Beware, a long intro!!!
 

Hey guys/gals,

Just want to introduce myself. I am pretty sure I am going down the path for a double/triple level ADR.

My back problems started in college when I got addicted to racquetball. I got quite good but after about a year my back started to hurt. I got an MRI, found out I had a moderate bulge in the L4/L5 and a slight bulge in the L3/L4. The first doctor wanted to fuse but the second and third said no because I didn't have any symptoms going down my legs (it was just pain in my lower back). I got some exercises to do and with rest I recovered.

But about every year I would do something (usually a small twisting motion or bendover) and throw out my back. The initial symptoms were crookedness (upper torso lean to the left), lightning bolts, spasms, and sensitivity to movement. After about 3 days this would subside into just being tight and soreness that would last another 4/5 days. But I would always recover back to normal. Chiropractic care and laying down would help out alot.

This year I don't even know what I did. In the middle of April I noticed the back of my left knee was tight (thought I pulled a muscle). Then a couple days later I came down from a ladder and felt a tweak after a couple steps. Well, the tweak turned into a throwout. But this time it didn't recover after a week. I got an MRI which showed the same moderate bulge and moderate DDD in L4/L5, slight bulge L3/L4, and another slight bulge L2/L3. All these discs were black on the MRI (facet joints and lumber curve was fine). Then I went down the road of alternative treatments.

In the beginning I couldn't sit for more than 10 minutes at a time, couldn't walk that long, did not want to make any movements because it would bring on a lightning bolt, and would just need to lay down for 20+ hours a day and not move.

My chiropractor recommended spinal decompression and off I was to chiropractor #2 and the DRX9000 machine. In all I had 26 treatments. Ever so slowly I improved (don't know if this was do to time or the treatments). Somewhere in there I developed a severe tightness about two fists up from my belt line. It felt like there was a super tight knot in my back. About a month in I found out about laser therapy and gave that a try (no success here). I then tried 10 sessions of acupuncture with no success. Toward the end of the spinal decompression I started to see a couple surgeons to get their opinion. Both basically didn't want to touch me because I had nothing going down my legs and recommended physical therapy. I gave up on spinal decompression and started PT.

The back has gotten better along the way. I can normally get around with no pain. I started being able to walk (now I walk about 2 miles x2 a day). I can bike on pavement for a long period of time. I can finally sit more than 10 minutes at a time (now around an hour) and stand more than 15 minutes at a time (now pretty much unlimited). My problems are I am very hesitant to bend over (warning flags go off in my head when I do). The tightness two fists above belt line has turned from a super tight knot, to a knot, to a moderate tightness when I try to stretch or move (if this damn tightness would go away I would kinda feel normal). I would say I am about 60%. I can do the basics but that is about it. When people look at me from the rear as I bend over they say my upper back starts to arch fine, then my lower back just stays flat, and then I bend at the hips. I am thankful that I am not in any pain and don't really need any medicine.

Right now I am still doing PT (don't know if it is helping) and stretching x2 daily. I just started with a guy who does soft tissue therapy (he said I just have loads of adhesions on my muscles in my lower back and a nerve impinged in my left hip). I am soon to try an epidermal shot to see if that helps.

I am heavily researching ADR. I got my info in a dropbox for Dr Bierstedt to look at. I filled out the contact form for Dr Clavel (no correspondence yet). Next Monday I have an appointment with Dr Blumenthol. The one advantage I do have is being a pilot, so I can go wherever on the cheap.

That's about it for now, sorry it was so long

Chris

Questions
 

Questions?
- how long does it take for Dr Clavel to respond? Kelli at ONZ said I should here something from Dr Bierstedt this week (something in there about vacation)
- when do discs auto fuse? I'm scared to death with this one.
- is the EP shot worth it?
- did anyone else have this tight knot in there back? I swear that if the tightness went away I would be near normal

Whether or not the ESI (epidural steroid injection) is worth it is one of the most controversial questions going on in the field of pain management. One of the members on our board is a physician and pointed out that the alcohol in ESI's is toxic to the nerves in our back, leading to a causal link between ESI's and arachnoiditis (a condition as scary as it sounds). Many people who are passionate about regenerative medicine are hard on ESI's because the amount of steroids used in these shots is toxic to the human body and has the potential to make things worse (Regenexx just blogged about this, I recommend you read those blog posts but keep in mind that Regenexx has an interest in painting everything that is not regenerative medicine in a negative light). Many people get relief, but it is only temporary. The more shots you have, the more likely it is you might have a complication. So it just comes down to the patient's risk analysis.

Dr Clavel is essentially on vacation for most of August

Vacation or NGO work re Dr Clavel, Philly?

Anyway... I would say you sound too healthy for this kind of surgery. That is my take for what I am hearing. Way too healthy. Just my opinion.

However, how old are you? Height and weight also? Yes, it does matter.

You sound like you are doing very well and there is the reliable process of aging itself that does allow for very many people to live a good life as the anatomy changes and begins 'to settle' into its new position as the deterioration occurs. Not everyone requires this kind of intervention. Some do, most don't.

Your concerns sound minor compared to the burning fire/numbness/sleeplessness/cauda equina symptoms of many folks here. Am I incorrect in that assumption??

Doctor Clavel told me in May that he would be taking a three week vacation in August. That is all I know about so, expect a delay for at least that amount of time this month. He's a busy man!

EP shots have a 50/50 probability of helping temporarily to reduce pain. In hindsight, I wish I never had allowed them to give them to me in my spine because of the risks. They never gave me any relief with my spinal pain. I have heard that multiple steroid shots in the same area can break down the joint over time. You might want to research that aspect.

Massage, PT, dry needling, stretching and Pilates all are very helpful with helping or reducing spinal pain. Once the body starts guarding and having muscle spasms, it throws off our posture which leads to more pain and problems. Posture is something we really don't pay too much attention to when we are younger but, it sure needs to be paid attention to as we get older especially after reoccurring episodes.

Autofusion can occur after a trauma, injury or surgery to the spine. My C6/C7 autofused after I had several neck surgeries in a short period of time.

I know he did his charitable foundation work in July, but I don't know if he was doing more, or taking a well deserved vacation. I think, like Cyn said, that he is back around 23rd.

Can someone explain the auto fusion concept a bit more? Even though I was having neck surgery, on follow up, Clavel discussed my back. He said I wasn't a candidate for ADR at L4-5 due to spondy, and that L5-S1 was auto fusing. So the discussion ended there, ie o adr, so no need for me to waste his time with a waiting room full of local patients. But what happens if 5-1 auto fuses? does it take away the pain? or is the nerve forever entrapped?

That is my dilemma. When I used to throw out my back I was just down for a good week. But this time it has taken hold and won't let go. Some aspects have definitely gotten better but I still have that knot in my back, can't sit comfortably for more than a half hour (it hurts in my tailbone), and every time or twist/bendover the back yells warning signs "I may start spasming on you".

I know my L4/L5 has about had it. It bulges straight back and fills every nook and cranny without putting pressure on the nerves to the side. Actually at the start of this episode I did have tightness behind my left knee that chiro #2 said was sciatica. It wasn't ordinary tightness because I had active release (ART) done on it, lots of stretching, and multiple massages on it. It did finally go away after a half dozen spinal decompression treatments.

My question is how bad does a disc have to get before they will replace it? That is one of the big questions I have. Can I just get the L4/L5 done leaving the other two in place? The two above have mild bulges, show up black on the MRI, and on one the MRI reports a healing annulus tear. I am 47, am very active, do lots of home projects, and have two kids, 3 and 7, that I can't hold or pick up.

Do you do the surgery earlier when you have mild to moderate problems or try to hold try to hold off until you have big time problems, that is the question? I think the recovery may be quicker and easier if I don't wait (less nerve damage). Plus I don't have to be constantly being worrying about throwing out my back.

Chris

Chris, i have a lot of knots in my back and the backs of my legs due to spasms. try some deep tissue massage to get rid of them. i did one session a couple years ago and needed more but the therapist moved. she did break one not up almost completely. most therapists here don't do that kind of massage, mostly for relaxation, not busting up stubborn knots which can be torturous and need multiple sessions. i haven't heard back from Bierstedt, but Clavel has given me the most thorough review of all the spine docs i have contacted. most will treat 2 or 3 levels, Clavel said i need 9 levels treated with 3 adr in my cervical spine, C4-5, 5-6, 6-7. fusions in my thoracic and lumbar, T8-9, 9-10. L2-3, 3-4, 4-5, L5-S1. i think you are a little soon for surgery too, but keep doing your research there are other option besides disc replacement, like laser discoplasty, micro surgery. i also have had decent luck with epidurals, but like EVERYTHING there are risks.

Multi -multi level fusions?
 

randolf, Hello you state: "Clavel said i need 9 levels treated with 3 adr in my cervical spine, C4-5, 5-6, 6-7. fusions in my thoracic and lumbar, T8-9, 9-10. L2-3, 3-4, 4-5, L5-S1". WOW!!! fuse 6 levels T-8 thru S1 , did Dr Clavel mention anything about doing a hybrid ADR / fusion in your thoracic / lumbar spine?? Like maybe an ADR at T8 or T8-9 and T9-10? Did Clavel mention anything about "dynamic stabilization" in regards to your T8-S1? Would all 9 levels be done at one time? I was under the impression that fusion especially multi-level was a last resort for Euro drs. TAKE IT SLOW. Thanks for your posting.