runner's surgery blog, L4/5, 2008

[runner]

10-24-2008, 02:28 PM
tconner94

MRI vs. CT
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I will try to offer a little info on your questions about imaging studies after ADR. MRI artifact at the level of surgery will prevent that level from being evaluated. If IV MRI contrast is given, it won't help visualization of the surgical level. MRI with contrast can be used to assess for nerve root irritation/inflammation away from the hardware, and it can be used to check for complications of the surgery such as infection. Also, the other levels can be assessed with MRI either without or with IV contrast.

I used the term "IV contrast" deliberately. CT of the lumbar spine is usually done without IV contrast. The ADR will cause a different type of artifact on the CT that will also affect the evaluation, but it is easier to compensate for this when viewing the CT. However, CT is not that good at evaluating disks, nerve roots, etc. I believe that you are referring to CT myelography. That procedure involves a lumbar puncture (spinal tap) where 10-20 cc's of contrast are injected directly into the spinal canal. A few regular X-rays are usually taken, and then a CT is done soon after to evaluate nerve roots, spinal narrowing, etc.

In general, it is difficult to predict in advance which test may help. MRI with IV contrast is quicker and safer, but it may or may not help. CT myelography may help, but it's more involved, a little riskier, and there's still a chance it won't show the ADR level due to artifacts from the metal.

Hope this helps.
__________________
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L5-S1 rupture 11/04, left leg pain for 2 wks.
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
L5-S1 Charite Jan. 19th, no back pain so far

[runner]

There you go. Glad TConnor94 had some answers, as I did not know intimately the different procedures like he/she did. Very helpful. I would ask the doctor, when you go in, based on all the different and unique symptoms you are experiencing right now, which diagnostic tool could we extract the most information from, and hopefully, with the least aftermath of potential problems. Good luck runner. I do hope you get to the bottom of your symptoms and get the answers you need. Hang in there!
__________________
CindyLou
bicycle accident 6/19/01
2 compression fractures sustained, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 right hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. Bertagnoli, 3 levels; L3-6
7/2/08 ALIF and Laminectomy of L6-S1
7/30/08 Removed bone cement that leaked thru onto S1 nerve root.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion. Hospitalized 1 wk.
Wear bone growth stimulator 2 hrs per day.

[runner]

Thanks TConnor94 and Cindy,

Explains things clearly.
My PT wants me to get trigger point injections. He said today that my sciatica could be from tight muscles.
I feel that my muscles are actually getting looser as they hurt less when they are massaged out in PT.
He said I should demand trigger point injections from my doctor--I thought that was pretty funny. I can still laugh even when my feet and legs are falling alsleep half the time.

About the TENS machine, he said that ones on line are a lot cheaper. So instead of renting one for $24 a month, I can buy one from 50 to 100 dollars. Sounds like that's okay.
I'm going to check on it since saving money is uber important for me now.
On a side note, got my OBAMA bumper sticker today. Also got one that said, "Soccer Mom for Obama".
It just took me a while to find where the democratic headquarters was down here. Once my daughter explained where it was located, I found it. Got my Obama/Biden lawn sign too.

Watching 20/20 now..got to go.

[runner]

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Update:

Getting closer to Halloween.
Had a lot of numbness and tingling in my legs and feet today.
Don't know if it is partly due to my activities yesteday. I had a 15 minute freebie massage and the massager pressed hard on my lower vertebrae and I kind of decided right then and there that I could skip the massage in the future. Ouch.
She told me she could work out my trigger spots in three one-hour sessions. I think she would be a miracle worker because i had massages before my current back problem and that person took several sessions to work out the kinks and they were never quite worked out. Now I know why, because my L4/5 vertebra was deteriorating. There was no stopping that. The bases were loaded with no outs and Hank Aaron was at the plate.

Anyhows, I get to have an MRI on Halloween. Won't show L4/5 but will show other discs. They need to make discs so you can see your whole back on an MRI. Oh, well. I get new x-rays too. I will be positively glowing on Halloween. LOL.

Doctor spoke about switching from Gabapentin to Lyrica. Not yet though.

My son's coach had a knee replacement about same time as my surgery and he has carpal tunnel problems in both hands and he was talking about having to go back to doctor because his hands were swollen and he said once you get in the medical system it is like prison--they won't let you out.

I feel a little like that. I keep comparing my life before excruciating back pain to my life now. Things can really change on a dime.
I miss my old life.
Just as I was getting back to some semblance of normal, it was snatched away from me. Hopefully it is a minor bump in the road, but I don't know. Just having sciatica and numbness which is 10 x's worse than last time makes me wonder.

Won't have to wonder very much longer though.

[runner]

10-30-2008, 12:18 PM
rhatzy
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Hi,

Just finished reading all your posts. I had L4-5 and L3-4 done with the maverick discs back in January 08. My recovery was pure hell with all the ups and downs of a roller coaster. I was on percocet, the gaba (however you spell it), did the PT stuff and everything. I had the financial worries, as I am the sole provider, and depression like you wouldn't believe. I thought my life at 50 was over. However, I am ready now to go back to work. I am an airline captain for American Airlines and I am off all meds and was cleared by the FAA to return. I have just finished recurrent training and my first trip is November 4. I am so excited.

My family doc was great. He thought that I have made all the right decisions. He said that PT was going to make it seem worse because they were going to involve the muscles that i didn't use much and the ones that had atrophied and that to take the pain meds to cover the pain of the PT.

I have had the MRI's and the myelograms, both which were useless in determing any problems at the implant levels, so my suggestion is forget the myelogram, it wasn't fun. There is a guy in Dayton, Ohio that uses a very tiny endoscope to insert into your spinal canal thru a natural opening at the base of your spine. It's just at the top of the crack in your butt. With this, he can check out your whole lumbar region and if he finds any tears or bulges or scar tissue, he can fix them them, He found that I had some annular tears at L5-S1 and lased them. At my L4-5, where I had a discectomy done in 1996, He found major scar tissue. He removed as much as he could and freed up a nerve in the foramina and that's about it. After that procedure, most of what pain I had was gone. I only had a quarter inch incision and except for that I didn't know I had anything done. I am a little worried tho that that level might be needing some help in a few years.

I have talked with a nurse down in Georgia or somewhere that also does a lot of lifting. I think she had a two level done and she is back to work and doing the lifting with no problem. A guy in my group who is a body builder, weight lifter and trainer had a two level done. He is back to work and the last I heard from, he was squatting 315 pounds with no problem. that makes me wince. Don't think I'd be doing that. He said that he really never did the core excercises until after the surgery and now does them religiously.

I found that the gab and percocet made me feel even worse. I had been off the gab for awhile and then finally, the percocet. I was down to just 10 milligrams of Vicodn when I just quit. For about 4 to 5 hours a day for 4 days, I had stomach cramps and headaches but it just finally went away and I felt a lot better. I think it also contributed a lot to my depression.

Anyways, that is a short bio of my story. I hope you finally get your life back. I know how tough it is and was really tough to see the light at the end of the tunnel. As for insurance, that's another story. American is self funded and administered by United Health. Tried to explain to them that fusion, which they would pay for would have cost them about $100,000 and I know I would never had returned to work. Plus American would have to pay me disibility until I retired and now be paying two pilots to do the work of one. They don't get it. Now that I am back to work, maybe they will see it differently. If not, then I will have a nice deduction on my taxes.

Anyway, I hope that things will get better for you and that life will be good again.

Mark

[runner]

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Thanks Rhatzy (Mark),

Going to get my MRI today. I hope it doesn't show anything bad. But if it does, I will deal with it.
Happy to see you are going back to work. I have thought long and hard about work and have asked some of my co-workers what they thought. It is easy to say that you can go back to the same kind of work and then I wonder what further damage I would do to my body. I mean maybe I could do the work, but I would probably not be doing what is best for my spine.

Nurses know you need to protect your back, but even the best lifting techniques don't matter when you have an emergency and you have to hold a patient down or a patient is trying to hurt him/herself. I always thought that I might be doing myself harm but thought it would hit me later in my career. I was kind of naive about the damage I was doing, because I thought it was sore/tight muscles and not a disc tearing.

I am still a nurse but I have to find a less labor-intensive job and I kind of know the path I want to take. Right now, I am concentrating on getting better and worrying less about the resume. I am disappointed because I am used to pushing my body to its limits and i cannot do that. My heart rate is like above 100. I did have a resting heart rate in the 50's. I don't know if it is pain or the extra weight I have gained or what.

I don't like the Gabapentin (Neurotin) because of the swelling it causes and the kind of med it is, but when I had sciatica I absolutely couldn't stand, I asked to go back on it. I was also given permission from my doctor to take a mild pain killer if I needed it. Sometimes Tylenol and Aleve are not enough.

I am busy and feel like I am working with four kids to take care of and a house to kind of clean and laundry and writing and fighting insurance companies and PT and working out outside of PT. Then throw in a couple of doctor appointments. Tomorrow, is Halloween and I am trying to figure out how to fit everything in. Feeling a little rushed because there is trick and treating and then there is the high school homecoming football game. My daughter is performing in the senior skits. My husband is going to try to get home early but typically he works until after 7 pm so I have a lot of children stuff to do before he gets home.

I felt pretty good today, sciatica and numbness way, but I did not do very much physically today. So we will see about tomorrow.

You had your surgery two months before me. I think I would be doing a lot better if I had had my surgery on my first surgery date instead of waiting for insurance to be there. Waiting four months for surgery was a bit much.

My advice for anyone trying to get the insurance company to pay for the surgery is fight tooth and nail because there are ways to win and the insurance companies don't care about you and you have to intellectually try everything to get them to reconsider. I am glad I did not get the fusion my insurance would have enthusiastically paid for. I will continue to fight them and I believe whole-heartedly that they are terribly wrong.

Just today they denied my prescription for Gabapentin that is an increased dosage. They are bean counters and don't understand that if you go cold-turkey off Gabapentin you risk seizures. Just one more battle to fight...

The more we stand up for what is right and demand service from insurance companies and demand that our doctors do what is right and that we are better informed, the better off we will be.

Have a nice flight.


__________________

[runner]

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As I sit here today, reading from my fellow spineys, I am thinking about how nice it will be to start our country in a different direction after next Tuesday's election. I am hoping that we start down the path where people matter again. The current regime has proven, in so many ways, that we don't count. They cling on to the; "right to life" mantra but do little to protect it once it pops out of the womb. Then the mantra becomes; "protect the shareholders."

Profit above all.

Remember to vote next Tuesday. Vote once, vote often.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5

[runner]

Positively Glowing

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Had MRI on Halloween.
It was different than my last MRI over a year ago. Yesterday, it must have been a closed MRI and you went in head first and it was a tight fit.
The bummer was that there was no music available. Forty minutes or more in a tight tube, not exactly for the clausaphobic.

Got MRI without contrast and then was surprised to learn, part of it was with contrast.
So that is the reason for my title. Then it was off for x-rays. Two hour ordeal but it was okay.

Got the MRI on CD but have not looked at it, since I would tend to self-diagnose myself and worry about it.

Managed to get in Halloween, ended up dragging my two young boys (fireman and pirate, Jack Sparrow) around to a few houses, went to high school half-time to watch Homecoming show and my daughter.
Got back home to find husband and eight year old absent.
Found them at a neighbor and stayed up a few more hours.
A lot of people in our area were at the game.
My girls' high school, won 57-14. Fun. But not for the other team.
Oh, and someone TP'd our house.
Did a good job. It was hillarious.

[runner]

Rainy day
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Phylly,

I found out some more stuff about the myleogram that I didn't know about. I have been surfing the internet last few days.
Anyway, saw where some doc said that the dye they inject in your spine can stick to your ADR (I think it was on here on adrsupport or a link, I was just surfing around and investigating sciatica).
Now that doesn't sound so good.
I hope you are feeling better. Are you getting some answers from your doc?
I felt so much better when I saw my doc last week and he was very understanding and listened to me.
It should always be like that.

It is a rainy day here. Probably for you too.
My back is hurting more today and I wonder if it is the rain or the PT workout yesterday. The sciatica (primarily right leg) is hurting too. I am up to 1800 mg of Gabapentin a day and it helps. I am just really tired (side effect).

I was standing at the voting booth today and trying to make final decisions on all the propositions and my left foot and lower leg were falling asleep.
The past week it has been my left foot and leg that are more tingling than right. It switched around, which makes me think something is floating around.
Who knows. Hopefully, the MRI will show something that explains the symptoms.

This all could be part of the healing process but I kind of have doubts about that. I am sitting on my couch and have tingling feet, calves, front of lower legs and some burning in right leg and right thigh.
I can just say I am tingling all over..ha ha ha.

have a good day.


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[runner]

Myelogram contrast
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Just a quick hopefully helpful correction. The contrast injected for myelography cannot affect the ADR hardware. It is a water-soluble agent that is directly injected into the spinal canal (thecal sac). Unless there has been penetrating trauma causing a tear in the dura, the contrast remains within the dura and is gradually absorbed by the vascular system and excreted by the kidneys. Of course, the myelogram itself does cause a small penetration posteriorly, and there usually is a small amount of contrast leaking along the needle tract which can be seen on the CT done after the myelogram.

The contrast used is for all practical purposes the same agent injected intravenously for CT's of multiple other body parts (chest, abdomen, coronary CT's, etc.) It is also injected during a discogram to confirm that the needle is within the disc. It is gradually absorbed from here, as well.

If someone were to have an injury resulting in an unhealed tear of the dura, they would have possibly multiple other symptoms, spinal headaches being the most common. However, the leak would have to also extend through a ligament in front of the spinal canal and in back of the vertebrae in order to reach the ADR hardware (the posterior longitudinal ligament, not the anterior longitudinal ligament-which is opened for the ADR insertion).

Even then, the contrast agent would simply be gradually absorbed. It would be no more toxic or damaging in this location than it would be when injected into all of the various places it is normally used for other studies. It would essentially be the same as if saline were injected around the ADR hardware.

OK, maybe it wasn't a "quick" correction, but hopefully it was "helpful."
__________________
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L5-S1 rupture 11/04, left leg pain for 2 wks.
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
L5-S1 Charite Jan. 19th, no back pain so far