runner's surgery blog, L4/5, 2008

[runner]

Well, an update:

I did get my surgery done last year for my cervical spine. Overall, it was "easier" than my lumbar surgeries.
I was in new territory when I was trying to find out what to do about my neck problem. I had an anterior cervical disectomy and fusion at C5/6 and C6/7 with corpectomies.
Of course when my surgeon did get in there, poking around in my cervical spine that is, he found a very degenerated disc, especially at C6/7. It was bad so it was a very good decision that I had surgery.

My discs actually collapsed in a short time so there was no chance of getting ADRs at any of the two levels. I did ask my surgeon to explore that option and he did, but with new data, he flat out said he couldn't do it and then explained why, and that was after he had me go for an up-dated CT and x-rays. I would not gain any more motion in my neck even if he could slip an ADR inbetween the vertebral end plates, which he doubted was even possible, and so fusion was the way to go because those two discs had no motion. Remember, ADRs are motion-preserving devices.
I have been around the block enough with my surgeon, so to speak, that I trust his opinion and expertise.

I did get to get a fusion surgery without a plate and screws outside. My one-year anniversary was May 15 and at my last appointment, I found out my discs were trying to fuse but not in the middle like they should. I have heterotopic ossification, and the minute he told me what was going on, I knew what that was. I am not sure what it means for the future but I am doing pretty good with regards to my cervical spine. I have a little hand/arm pain but it is infrequent and most of the time, I get numbness in either hand/arm, it seems to be positional and I can get rid of the numbness by adjusting my neck.

My doctor told me the H.O., a short abbreviation for a complicated distinction, is like stalactites and stalagmites and they are trying to come together. I have bone growing where it shouldn't.

Runner

[runner]

Really, my cervical spine is small potatoes compared to my lumbar spine. After getting my second ADR, which was at L5/S1, I started with new symptoms some 14 months post-op. I haven't gotten better, I have declined and it has been frustrating fighting my insurance company. It is a work comp case, but it is an insurance company I am fighting.

I made some head way this week, though. I have been on bed rest, with just quick trips to the loo, because I had a CT myelogram Wednesday. Since I have ProDiscs, which are made out of stainless steel, the ADRs throw off artifact when I have a test like a plain MRI or CT, and that obscures what a radiologist can see. I have had an EMG that has indicated that I have nerve compression at L5/S1 and when I underwent the test last September, it showed moderate nerve compression and a moderate loss of axons. So I have both objective "proof" and subjective proof and that adds up to nerve compression.

My subjective proof is my strong radiculopathy symptoms. I am in moderate to severe pain every day in both my legs and back. Never mind my numb toes and feet, a numbness that can creep up to my knees. My pain doc has tried working through the process with my wc company but they have been denying most of my care and they have doctors that point to my MRI results that were basically inconclusive because my entire lumbar discs could not be visualized. WC docs contend nothing indicating radiculopathy showed up on the MRI.
Really, the gold standard for people like me that have artifact-producing stainless steel ADRs, is to get a myelogram both IMHO, and according to what I have read in several spinal studies. It is a way to get around the artifact issue, so to speak.

Without going into the whole process, let's just say I got fed up last week, made an appointment, and went and got the myelogram anyway. Since February, when I found out that the hospital wanted minimum $5,000 for a cash-pay procedure, I thought I couldn't get a "self-pay" myelogram.That it would be too expensive. I got one outside the hospital and the terms were reasonable.

Now, I have to wait for the results but I am pretty sure the radiologist will find that I have a compressed nerve at L5/S1. It is a "no-brainer" to my docs and myself. With the results, I hope and pray that my neurosurgeon is able to do something for me.

So that is where I am at. I am sure that I can dig up some posts I have about my journey that can clarify things. (Or not on second hand, I already write too much so excuse the long blog) I can tell now that I feared getting a myelogram but did feel it was the prudent thing to do. The good news is that so-far I do not have the dreaded spinal headache, that I read happens to about 30 percent of the people who get this test.

R

To be continued...

[runner]

Truthfully, I haven't been on here and I feel a little guilty. Some days I want to document this crazy spine odyssey and others, I don't.

I am doing something a little different here, I am attempting to document what to me is something I have been looking towards for a while. But first: Since November, 2012, I knew there was something majorly wrong with my spine. After a long recovery from my second major spine surgery an ADR at L5/S1, I had one noticeable deficit, the toes on my right foot would sometimes be partially numb. Doc said it was most likely permanent nerve damage, I wasn't so sure.
Then, they went permanently partially numb, in other words, I had some feeling in them.
Late Nov. 2012, in less than a few minutes, my toes on my left foot went numb. I had the misfortune at about the same to have my cervical spine became symptomatic. The numbness progressed and I started getting major pains in my toes, heels.

I always knew that my cervical spine may one day blow up. It started with my right hand cramping, so I went to an orthopaedic surgeon who was known to be a great hand doctor. Couldn't get in right away to see him, saw his P.A. Diagnosis: most likely carpel tunnel syndrome. Finally saw the hand guru, he suggested x-rays of my neck to see if that was the problem because I told him I did not have a great neck. He looked at the x-rays and told me the problem was with my neck. Told me to get an EMG study, then go to a surgeon right away. So I got the study, no surprise, my neck was a mess, much worse than I could even imagined. I called my surgeon back up and left a message that so and so told me to see you for my neck.

So, I had some thecal sac compression and I asked, "Could my leg symptoms be from my neck?" Both my surgeon and pain doc said, "No".
Well, like with my back, we tried conservative treatment. Finally,after I kept failing exercises in PT, my PT wrote a note to my surgeon, saying I needed surgery and he needed to evaluate me again soon. My surgeon was incredibly busy and they put me in the schedule as soon as they could. Then of course, the surgery was cancelled, and I waited again, until I had it in May, 2013.
As I recovered, I nudged my doctors, like hey, my back is giving me fits. I was politely told to let my neck recover, before we went back to my back. Too many problems at once.

My back kept nudging back, in August, my back started hurting again and then the next month, I had sciatica in both my hamstrings. AGAIN. I was taking pain pills more for my back than my neck. I was in another insurance hell, this time with WC.
My fears about my back were confirmed, September last year, by the doctor who did an EMG/NCS on my lumbar spine. She told me there, I had a compressed nerve at L5/S1. The worse part of the report was something was moderately compressing nerves at L5/S1 and I had a moderate loss of nerve axons.

I knew when I got ProDisc ADRs at L4/5 and L5/S1 if I had further problems, the discs would cause artifact on an MRI or a plain CT. My insurance company, denied I even had radiculopathy. After a bit of a fight from them, we (my two doctors and me) and a few other medical people, have kept on fighting.
On Wednesday, I felt like I had won the war when my CT Myelogram was completed.

R

[runner]

What is going on with the spine?

Seems appropriate enough of a title. Or What isn't going on with my spine?

The CT myelogram still had artifact at L4/5 and L5/S1. So now I get the picture that even with the myelogram, you are still going to have some artifact on the images.
The guy who did the test used in the report the words, as far as can be determined there was no...

Anyway, it did not show what I thought it would show. But I am not convinced that I cannot do anything for the L5/S1 level, yet. I asked my doctor if I could still have something that was hidden by the artifact and he said, "Yes".
He suggested going to get another EMG/NCS test to see if the pain/symptoms were coming from a peripheral source rather than the lumbar area.

It is all coming from the back according to the neurologist I saw. I have all kinds of funky nerves and some got a little better from when I had an EMG/NCS a year ago and some got worse. The gist of it is:

1. The electrodiagnostic study reveals evidence of moderate subacute-chronic left L5-S1 radiculopathy.

2. The electrodiagnsotic study reveals evidence of mild chronic right L5-S1 radiculopathy.

So one doctor thinks that there is nothing pressing on my nerves, although the neurologist said a year ago that I had a "pinched nerve" at L5-S1. I asked him what happened with the pinched nerve and he told me it must not be pinched now. In the absence of no treatment, I find it kind of hard to believe that I do not have a pinched nerve.

So I thought, well, I really need to speak to the neurologist in person and I went ahead and made an appointment for the end of this month, the first available that I could get.

All this is not exactly want I envisioned when I got my ADRs and for that matter, when I had fusion at C5-6 and C6-7 and have ended up with Heterotopic Ossification. ("kissing osteophytes").

R