Visit with Dr. Coufal

[Jim M2]

I saw Dr. Coufal today and I thought he was pretty amazing. I showed up with no imaging or reports. I wanted to know if he had ex-planted artifical discs to confirm what I'd read on the forum. He confirmed to having perform many explantations.

As part of the examination I could not hold up my foot rigidly when he pushed against it with his hand. It slowly gave way, especially the left foot. He said the nerve from that muscle mapped to L4-5. It is a strong muscle that should easily hold up to the pressure of his hand. I recalled the last couple of MRIs dating back several years mentioned a bulge with small herniation on the left side.

I told him about my Charite complications and my self-diagnosed DDD at L4-5. He ordered a CT Scan, MRI and x-rays. He said when the new imaging is available he would use it to come up with a strategy for ex-planting the Charite. He warned that there is the risk of dealing with the scar tissue and arteries which I already knew.

I'm very impressed with his attention to detail and his reputation. I'm glad I may have this option available. I would have preferred to go with stronger meds but that wasn't happening.

[Maria]

Hey Jim
I went with my neighbor to her 6 month visit to Dr. Coufal. He did a cervical surgery for her and I believe she will be having her low back done this coming year as well with Dr.Coufal. She is extremely pleased with her cervical results so hopefully her lumbar will have equally as good results or the best possible because of the surgeon.

I would hope if and when the time comes that I need some type of spine surgery that I could utilize Dr. Coufal as well.

Good luck with your imaging and what the New Year might bring with regard to surgery and hopefully a marked improvement!

Maria

[Jim M2]

Thanks Maria,

After Dr. Coufal is done with my lumbar problems I'll be considering him for follow up with a cervical surgery.

Jim

[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.