Discogram on 9/6

[looeez]

Have not posted in about 6 mos.
AGE: 46, Profession Involves Heavy Deskwork
UPDATE: 1. Leg pain front, around knees, and rear all the way to feet; 2. Buttocks - same; 3. Pressure, pain (burning and aching) across low back.

Hips & rear feel like sitting on a hot stove, and no more than 5-10 minutes in the car driving or riding. Up to 20 minutes or so standing with pressure and pain...then, sit for a while and begin again (i.e., grocery shopping, etc.). 3 MRI's show a pretty distinct L5-S1 annular tear, Last one in April 2007, (don't know grade) with a slight bulge to the medial/anterier-ish? The L4 is also dark showing some DDD. While the MRI's are not extremely remarkable, both ortho (ADR/fusion surgeon) and PM doc think next stop is discogram for which I delayed prior. Hence, disco scheduled for September 6. Prior opinion from neuro surgeon who does not do ADR was that discography does not tell him everything and he noted a low-back pain patient whose symptoms were coming from thoracic...okay...what am I to do with this? Perhaps too much information.

pm doc wants to do IDET asap, but my understanding is that this is a hopeful band aid designed to reduce pain while buying more time before inevitable. If this is the case, I've been dealing with this gradual onset of symptoms for about 2 years with periodic episodes of absolute down-time for days. Usually following a long work meeting or car trip. Sorry for so much detail but this is the extent of the issue.

Rheumatologist states that blood tests 2x indicated a "marker" for Sjogren's Syndrome (what?!) but he would not hazard to say for sure. Prescribed lyrica and ultram (don't ask- not taking it!) Feel that the rheumatology pursuit is a red herring since no other Sjogren's symptoms i.e.dry mouth and eyes, etc.

I'm hearing increasingly positive success stories about both ADR and fusion percentages for reduction or elimination of pain, which is my main objective.

I'm on 1/2 days work until further notice, sitting on a heating pad and using thermacare wraps in the evening. Work at home some in a deep soft chair as long as I can.

Tried 3 rounds of pt, prednesone, and 2 inj (inj were inneffective)pt is good tool but not a fix. Therefore daily functon is impaired and increasingly limited.

Some relief from lying face down massage table style at 20 minute intervals but this is pretty much my only reasonable position and I feel warmth in my feet when doing this. I'm guessing because it takes the load off the anterier portion of offending disc(s). Interestingly, I wake up in the am w/ little or no pain, depending on previous days activities, (because the loading is off and my muscles have a chance to relax for a long period?), but sytmptoms begin immediately after moving around and build to blinding by end of day. Limp home and pain meds when I get in the door and pray they work immediately. They take about 50-75 percent of pain, but I don't function on them for obvious reasons. Incurred major gastritis from associated use of NSAIDS, subsequently eliminated.

(*whew*) When is enough enough? Does this pain correspond in frequency to anyone else and what was the action and outcome? Can someone suggest more ADR surgeons in FL? Mine in Naples would be Menzanares, while talented, I'm not certain he has done alot of ADR's himself although his training had him involved in many. I know of one pt. in the area who's Charite shifted and failed dangerously which was what deterred me from surgery in the first place. Could be two levels I'm needing to address since pain in leg would correlate more to L4 I'm told.

Still in process and kind of feel like "conventional" efforts were in vain.

Any feedback is helpful. Thanks in advance...loo
Pain for 2+ years in legs then back
2 cort. inj - no effect/3 pt rounds
Discography on 9/6

[Harrison]

In regard to the Sjogren's issue, you may want to contact Sandra, who seems to know something about this condition. See her post-op topic here.

Here’s the bad news mixed with my opinion: any auto-immune condition disqualifies patients from ADR. Look at the device mfr guidelines carefully, and you will see many differences among the guidelines that each mfr stipulate for their devices. But whether cervical or lumbar ADR, auto-immune disorders are a disqualification. But be careful -- some device companies state "autoimmune disorders" explicitly as a disqualification; while others say "infection throughout the body" as a disqualification. Do you know the difference? Do all doctors? This is a very complicated subject on many fronts.

Rightly or wrongly, I see Sjogren’s as another chronic inflammatory disorder, though many articles spell out a strong genetic component as the root cause. And it seems any “autoimmune” disorders can play havoc with hormones and the delicate balance of bone growth. IMHO, the prevalence of osteoporosis relates to the myriad automimmune disorders which do effect bone growth. As patients, we must consider that any one of these conditions COULD lead to device subsidence and/or other post-op complications.

If you ask me, I urge you to disqualify yourself from any ADR until you resolve some of the tricky issues around Sjogren’s. As well, I am concerned with some of the “state of the art” testing for osteoporosis with DEXA scans and others; as the results sometimes appear to be inaccurate. (Example: patient has a “normal” DEXA value, meaning healthy bones, but during surgery it was found that they had bones like butter. Not the norm, but it has happened MANY times!)

So, there is much to be concerned with in terms of untangling these issues. Again, I suggest extreme caution before proceeding, if at all. However, if you and your doctors decide to proceed, these ADR docs may help you with a consult. Should you see them, pls bring all the details from the rheumatologist et al…

Southeastern Spine Institute - Donald R. Johnson
900 Bowman Road, Suite 300
Mt. Pleasant, 29464
Phone: 843-849-1551

Southeastern Spine Institute - Dr. Steven Poletti
900 Bowman Road, Suite 300
Mount Pleasant, 29464
Phone: (843) 849-1551
Fax: (843) 884-0629

Hope this helps.

[GMW]

Looeez:

I agree with Harrison with respect to the auto-immune issue. Now, should that be a false marker, you had asked "how much is enough?". Sounds like you are there. My situation was essentially like yours. In terms of diagnostic tests, I also had the full body bone scan (cannot recall the name of the test), and Harrison also pointed this out to you. And, like you (possibly), I had an IDET procedure done. You are correct in that it is a "bandaid" so to speak, to buy time for the next round of treatment. Unfortunately, I slipped on ice the very day I had the IDET done, which caused additional damage to an essentially liquified disc. I did exhaustive research on ADR, and this was my solution. Is it perfect? No, but it is better than it was. I was also determined not to be fused, as my mobility and flexibility is important to me. How much do you weigh? I had mine surgery at your age, and if I had to do it again, I likely would, using the same equipment. I don't think any of the new devices are an outright improvement on the current version of the Charite disc, but that is just my personal opinion. I am happy to discuss this situation with you in more detail, if you wish. GMW