My SED - Good News, Bad News

("Harrison": I'm in Phoenix and had to re-register. Maybe you can merge this post under my member number 617.)

Guys, I haven't posted in a few weeks. How about some input?

I decided to have SED. I'm in Phoenix now. Monday, Dr. Yeung did my discogram. Tuesday, I had SED. Wednesday, today, was my follow-up.

The good news was that the discogram showed L5/S1 to be the primary pain generator. L4/5 was moderately painful. The two discs above had no pain. (L5/L1 caused the most pain I have ever experienced. Dr. Yeung does not sedate for a discogram.)

SED was a piece of cake. With a prescription for oxycodone, I went to the hotel to recover. After a couple of doses, I was mostly pain free, so didn't even take the medication before going to sleep. I had no pain overnight, but after getting up, realized it wasn't going to be that easy; I had some pain and difficulty walking, but felt better through the day.

The bad news was that Dr. Yeung removed most of my L5/S1 disc! He said he tried to seal the two large ruptures, but it didn't work. The disc was apparently too far gone. However, since my pain improved, Dr. Yeung considers the operation a success - for some unpredictable period of time.

Other good news was that Dr. Yeung still considers me a candidate for single-level ADR. This, despite that the other two discs are bad according to my MRIs. I was under the impression dessicated discs could not be left adjacent to an artificial disc.

I can elaborate more on my experience after I get home. In the mean time, what should I think about this? I asked Dr. Yeung, "If the disc is mostly gone, what is providing support"? He said, "nothing." When I asked when I can expect to return to work, he said "six weeks."

Should I be shocked at this?

To be continued, I am sure...

Hi Tom, I too am considering this procedure but am very hesitant for 2 reasons: what's up with the most painful discogram known to man?? Why he had to perform the procedure that way I cannot understand, seems anesthetic discogram is much more humane, if the pain goes away, then the disc was the generator.

Also, I don't have a good idea about the prospect of returning to an active lifestyle. What sort of restrictions do you have and for how long? Does he think you can skate agian?

I do know of people who have gotten relief from the segments fusing on their own but some of the risks are foraminal stenosis and increased load on the facets at that level.

I realize you were asking for answers and I'm just presenting more questions...Sorry aboout that. But I hope you have a good outcome and get your questions answered.

Take care and good luck...

[Harrison]

Tom, it does seem baffling to think that you no longer have a disc! I've heard of this before (this and other forums) and don't know what to think. Like you, I just have questions -- like how long or short your window of opportunity for ADR is. E.g., if you wait 6 months, will it be too late? Perhaps we can help with more of the questions than answers.

My L5-S1 degenerated rapidly over 18 months. Had I waited another 6 months, I probably would have been autofused. Not to scare you with this, just food for thought. Everone's vertebral condition is different...

scsurfgirl and "Harrison":

Thanks. At least you guys seem to understand my questions.

I may have a better understanding after I read Dr. Yeung's report. Maybe he just removed the middle part of my L5/S1 disc.

If Dr. Yeung had known he wouldn't be able to repair the disc, I may have preferred ADR - especially since he considers me a one-level ADR candidate - not a three-level candidate as Dr. Zigler said.

Here's more detail on how my week went -

* Sunday, March 12

Although lower back pain was my main complaint, my left leg pain had returned and was an eight out of ten while walking to a restaurant for breakfast.

* Monday, March 13

Office Visit with Dr. Anthony Yeung - There was some confusion with my records, but otherwise, no problem. Dr. Yeung was annoyed with his staff because he had to search for my most recent MRI report and because my films weren't ready for him to view. I came away convinced that it's uncommon to have a right side rupture followed by a left side rupture at the same level.

Discogram with Dr. Anthony Yeung - L5/S1 and L4/L5 were painful. L5/S1 was tested twice and was extremely painful - more pain than I have ever experienced - ten out of ten. L4/L5 was three out of ten and showed a tear. (This was completely different from my previous discogram, done prior to my left side L5/S1 rupture and with sedation. It showed moderate pain at three levels.)

Dr. Yeung mentioned that he would actually do two procedures - SED and something with my facets.

After the discogram, my pain was significantly worse. Despite my tramadol, I had only three hours of sleep.

* Tuesday, March 14

Bi-portal SED with Drs. Anthony and Christopher Yeung - This was a "piece of cake." Before the procedure, Dr. Christopher Yeung asked me how many levels the discogram had tested. I said I wasn't sure - three or four. After looking at the records, he said that the discogram had tested four levels.

During the SED procedure, there were a couple seconds of intense leg pain and later a few seconds of low level leg pain. During the procedure, I wondered why I felt bone being chipped or cut away.

Dr. Anthony Yeung prescribed oxycodone. Even though I didn't take any at bedtime, I slept through the night with no pain.

* Wednesday, March 15

After sitting and standing, I had some leg and back pain.

Follow-up with Dr. Anthony Yeung - Dr. Yeung said that he had removed most of my L5/S1 disc. I asked what was supporting my spine. He said "nothing." He said that he had also killed the "nerve to the spine" and had widened the spaces for the nerves to my legs.

Since my pain was reduced, Dr. Yeung seemed to consider the procedure a success, but for a limited time. He said that I should return to work in six weeks. I asked whether he thought that would be risky. He said, essentially, that there is risk to everything. He said that returning to work for one week would indicate success.

I asked if and when I should have physical therapy. He said to start physical therapy in four weeks.

He and I discussed possibilities for the future. I told him that I had researched ADR and had communicated with two surgeons in Germany. He said that I am a candidate for one-level ADR, but for a limited time.

He recommended that I follow up with Dr. Zigler at the Texas Back Institute in four weeks. He said that he would send a report to Dr. Zigler stating that I am a candidate for one-level ProDisc ADR.

Thursday, March 16

Against instructions, I went the entire day without pain medication, but relented before I went to bed.

I continue to have some pain, mostly in the morning. It is a bit different from the pain I had before the SED procedure - a deep ache in my lower back, a less sharp leg pain and some pain in the two wound areas.

The pain has at times reached three out of ten. The leg pain is prominent in the morning. The lower back pain is prominent in the evening.

Overall, my pain situation is much improved. I will know better in the days and weeks ahead.

Even thought the procedure may be considered only a qualified success, I think I can recommend it for the following reasons:

1. It bought me some time - how much, I don't know.

2. It was minimally invasive.

3. Drs. Yeung were able to work on two ruptures of the same disc (and could have worked on multiple discs, if necessary).

4. Assuming it was good to remove so much disc material, this may not have been possible with a different type of procedure. In other words, even if you are just planning to have a discectomy or microdiscectomy, SED may be a better alternative.

I did a little Googling of "discectomy" and "microdiscectomy" and came away with the impression that the amount of disc material to remove is debatable. With little disc material remaining, I suppose that my L5/S1 disc is unlikely to rupture again. Of course, I now visualize the vertabrae themselves pinching the nerves to my legs.

One final note - United Healthcare said they would cover the procedure. And since I had to travel more than sixty miles, it would be covered at the in-network level.

[Harrison]

Tom, it sounds like good news. I know you put a lot of thought into this...I'd be curious to hear about your sitting tolerance in the coming weeks...I know that's very important for you!

Congrats on the milestone(s), they are so hard to struggle towards. It's a big deal when you reach them. Keep us posted!

[spotty14]

Another question - is it possible to have SED on discs that have already had the IDET?

[Girija]

Yes, i had IDET in 1997 and had SED from DR. Yeung in Jan 2004. My disc heights have reduced noticeably in 10 months now. I am down with right leg pain again! I had rude awakening with Dr Yeung during my discogram.As I was not aware of the needle coming in; I screamed with pain. He said, “ If you shout I will not treat you”. I bite my tongue and tolerated the pain with all levels of discogram. He is a bright doctor

[spotty14]

Girija,
Thanks for your reply. I guess it's not a good idea to scream while he's working on you. Does he do the SED without any pain medication also?

[Girija]

no, he doesn't.Spotty, sorry about the AdR clinical trial.

[Kim]

Well it was suggested to me to look into this procedure for myself but after seeing what I have here I am very reluctant to do so.
As a medical professional for the last 25 years I think it should be considered cruel and unusual treatment for any physician to do these types of procedures without any anesthesia or pain medication.
And Girga for him to tell you if you screamed again he would not treat you is uncalled for in my humble opinion.
I have had a discogram and it was with some anesthesia and am very thankful for it! I would not let anyone touch me that was so cold or cruel or behind the times that they refused to offer a chronic pain patient any type of help that they could in order to make a procedure more tolerable for the patient.
Dr Yeoung may be a bright man and a good physician and surgeon but he has a thing or two to learn about compassion and caring and how to treat other human beings. I have read these posts 3 times and have not replied till now because I was so angry when I first read it that I was unable to post about it.
Pain management and anesthesia are parts of medicine in this country and we as patients should be able to demand that we are well treated and get the comfort that we need during procedures.
There is no reason u cannot anesthetize or medicate and get the same results and pain generaators from a discogram.
Are we living in the dark ages here?
I am sorry folks but this is sad in my opinion!