My c-spine acting up again... (discography results)

[mmglobal]

Here is a tip, boys and girls.... with a 10 month-old around the house, you cannot walk around in the dark. Last Thursday, I tripped over some baby stuff and had a great fall. Good thing I didn't drop the laptop... but I did break the cable-end for the AC adapter. Got some good bruises, but I thought that I was just OK. Just a few hours later, I was beginning the 20 hour travel ordeal, LAX to Munich. The flight to Atlanta was OK, but by the time we boarded for the ATL-MUC flight, I started to notice that all of my c-spine symptoms were flared... not too bad yet... but definitely there.

In all the trips I've taken with clients for their surgery (now more than 20), this is the first one where I've had a worse time flying than my client. Interscapular pain constant with great increase if I turn head in either direction or put my chin to my chest. Extension is OK. Hand numbness was worse, but that has gotten better. Neck/upper back pain is a little better, now 4 days later, but it's still way significant compared to before.

Those who have followed me on the forums for years know that I've been talking about getting discography on my neck for the last 2 years. I've always been too busy and my pathology puts me into the 'quality of life' decision category instead of needing to do surgery because of more significant symptoms or fear of permanent damage. This has me motivated... I'm always an accident waiting to happen. I know this isn't getting better on it's own. I should have time on this trip to do the disco... if the results are conclusive... I may be good to go. The problem is that I have 2 obvious bad levels, plus a third level that may be causing some unusual symptoms that are difficult to correlate. We'll see what the disco shows... hopefully Friday or Saturday... I'll know more.

All the best.

Mark

[dshobbies]

Mark,

I wish I had the words to express how sorry I am for your pain and plight. I believe your own sufferings have turned you into an angel of mercy for so many of us... you have walked a mile in our shoes... but it ultimately makes it no easier to bear.

You also need to know that in a marriage, it is usually agreed upon that only one of you can go crazy at any given time so you'd better discuss this flair up with Diane and decide which of you needs to take care of the other! Maybe you can delegate that responsibillity to the 10 month old.

Please take care - and I hope this doesn't affect dinner

All my best, Dale

[ellecincos1]

Mark,

When my children were little I constantly looked down to the floor to make sure I wouldn't fall and break my neck. The large amount of toys all over the floor kept me in a constant alert. Luckly I mastered the technique to jump over them. I hope with some antinflamatories and rest it will calm down and feel better. I agree with dshobbies you have walked in our shoes we don't want you to have to also deal with more pain issues. I hope all goes well.
Take care

[KL Aguilar]

Mark, I am so sorry to read this, but thank you for the new word (for me) to describe my almost constant companion: interscapular. Flexeril helps for me and I have gotten trigger point injections in the last month that have made a big difference.

[fuzzy]

I hear you Mark, I am still watching very carefully where I step even though the few minor mishaps I have (already) had clearly show that my spine is a lot better then it was before, but I really dont want to chance any more trouble down the road (no more motorbikes, traded those for some more camera gear!). Dr. Z. told me to "live life, don't worry about spine .. but at the same time to always use the hand rail." When ever I "forget" to use the handrail and my wife reminds me of Zs words it becomes very obvious how we become complacent so easy in light of lower painlevels. I tripped over one of the cats a couple of days ago, o boy!

[fortitudine]

Mark,
I hope your pain disappears, and I hope you don't show up as needing surgery ASAP. Keep us posted.

[Maria]

Hey Mark,
Yeah that can be so limiting as well as incredibly painful when the cspine flares up. My acute incident took me a few weeks (3) plus toradol shots every week and being very careful to get over and then a few months to be rid of the weird sort of guarding pain.

Acutely I couldn't even look downwards w/o severe spasm/pain in neck and rotating head left to right wasn't even possible. That was so weird and actually worse than my lumbar spine in terms of limitations.

Good luck with your disco results and whatever you might do. Hope you get yourself taken care of pain and spasm wise and your trip back is easier on you.

[mmglobal]

Thanks for all the kind words... all the acute stuff is almost gone (6 days after fall)... not too bad now. Focusing on this kind of brings it home... how limiting the daily stuff is. It's strange not having acute pain, but by the end of the day, what seems like a minor, dull ache; pretty much has you exhausted. Trying to sit and get some work done when something is gnawing at you is really difficult.

We'll see what the discogram says. It'll be wierd being on the table.

"Ow, ow, ow.... that's a ten!" said Mark.

"I haven't even touched you yet" said the doctor.

Take care all... I'll keep you posted.

Mark

[mmglobal]

Well, I got the answers I needed, but they are not the answers I wanted. Maybe they were.. maybe not. I've been trying to get this discogram done for a couple of years now... but I'm always too busy or Bertagnoli's out of town towards the end of the trip, or I can't consider having a discogram done the day before I have to fly home. It's done now.

C5-6-7 both look severely collapsed w/big osteophytes. C3-4 clearly has a significant bulge, but it's unclear how it it's involved in my symptoms. Remember that this is not about discovering about bad discs as we already know that... it's about discovering if there is a very positive relationship between the discs that seem bad and my symptoms. The symptoms we are not sure about are the neuro symptoms on the side of my face. There is no dermatome from my bad discs and that area. Some doctors pooh-pooh the idea that a symptom pattern that doesn't match a dermatome could be in play. Others have seen too many unexplainable situations to simply write it off as impossible. (Note that before I told Baumbach about C3-4, he told me that my known bad C5-6-7 are mostly not involved in this symptoms... probably higher up.)

Bertagnoli did C3-4 first. As soon as he attempted to pressuize the disc, he noted that he was unable to generate significant pressure as the dye immediately extravasated into the canal area. "Just like on Tuesday" (Some of you will have read my post in another thread about the surgery a few days ago.) With higher volume injection, he generated 7/10 pain in my shoulder. More importantly, it also generated a warm tingly feeling over the entire left side of my face in the same pattern that I usually experience. The rest of the day, that has been more active than usual.

He then moved to C5-6. He was better able to generate pressure, but the disc is pretty severely broken down... there was no question about it needing ADR.... only if it is involved in my symptoms. He clearly generated 8/10 without too much pressure, but the pain was only similar to my pain. I could not really call in concordant.

I suggested that we already knew that C6-7 was completely compromised... No need to test it. Bertagnoli agreed. Upon further consideration, while I did not want another needle in my neck, I was not comfortable with the non-concordant response at C5-6, so I asked him to continue. 9/10 concordant pain at C6-7.

Bertagnoli had to leave, so we did not get to debrief the results. I don't expect any surprises, but I look forward to the lengthy discussion we'll have tomorrow. What I know for sure is that if I'm considering cervical ADR, I'm clearly a 3-level procedure. These three discs have looked like this for some time and will not get undegenerated with time. I'm glad to get confirmation that my neuro symptoms in the L side of my face are related to C3-4. My interscapular pain is likely related to C6-7. However, I am still very high functioning to consider 3-level ADR. I cannot consider surgery before the GPN conference in May, in Miami. So, now I know. I'll let this cook for the next few months and if things don't improve substantially, I'll probably have 3-level Cervical to go with my 2-level Lumbar ADR.

While cervical discography without any sedation was quite painful, I've been functioning pretty well since then. It's 9:30pm and the procedure ended about 3pm. I've been to the hospital to visit my client (she's doing quite well.) I had dinner in my room, but went out later for coffee and dessert with a friend and have been working for the last few hours back in my room. I'm still a little sore and a little nauseous, but I've only had some Tylenol and ibuprofen. (I don't even carry a vicoden any longer.... probably should.)

I hope that the blow by blow report helps someone to understand the process better.

All the best,

Mark

[dshobbies]

Mark,

That which doesn't kill us only makes us stronger and in your case, you only continue to get better at what you do. I'm so sorry that you are experiencing cervical disc degeneration with the subsequent pain and further surgery but your reward, if one there be, will be an empathy for others that has no parallel.

On another note, and I know I've posted this before, is that though a discogram without anesthesia is painful and for me, a huge deterrent in going to Germany, it isn't as bad as it sounds. Yes, you may experience a level 10 pain but the duration of this pain is so short that before you can even say 'ouch' or some other expletive, the pain is over. I realize this post is about Mark but it was posts like his explanation of his discogram that caused such a fear in me over this test, I was willing to compromise my best interests just to avoid it. For any in this situation, it's really not as bad as it sounds. I would not hesitate to go through it again.

Mark, I hope your pain and discomfort continues to allow your usual high functioning. Please take care and take it easy!

Dale

[JeffreyD]

Mark,
Please know that Pauline and I are praying that you receive a spot-on, accurate diagnosis that will lead to catching the correct pain generator(s).

Don't forget to have an Augustiner Green Label for me (just one, now....).

God Bless,
Jeff

[Jim M2]

Mark,
Fascinating how we're all wired a little differently. I'm referring to the facial symptoms from the C3-4 disco. No mention of C4-5, was it negative? Yes, your blow by blow reports helps me understand the process. I'm following in your and Doreen's footsteps with the cervical problems. Whaaaa! Misery loves company!

Jim

[ans]

Definitely not what you wanted to hear. So sorry about this Mark.

Allan

[Hucky :)]

Mark,

I'm sorry you're having problems with your C-spine. Being a fellow C-spiney, I know what you're going through. They use the Mobi C at the Alpha Klinik don't they? Is this what you will have implanted when the time comes?

It just hasn't been yours and Diane's year has it

Hucky

[mmglobal]

Man oh man... the surgical decision is so tough. For years, I've been too high functioning to consider surgery. I still am, but the episodes are getting worse. The radicular symptoms are getting worse.

I'm having a pretty bad episode now. It's very interesting that the face symptoms are very active with this, but in a different way. I was not specific enough when I said that the discography lit up these symptoms in my typical pattern. The normal pattern was there, but the area lit up on discography extended down the left side of my neck. With this episode, left side of face is more active than normal. Interestingly, it's extending around my neck and shoulder area as I remember in the disco. Unfortunately, it's even worse than that and includes most of my shoulder most of my arm... greater on the inside than outside.

Purpose of the post is not to whine... I think people will find it interesting that I have this corrolation in a very atypical pattern that does not follow the dermatome charts. Also of note is the fact that my surgical decision is not any easier than any of yours. Most of the time, I'm saying that I'm in too good of shape to consider surgery. When I'm in episode, I'm saying that I know it's only going to get worse... I stand better chance of success if I go earlier rather than later.... what am I waiting for... the big episode that will completely knock me down and may be dangerous?

After the discography, I was saying that if I did surgery, I'd probably try C5-6-7 and leave C3-4 alone because re-entry for the c-spine is not a problem and that the symptoms associated with 3-4 are only annoying. With this development that gives me even clearer corrolation to 3-4 puts me back into the split 3-level spanning 4-levels category. I know several 4-level patients... but it's still a big surgery and a risk. This second, I'm leaning towards surgery... maybe in a few days this will be blown over and I'll again be too good to consider surgery.

What's a mother to do?

Yes, I'll have some cheese with my whine.

All the best,

Mark

[Maria]

Doesn't episodic stuff that blows over drive you crazy? Ya feel so bad and feel like surgery time then ya feel so good that it's like *no way Jose* or at least *later Jose*... I dunno... just wish you the best esp. with what sounds like a super sized surgery upcoming. Hope you get some serious relief ASAP.

[dshobbies]

Honestly I don't understand all of this in evolutionary terms. Dinosaurs efficiently roamed the earth for millions of years and have been speculated as the superior species had they not been wiped out by ?.

Mankind has specific weaknesses. Is it that medical science has prolonged life expecation faster than survival of the fittest could strengthen our spines, knees and hips? Are we a dead end branch in favor of a better engineered species? Do other primates have these problems?

I've heard that if we are wiped out because of ?, spiders will evolve into the BMOC. Did you know that black widow females eat their mates? Interesting, very interesting!

[mmglobal]

Dinosaurs didn't wander so efficiently. There were 2 different types of T-Rex's. The big ferrocious ones were prone to DDD... that's why they were so angry all the time. The others evolved into Barney.

[mmglobal]

Soljagal,

All of the differences from one device to the next come with advantages and disadvantages. I believe that for most 'average' cases, if you are a good candidate and get a good job done, all of the current crop of discs are likely to succeed. I don't want to speak for Bertagnoli... I'll just say that the doctors who prefer ProDisc embrace the greater stability that the more more constrained designs offer.

For me, I choose ProDisc-C because my construct will include 3 artificial discs and will span 4 levels. I believe that the stability issues are of greater importance in big multi-level procedures and also when there is instability present.

I have a surgery date... end of January. I was hoping that I'd go back to "I'm too functional now to consider surgery", but the flight home from Germany last week flared me up and I'm still pretty bad. I'm convinced about the increased symptoms and their relationship to the discs indicated by discography. I'm convinced about 'sooner better than later' for the pathology we see on the imaging... it's going to get worse and my chance of success is greater before the DDD advances further.

Thanks to all the well-wishers for your support!

All the best,

Mark

[mmglobal]

bumping to top for Gary

[Terry Allen Blackburn]

Mark:

I'm sorry you are going through such significant struggles. It's amazing to me how many lumbar's end up being cervical's as well. I wish you the best.

Terry Newton

[mmglobal]

Terry... yes, it seems that most of is having significant DDD in one area of the spine also have it elsewhere.

For those of you who are following this... read: http://www.ispine.org/forum/ispine/1...hest-pain.html

[mmglobal]

Not a good day. I spend a lot of time in doctors offices with clients. The "house of pain" that the waiting rooms are can be pretty oppressive. When I'm there with clients, I usually feel pretty good about the service I'm able to provide. Today, I returned to the house of pain... step 1, MRI... step 2, I already have the referral to pain managment doc. (Good news, I know him and like him. Read Marissa's story here.) I cannot express how depressing it is to be looking into pain management again.

I guess it's a bad news / good news story. I was asking for a referral to pain management to give it one last good try to avoid surgery. I want to return to PT and see what the PM doc might offer for managing the chronic pain in a more serious way. I take Voltaren and a occasional hydrocodone... no regular opiates... typically just a few a month... recently about 1/3 of the days or more.

The good news is that I don't think I'll be seeing the PM on a regular basis. The bad news is why. I don't have the radiologist's report yet, but there is much here that is obvious.

BIG SURPRISE... this is new. My last MRI 1.5 years ago shows a minor defect at Th1-Th2. Now I have this substantial herniation:


The C3-4 pathology looks substantial. lateral disc herniation is right side, neuro symptoms on left face and neck don't seem to correspond to the herniation, but discography showed huge annular tear with rapid extravasation of the contrast into the canal area. Injection at this level did fire up symptoms. Chemical irritation of left nerve root?



The following two images represent the worst level that I believe is my interscapular pain and symptoms in L arm. First I show the slice below the defect to demonstrate what the CSF (cerebrospinal fluid) layer should look like around the spinal cord. The next image is actually the slice ABOVE the first image. The cord compression is not severe, but it's wors than it has been and it's substantial.




OK... so it's back to the house of pain, but I think I'll be having the surgery... hopefully in May??? Anyone want to go with me?

[mmglobal]

bumping for newhere

[newhere]

Thank you mark