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???!!!

[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

[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