Visit with Dr. Coufal

[Jim M2]

I met with Dr. Coufal on Friday (2/7/14). The facets are severely degenerated and one facet has fragmented. There are other issues. He feels the best approach for pain reduction is to remove the L5S1 charite and fuse L5S1 with fixation on the back side, i.e. 360 deg fusion. There will be a vascular surgeon assisting. Dr. Coufal's scheduler will call me later this week so we can talk about dates.

Having a vascular surgeon assisting will somewhat mitigate the risk if one of the iliac arteries gets accidently cut but obviously it's still a risk. Another risk is associated with removal of the plates. I pointed out in the CT that there appears to be bone growth around the edge of the plate and this may make removal messy or impossible. Dr. Cougal said he will not attempt to remove the plate if it is beyond his strength to do so safely. If it takes too much of his strength it makes for an unstable situation with the risk of damaging the spinal cord or other body part. If he can't get one or both out they will stay in and he will continue to fixate L5S1 from behind.

That's it for now.

[Maria]

Hey Jim,
Wow.. that's some interesting stuff. Kind of scary to read about it but then again in his capable hands I'm sure you would have the best chance with whatever needs to be done.

Have you had a bone mineral density test done.. just wondering..

Well when do you think this will all take place or are you still thinking about it and just in case you didn't want to do it what would the outcome be or what could you be looking at?

My OSS said my facets fused at L5S1 which alleviated much of my pain at that level but then again I have had no instrumentation at that level (hardware) or fragmentation of the facets just a failed discectomy with rebulging.

Maria

[Jim M2]

I don't schedule until later this week after they see what dates are available for Dr. Coufal and the vascular surgeon.

I am ready to do this. I don't think it will address all of my pain issues but I need to start somewhere.

I should clarify about the fragmented facet. The facet is fragmented but it is only a small single piece of bone that has separated from the rest of the facet.

[Maria]

Wishing you the best with this endeavor whenever it gets scheduled with Dr. Coufal and the Vascular surgeon!

Re the BMD test.. since you're going to get what sounds like a revision surgery or at least have more hardware placed that's why I asked about the bone mineral density testing.

[Jim M2]

My insurance voided the pre-approval application after a single attempt to contact Dr. Coufal for a peer-to-peer call fell through. They say the process must be restarted. Idiots.

In the mean time I got a second opinion from a pain management doctor at Scripps in San Diego. Contrary to Dr. Coufal he felt the L5S1 facets were not necessarily a pain generator. Also contrary to Dr. Coufal he felt L4-5 could be a pain generator. Currently the medical community rarely recommends discograms but the PM felt like it would make sense in my situation to better understand L4-5 prior to a surgery.

I feel his conclusions on my L5S1 facets are incorrect mostly due to his lack of knowledge of my history. I do like his recommendation about the discogram. In fact I would like to conduct more diagnostics to better understand the pain generators. At a patient seminar in 2004 Dr. Yeuug (of DISC - Desert Instititute for Spine Care, The Leaders in Minimally Invasive Endoscopic Laser Spine Surgery fame) said he could always find the pain generator. I wonder why surgeons seem happy with only a MRI and CT.

If anyone has any thoughts I'm all ears.

[jsewell]

Jim i have only just read this thread and none of your others if they are out there.
I had some horrible pain in my thoracic region that kept getting worse, only relieved by me laying on the floor with my legs up. (it was pretty embarrassing to my kids at the airport one day) Any way i knew it was time to get something done. the MRI and cT did not show much of anything. Of course the thoracic is the most stable area . I won;t go into the whole story , but the deciding factor in the diagnosis was from a discogram which i suggested. It is a good test . It is the reason i am out of pain from my thoracic spine.
Judy

[Maria]

Per pre surgical protocol re diagnostics Orthopedic Spine Surgeons in CA that I've seen order discograms. I've had 3.

Neuosurgeons order myelograms. I've had 2. I leaked spinal fluid both times and ended up in the hospital for a week post procedure with severe h/a. No blood patch given per each Neurosurgeon's decision.

That was as far back as 2006. I don't know if that's changed at all with regard to the difference between Neurosurgeons and Orthopedic surgeons pre surgical diagnostics so you may want to check that out for yourself.

Good luck with getting the ball rolling again re insurance BS.