My Thoracic Discography - NEGATIVE

[mmglobal]

Sorry my capacity for posting is quite low. I'm in Bogen with a client and was OK for the first few days, but yesterday was very bad and I was down from 3pm.. could not even go out to eat. (Thanks Tim for bringing the Pizza!) If I can get through today, I'll be OK.

Was scheduled to come home on Monday, but instead I'll drive (6+ hours) to Holland. Tuesday, I'll go to the BetaKlink for discography. I had a wonderful conversation with Dr. Reul last night. When I was lamenting the fact that if discography was positive, thoracic fusion was indicated, he disagreed. It was great the way he put it:

"You look too much through orthopedical goggles!"

He suggested that fusion is not necessarily the next step. Perhaps PLDD (percutaneous laser disc decompression) or other MISS procedure would have an impact on my pain syndrome. We'll see. I'm glad that I get to continue the investigation there.

I have some clients with similar situations. I really love it that I have experience that may help them with their problems, but do not wish to acquire this experience by going through it myself!

I'll keep everyone posted. Wish me luck.

Mark

[Hooch]

Good luck. You'd think this has to stop for u sometime. Hopefully stem cells kick on a bit and give some options too.

[Keano16]

Well said by dr. Reul.

Depending on tear size, PLDD or endoscopic treatment should indeed be a first line of treatment for annular tears.

Good luck Mark!

[Maria]

Mark,
You are amazing! Or should I say your repaired spine is! Hope your t-spine allows you to resume traveling for further diagnostic purposes for yourself and although you are going thru it I do hope there will be good options for you (that unfortunately you are discovering re your own spine) and others as well! Hoping you have as safe and pain free travels as possible!

[newhere]

good luck Mark

[jsewell]

Mark i am glad you are having the discography , it should show the painful discs as mine did . You are the best person to be helping clients, they are all very lucky. good luck
judy

[Gil Denis]

HI Mark

I wish you the best You have been through the ringer

Lets catch up when you return.

Gil

[dshobbies]

Mark,

I'm so sorry you have to go through all of this, yet again. Good luck - I'm sending you my angels.

Dale

[mmglobal]

Postponed till Thursday.

I had a long discussion with Dr. Rosenthall while I was driving from Bogen to Maastricht on Monday. He practices near Frankfurt and is a leader in thoracic spine. He developed something similar to VATS at the same time that Regan was developing VATS in the US. He's also done many XLIF procedures and is working on some alternatives to VATS and XLIF. I look forward to meeting him and learning more.

Counting down the hours till my wonderful discography!

Mark

[steve55]

Well, Mark, .... it looks like we both had our procedures today. I had facet injections at c4 and t1. It's the first diagnostic step for me that might ultimately lead to a thoracic discography myself. I'll be interested in seeing your next update.

[mmglobal]

Discography is done. I can't say enough good things about Dr. Reul. I have heard so much about how difficult and risky thoracic discography is. Some of the doctors I know who do discography warned me against it. When they found out that I was having it with a doctor with a great deal of experience with CT guided discography, they were more relaxed.

Having been in the procedure room observing more than 50 discographies, I have seen many that were very well done, and some that were not so well done. This was my fifth discography and my 11th level tested. As with all the two other needle procedures I had with Dr. Reul there was no sedation. However none of the past procedures were discographiy.

This procedure may have been the easiest of all the needle procedures I've experienced. Dr. Reul's caring, skill and experience are amazing. The pain I experienced on needle placement was very minor. He would get the needle close to where he wanted and take an image. He'd adjust the needle placement and repeat the process. There was not an intense pain when he penetrated the annulus as I have felt on other discographies. I was surprised to learn when he was all the way into the disc.

When he pressurized the disc, I felt a low-level pressure. At times I felt a very momentary sharp pain that shot horizontal across my ribs. People with thoracic problems will know that pain. However, none of what I felt was "my pain". My notes say 5 - 6 out of 10 NON concordant pain. Negative test.

I didn't know whether to be happy or sad. I'm glad that I'm not looking at thoracic fusion. I'm sorry that we still don't know what the problem is. Dr. Reul suggests going back to the facets. I'll write more later. I don't want to type a lot now.

Here are some of the images from today. The post-disco CT shows a pretty typical degenerated disc's distrubution of the contrast. The red arrows point to an accumulation in the 'sub ligamentous' space. The disc is herniated with an open annular tear. However the herniation is 100% contained by the posterior longitudinal ligament.



Note how narrow and curved the space where he needs to get the needle through is. This is why this should only be done with CT guidance and by someone with a great deal of experience. You may ask, "how can a doctor gain the experience?" The answer is, ON SOMEONE ELSE!

Mark