied sufficiently in vivo to provide some real-life recommendations for us so we can avoid injury to other areas of the spine. If this hasn't been studied, there are a few doctoral disserations in the offing!

[dshobbies]

Interesting note about posture. I've had bad posture all my life despite modern dance all through high school. Since starting pilates 2+ months ago, suddenly I'm very aware of those muscles that hold you straight. I notice myself standing straighter and my hips have loosened to the point my bursitis is gone.

So far, I haven't noticed any benefit to my back but as the rest of me gets stronger, I've no doubt that will fall into place. My biggest regret is that I didn't start this last year.

Just for the mention, my left leg is still weak. I'm wondering why, if the muscles are capable and able, the nerve damage prohibits full function???

Dale

[mmglobal]

Dale, I wonder if it's possible that leg weakness is not related to lumbar... possibly cervical, thoracic or other issue?

[dshobbies]

Mark,

Possilbe, I suppose but it's the same weakness I've had since my surgery 4 years ago now. My leg (muscles) has gotten stronger and stronger but the weakness and cramping has remained the same since I was able to give up the crutches.

It's frustrating at times but it is what it is??? I'm still able to do most of what I want to do. Just wondering how or why the nerves tire easily

And while we're on the subject, I hope your muscles are working overtime and just need some time off. Would be nice.

Take care, Dale

[mmglobal]

I have a client who had relatively benign cervical issues. Dr. Baumbach identified muscle weaknesses that he said could not be addressed via exercise... If the muscles are not firing, working out does not build them up. The patient did single level cervical ADR months ago... the atrophy is now going away.

Dale... you know that I'm not suggesting that I know what is happening in your case... it's just something to consider as a possibility.

Mark

[ans]

Sorry to hear this Mark and I hope this can be resolved non-surgically.

[Eddie G]

I hope you feel relief soon man.

Your big problem is how do you scrub and sit in on an operation where you are the patient? Maybe clone yourself?

[Crystal33]

I initially read that thoracic spine herniations were not common.....until i read this MRI study of 90 random people with no spine pain history or symptoms.

"Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals"

Over 50% of the people had t spine disc degeneration, tears, or bulges but never have had any pain and were therefore unaware.

interestingly a lower % of ppl under 40 had disc tears than over 40. If tears don't heal then a higher % of >40yo should have them.

I imagine the figures would be even higher for incidence of lumbar disc injury in general population.

I guess the answer is if MRI shows a problem there is no need to worry provided u are fortunate to have no symptoms, which excludes us members here.

The incidence of injury also makes it hard for me to believe genetics is the major cause of disc problems. A light-moderate active daily life with good posture and no adverse stress or strain on spine probably is key to no problems through life but must start from childhood. Is a pity there is no education about it.

[Maria]

Mark,
Have you had any recent news re what's going on w/your t-spine?
I've been to H-dog beach w/Lola and thought about calling you but didn't know if you're able to hang at the beach w/Taffy or not.

take care and hope you can at least knock the pain out~

[Joe56]

Mark,
Do you think that the added stress on your ligaments and muscles, due to the freedom of motion in these older ball n socket designs, may be part of the problem. I am looking into the M6 disc, which adds resistance to motion. I think this looks like a major step forward. Does Dr B offer this product?

[dshobbies]

Hi Joe,

Just wanted to welcome you to the forum. Why don't you start a new thread and tell us a little bit about you and your circumstances?

Dale

[Joe56]

OK how do I do that?

[dshobbies]

Joe,

Go to main forums, then ISpine. Just down from the top of the page, in a darker blue box is NEW THREAD. Click, name it and tell us your story.

Still can't find it? Let me know and I'll send you a pm with my phone number.

Dale

[mmglobal]

Hello everyone, time for an update. I’m so sorry that I haven’t been around for so long. It’s been our rough few months, and while I’ve started to post many times, it’s difficult for me to post bad news. Over the years I’ve posted every victory and setback (in perhaps too much detail), warts and all. Perhaps the procrastination has paid off, at because now I have a little good news to go along with the bad news.

I’ll recap the situation briefly and bring everyone up to date. I seemed to be recovering nicely from my April surgery. I had my knee very strenuous and stressful trips to Germany with clients for surgery in May and again in late June/early July. Things became more and more difficult through the summer with advancing pain in the middle of my back, below my shoulder blades. My fifth trip this year was in mid September. During that trip, things got much worse. With the April surgery having been cervical disc replacement that spanned C3-T2, and my new pain being below the surgery site, Dr. Fenk-Mayer and Dr. Bertagnoli decided that the first step was to determine whether not my pain was from my cervical slash upper thoracic pain, or below it. We did bilateral facet injections from T2 to T8. We only used local. There was no steroid in the injectant. These injections seemed to be positive. However I was in so much pain before they were done and the apparent relief was relatively short lived, I wondered about the validity of the test. I wondered if there was a placebo affect from the injection. It was a really hard to sort out. I also questioned whether or not my pain could be the facets in my thoracic spine. (I’ve had several thoracic MRIs, including a one in March, and my facets have never been called out.)

I struggled through the rest of the trip in came home on September 20th. For a couple of weeks after that I continued to try to work. On a good day I might spend 4 or 5 hours at work. On a bad day I would just go in for a very short while before I gave up. Since then I’ve not been out of the house except to go to a doctor, pharmacy or to run a brief errand (very rare and only when absolutely necessary.) I’ve been able to keep the business going with my staff coming and working out of my house. Good days are very rare and should not be considered good days. They might start off with 3 or 4 hours up and about, around the house, before things get bad. Bad days grind by with a minimum pain level of 6 or 7 and with frequent bouts of 8 or 9. There’s not a single day that doesn’t include several hours of 7, 8 or 9. One thing that makes it so bad is that when the pain levels get up there, there’s nothing I can do to get comfortable. Sitting, standing room, lying, walking… no matter what I do, it stays bad.

I’m still grossly under-medicated at 3 x 10mg/day Oxycontin, plus ½ Norco 2 – 4 times/day between Oxy doses. I’ll likely be going to 3 x 20mg/day Oxy soon. All of the nonsense that goes along with this is happening in spades. The pain management doctor’s office and insurance company have been particularly difficult. On the prior two refills, even though I started a week ahead of time, they still ran me all the way out of meds up. Even with that experience, on the last refill I really had to fight with them so they would allow me to refill the prescription before the day it ran out. It’s kind of a catch 22. If you push back when they treat you like a drug-seeker, it makes you look like a drug-seeker. It doesn’t matter that their office snafu and insurance snafu’s cause you to get a 20-day refill instead of 30-day because the insurance company fights tooth and nail against 3/day dosing.

On to the good news! It’s taken me two months to push through the office and insurance difficulties, but I finally got the first round of injections here approved and we did them yesterday. We did bilateral medial branch blocks (diagnostic facet injections) from T6 to T8 (that’s two levels). The most likely level is T7-8. Dr. Barreto really impressed me with his needle skills. He was fast, accurate and generated and minimum amount of pain with the injections. I was quite disheartened when the pain and pressure I felt during the injections did not seem to be at my pain site. However, just a few minutes later I seemed to perceive relief. I was going to go work at my office for a couple hours as the true test, but decided to do something pleasant instead. I called a friend and we went down to main street for a sandwich. (it’s been several months since I’ve done anything as active as that!) For the next couple hours I “seemed” to feel better, but just like with the last set of injections I wondered about placebo affect. (Although this time the results seemed more dramatic.) The real result came at the end of the test. At about 2 hours post-injection I started to get uncomfortable and at 2 ½ hours my old pain came back very strong. This put to rest any reservation I had about the test. This morning I was a little better than usual. I don’t know if there’s residual anesthetic or perhaps lubricating that joints helped them. By noon everything was back to full on strong. Hopefully tomorrow or Sunday the steroid will kick and an ill get some relief from that as well. (I forgot to mention that in late October I had taken a Medrol dose-pack with no relief.)

I’m pretty blown away by the positive results because I did not think that this could be my facets. I thought that facets would come on slowly over the years and would be episodic to have it come on strong and last for months now does not seem like a normal presentation. I believe that what has happened is that my T7-T8 level has been bad for years, had quit moving, and was asymptomatic. In the months following my cervical surgery I did physical therapy that was specifically aimed at mobilizing my thoracic spine. My guess is that re-mobilizing this level, caused the previously asymptomatic problem-level to become symptomatic.

I have been very discouraged because the feedback that I’m getting from the surgeons about potential thoracic repairs is not good. The positive facet injections represent wonderful news. I may be able to effectively deal with this problem with something as simple as a rhizotomy. I meet with my pain management doctor on Thursday. I don’t know how long it’s going to take to push through this but with my lousy insurance I’m sure all be waiting until at least January before I can proceed.

Again, I’m sorry I haven’t been around. I hope to participate more in the weeks to come.

All the best,

Mark

[Jim M2]

Mark,
Thanks for the update. They always think we're druggies. My old roommates (family medicine doctors) used to always complain to each other about 50-something guy looking for drugs. I know they get a lot of druggies, but some of us hurt like hell. I hate to see you at such high pain levels. It drains away all confidence and makes you doubt every thought. I hope you get the meds you need, so you can make good decisions.

Jim

[dshobbies]

Mark,

I'm so sorry and feel terrible that you're suffering so. It just doesn't seem fair, but then again, it doesn't for anyone. I'll call you soon and we'll talk.

All my best to you and hope your holiday season finds you in less pain. Here's hoping.

Dale

[Maria]

Hey Mark,
thanks for the very informative update and sorry to hear the pain has been that bad.

Insurance battles suck!!!! I've gotten 3 denials since August for an ESI from WC. Or rather WC sucks. No, insurance battles suck period... yep. affirmative.

Good to hear that your pain generator has been identified and I do hope you will be able to deal with it with something as simple as a rhizotomy.

Do you have a very local PM doc or are you still going to the one in LB? I still utilize the one in San Diego as he's great with my scripts and so exacting with the transforaminal ESIs which WC has limited to 2/year should that even be authorized.

Please keep us updated and of course I'm wishing you the best with the outcome that gives you the most best prolonged relief!

[sahuaro]

Mark:
I am so sorry that you are experiencing such debilitating pain--and hassles as well. Your absence has not gone unnoticed...I hope you find a solution and quickly.

[fuzzy]

Mark I really hope you get better without mayor interventions. I have had some strong and lasting t problems that were the highest on the painscale of any back pain I have had. Extreme, nausiating, heart rate raising and strangely it seem to play ping pong with my low back. Once a chiropractor decided to push on this spot high up in my t spin and it created a sharp pain in my low back. After that I was down for weeks with serious low back pain episode. Well interestingly the lumbar surgery 2 years ago cured the t problem to a much lower level. It has come on a few times but never the level 10 pain I frequently got before my low back surgery.

Also I was surprised that I was getting a certain amount of pain in my Tspine after my recent cervical surgery. It is now getting better. I really wonder if something in your t spine got upset and as you know it takes time to heal. Remember our general wisdom. Don't push the pain and take your time during recovery. Your mayor surgery was only in april and then you went on several big trips including those terrible airplane rides (you flew coach??). Its only been 8 month.

Take it easy, maybe a few more outings with friends to get your self into a different mindset will help also (you talk about "placebo" effect). This really helps me a lot.

I really hope and wish you the best in improving without more surgical interventions but in any case I hope you will improve.

[JeffreyD]

Mark,
I'm so sorry to hear of your worsening problems. I am praying for you, Mark.
Just wondering.... do you have any significant leg symptoms?

-Jeff

[mmglobal]

My last post was just over a week ago. It was one day after my diagnostic facet injections and I was confident that the short acting anesthetic provided a positive result. The injections substantially reduced my pain for the duration of the anesthetic, then my pain returned, big time. A couple of days later it was clear that the steroid component of the injections was kicking in. I experienced some " better than ever" time. I believe that I moderated my activities up and generated similar pain levels, but these were based on higher activity. Also, the pains were relatively short lived and not as severe as a normal.

The entire week has been better than any week during the last couple of months. I believe this is because of the steroids on board and also because of increased medications. (I waited until I was certain about the injections before I upped the meds so there would be no confusion.) I met with my pain management Dr. on Thursday. I like this guy. He doesn't seem to be interested in selling me a bunch of injections or rhizotomies.

I have a tough time believing it’s my facets (even with the positive injections) because:

1. The onset of problems, going from zero to 3 months of disability does not seem to be consistent with a degenerative problem. There is no episodic nature to my pain. The doc agrees this is unusual.

2. My facets are CLEAN on MRI. I have 2 thoracic studies this year with NO MENTION of facets. The doc agrees this is unusual

3. I can arch back and forward and bend to both sides with no distress. Again... the doc agrees that this is unusual for facet problems.

4. I perceive that the problem is related to axial loading and that the pain is much like my lumbar disc pain memory that gives me this perception. The doc does not agree that pain on axial loading implies ‘not facets’ as they are a component of the weight bearing system.

The doctor suggests that because of the unusual presentation, it’s prudent to reconfirm with another round of injections. I suggested doing only one level and he’s willing to do that, but recommends doing both. (Experience tells him that doing fewer injections as often as not, provides more confusion than clarity.) I’m inclined to go along with him and he has submitted request for another round.

I finally listened to Diane and the docs about being undermedicated and agreed to up my Oxy from 3 x 10 to 3 x 20mg/day. This is a tough pill for me to swallow... this was the highest prescribed dose from my lumbar years, but things are that bad. It’s been 4 days now on the increased dose (plus the steriods on board)... what a difference! While I’m not great and am still quite limited... this is WAY better. I’m way more functional and when I do get into pain, it’s not as severe and I recover much more quickly.

I still have some decisions to make, but at least the good news is continuing.

More as it happens...

Mark

[ans]

Odd about the facets and glad you feel better. Glad you saw your PM doc and feel more relief. Let me know of my offer over Christmas break (remember?).

My best. - ans

[Maria]

Mark,
So glad you're getting relief w/steroid injex and pain meds even if you feel like it's a step back to some degree the pain relief/alleviation is nothing to sneeze at and esp. during the holiday season. Ouch upon mentioning sneezing if your back is too sensitive! Wishing you the best with all and am hoping your pain quiets down w/time as your body "settles."

[Aaron]

1. I too had immediate onset (after injury) and I am young
2. Got some relief from 2nd facet inj, supposed to have rhizo but ins. a mess. The only strange thing is I had inj. in hip for pain and the relief is totally different hip feels like arth. from injury but facet feels as if a nerve releases or shrinks it is an unmistakable feeling and it is nerve reaction after facet inj.
3. no sign of facet problems on MRI, Cat scan, bone scan which should show uptake at bad facet.
4. I too can bend back and forward with out terrible pain

I am like you mark I am not believing it is completely my facets. Do I belive that the disc height loss causes some pain in facets, absoultely. Do I belive this is where the stabbing, burning pain I feel is coming from. NO. I think the steroid is getting to others structures in the area such as inflammed nerves and the disc annulus where I have herniation and tears and causing some carryover pain relief. I personally belive my pain is mostly from my annular tears due to the amount of inflammation I am dealing with. 2 of the three were pain gens.. Have you had thorasic discogram at the new levels of pain, is it possible the fusion caused stress at other levels and created tear or exasterbated existing one?

[mmglobal]

I'm doing a little better in the weeks since my injections. Better is a relative term and I still have not been very functional. The last few days are another step up. I'm doing more around the house and am actually getting out a bit. (Went to a doctor with a client yesterday... walk on the beach today... party tonight! Wow... Almost like a regular person!)

Rhizotomy approved and tentatively scheduled for Jan 13th for first set. There was a bunch of insurance nonsense that made it take so long, but we are past that now and I'm ready to go.

Mark

[nomorepain]

Mark,
out of all of us on here, and your knowledge of the spine and of course pain, i had hoped for better results after all of your procedures. As always hang in there,hope you get this latest round figured out soon, as pain is harsh.
Heres to a better 2010 for us all!

[Maria]

Mark,
hope this upcoming procedure works for you and you'll get more mobility/function and far less pain out of it.

I'm still here in Fla as Dad went into hosp. on 12/25 w/volvulus (part of intestine flipped over on itself and was strangulating) so 12/27 he had abd.surgery and it's been a rough go for the 88 y.o. guy.

Unbelievably my spine has held up to 6 hour days in hosp. watching over him and bothering nurses tho yesterday was a very bad spine and feet day(tendonitis and PF bilat) so a pull out chair was brought into the room for me to lie down on! Pretty cool!

Need an ESI dreadfully so hope WC won't pull another denial on me when I return. The insurance BS is really a complete drag (literally).

Meanwhile hope you're enjoying the lovely SoCal weather and some beautiful walks on the beach and/or sunsets. Hang in there and best~ Maria

[mmglobal]

I decided to cancel the rhizotomy and do another round of injections. (See update here.)

I'm continuing to improve. I'm still quite limited but nothing like just a few weeks ago. Thanks so much for all the prayers and well wishes. All the best,

Mark

[fuzzy]

You know, Mark, I am very glad you cancelled the Ritzo and are buying time with the injections. Its been proven that can help you heal and not need further surgery. Well worth a try. Exercise is important.

I wish you the best with continued improvements and reduced pain!

[Maria]

Hey Mark,
Yeah, let's go get those cadillac margaritas.. that should help us both feel better!

Really am glad to hear you're doing better and hope that time allows for even better recovery!

Now my spine is having a mini revolt here tho I've been expecting it and yet been so thankful for what I can do even if it's not anything spectacular.

Actually hanging in there with a family member while hospitilized is quite spectacular and Dad is really coming along quite well ~ and so I hope you do with your spine more and more each day

[Katherine234]

Mark,

I'm sorry you are not feeling well. I can say from my experience not all PT's are created equal. I had a painful expeirence with a young PT in a busy clinic. I was in more pain after just 1 session and it only got worse.

I have had a really good and long experience with a clinic that focuses on backs and has very experienced PT's. They all do body work too.

If your insurance will allow you some choice maybe a different PT?

I hope your tests do not reveal anything difficult to treat. Hang in there the best you can.

[fortitudine]

Hi Mark,
I haven't been on this forum for quite a while, and am chagrinned to learn of your ongoing spine problems. It's just not fair! I'm so sorry you are having such a tough time, and just want to offer my sympathy and support.
Hope

[ans]

Mark: I'm sorry about the pain. I'm going to see a new PM specialist who has a good reputation. I don't know why they'd put you on an Rx that's not continuous relief (highs/lows). I disliked my UCLA PM doc (he angrily refused to answer questions) but I liked his logic that oxycontin is not ideal b/c of this vs. Avinza/continuous release. But for each, it's different.

Btw, I found a PM doc who knows the most recent techniques in SI-joint rhizotomies and I'll go for this either with her or my forthcoming PM doc (whom my internist said that his doc colleague respects as a pt. and keeps him going).

The chauffeur offer still stands; you need an excellent PM doc.

I too responded to facet injections but it was a short-lived blessing. I'll never understand why at the L4-S1 levels I felt little back pain; this did not make sense but I'll take what I can get.

Call me when you need me.

ans

[mmglobal]

I faxed an update to my doctor today. I went mostly like this...


Dear Doctor and staff,

I’m sorry I’ve been delinquent in reporting my progress following the last set of facet injections. I suppose that is normally good news for you, as it is in my case.
In the days following the procedure, I steadily improved. Day 4 and 5 brought a huge setback, but that was because of increased activity. After the big setback, I began several weeks of slow, steady improvement.

I’m still doing so much better than I was in December. My pain levels are often similar to what I was experiencing, but this is coming with substantially increased activity levels. Also, I’m experimenting with reducing my medications. It is time for a new prescription. If the doctor recommends, I would consider cutting back.


______________________________

It's wonderful to be posting good news.

I'm still far from OK, but I'm sooooooo much better than I was and seemingly, still improving. Getting snippet of time when I feel happy and close to normal is WONDERFUL. I'm still taking substantial meds, but as I told the doc above... starting to taper a little has been going OK.

YAHOOO.

Mark

PS... it's raining now, but after the storms pass... anyone up for some skydiving?

[sahuaro]

Mark:
Yahoo, indeed!!!
Margarita time!

[Maria]

Hey Mark,
I second that motion! Glad to read the good news!

[Jim M2]

Mark,

That's excellent news. Keep control over those activities. Skydiving...OMG!

[Maria]

Am I a coupla margaritas behind or something?

[mmglobal]

Continued improvement... almost too good to be true!

OMG - It hurts!!!!! so good...

Mark

[mmglobal]

It's been a while since I've posted. That is an indication of how things are going. Things did get better for January and February... good enough that mid-Feb, I took a trip to Germany with clients. The trip went relatively well and I even got some time off over there. I got to spend a few days in Maastrict and Bonn with Dr. Zeegers. I got to tour the wonderful BetaKlink in Bonn and observer some surgeries there. I got to spend several days in Heidelberg with Dr. Feil at the ATOS Klinik and see some surgeries there.

Upon returning, things went south again. It's been a tough few weeks since I've been back. I'm actually in Barcelona now, at the end of a long-planned trip for me and Diane to go visit with our son and daughter-in-law.

On the flight over, we connected in Philly. On approach, the plane made a rather steep bank; the kind that fills the window up with cars, houses, backyards, etc... While I have no fear of flying, like most people, these views occasionally come with the unpleasant, "what if the bank continues steeper and we went in" kind of thoughts. I was a bit surprised when my brain came back with the answer... "if we went in high speed, it would feel good because the pain would stop."

I'm not suicidal... not even close. But, it has been so very long that things have been so bad. When I report that I'm doing much, much better... things still aren't good. Times of relief are brief, then innocuous activities take it away.

This is the 8th day in Barcelona and there was one day that I was saying "things seem to be improving." Back to miserable the next day. The good news is that I am managing to see the sites, but I'm always right on the edge of not worth it.

More later... Diane can't see me at the computer or I'll be in trouble.

All the best,

Mark

[Maria]

Hey Mark,
It's been a long time since I've been there, in fact went after my first discectomy allowed me to feel good sitting/traveling/siteseeing.

Don't know what to say.. when I'm in substancial pain I just can't do anything much so that's what I do. I've found that while my low back seems to recover much quicker (unless prolonged sitting on cummulative basis is hapening which I don't allow) my cervical spine seems to want to be a royal pain too often. That can be a definate deal breaker when it gets bad enough to involve a horrendous migraine.

I am always amazed at what you are doing and still am. You seem to do so much that I'm sure your body is saying "what's this guy going to do next?" so remember to give yourself a real rest/break when able.

[Crystal33]

Regarding T spine, all I have been offered is a posterior lami and microD by one surgeon and a side approach fusion by another. I have stuck with the pain option instead.
This is a recent publication. Maybe too good to be true?


Minim Invasive Neurosurg. 2010 Feb;53(1):25-8. Epub 2010 Apr 7.
Percutaneous endoscopic thoracic discectomy; transforaminal approach.

Choi KY, Eun SS, Lee SH, Lee HY.

Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea.
Abstract

INTRODUCTION: Because of the increasing use of magnetic resonance imaging (MRI), thoracic soft disc herniations are being easily detected in the early stages. To avoid a high morbidity rate and other complications that are associated with the conventional approach, the authors have applied a percutaneous endoscopic technique. METHODS: From May 2001 to July 2007, fourteen patients with soft lateral or central thoracic disc herniation (TDH) underwent percutaneous endoscopic thoracic discectomy. Under local anesthesia with intravenous sedation, the authors removed the herniated disc through the thoracic intervertebral foramen after performing a foraminoplasty, which is the enlargement of the foramen by cutting the lateral and inferior part of the superior facet with a round cutter. The clinical outcome was evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS Six patients were male and eight were female, aged 21-75 years (mean: 48.1 years). Mean follow-up period was 60.2 months (15-89 months), mean operative time was 61 min. The mean VAS improved from 6.5 to 3.0 for back pain and 5.8 to 2.5 for leg pain at the final follow-up. The mean ODI scores also improved from 58.1 before surgery to 24.5 at the final follow-up. Conversion to an open procedure was not required for any of the patients. DISCUSSION: As it has been proven to lessen the morbidity rate, this percutaneous endoscopic thoracic discectomy (PETD) technique for symptomatic soft TDH is a safe and effective method that provides a direct route to the lesion under local anesthesia. (c) Georg Thieme Verlag KG Stuttgart . New York.

PMID: 20376741 [PubMed - in process]

[Keano16]

Wooridul Spine Hospital? Then its not "too good to be true", its only - TRUE.

[mmglobal]

Crystal, thanks for the post. My problem is not the disc bulge. I have a ton of room in the canal area, so I 'should' not be bothered by such a small bulge.

An endoscopic thoracic discectomy sounds interesting. Note that they are performing a foraminoplasty where they actually cut clean through the lamina in order to enlarge the canal area. Not too minimally invasive, but maybe better than the alternatives. I'd love to hear more about what they are doing.

Mark

PS... Keano... are you saying that you've heard wonderful things about Wooridul.

[Keano16]

Yes Mark. I have a few Wooridul surgeons on my FB. Also, I discusses about Wooridul with my spine surgeon from Croatia. He is fascinated by concept of their work. Recently they have opened a center of excellence in Barcelona. They are using a lot of innovative techniques like X-MR. They utilize Hoogland's endoscopic system and all other traditional MISS techniques.

Indeed, their founder and leading neurosurgeon dr. Sang-Ho Lee is one of the world leading MISS surgeons. You can look at all of their work and studies at Wooridul Hospital-Human respect, World Top Quality..

[Keano16]

WCMISST 2 (World congress of minimally-invasive spine surgery and techniques) is coming in 2 weeks time and in "Opening remarks" dr. Sang-Ho Lee is having a lecture about "The Development of Wooridul Hospital". Interesting to talk about clinic advancements at the spine congress. This means they are really doing something special in Korea.

Dr. Yeung is executive director and past president at WCMISST.