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Jag100 07-12-2021 10:12 PM

I would say I'm glad to be here, but............
 
Good evening. Like most, I am here in search of advice, knowledge, etc. Besides the stuff listed in my signature, I have additional issues present in MRIs done over a year ago and in the most recent last week. I have bulges at L1/L2, I have subsidence in the XLIF (3/3 other spine docs consulted say the XLIF is too large). Dr that did the surgery is deceased. Oh, and the L5/S1 ain't looking so hot. Trying to be brief with this but thorough.

Leg pain has never been a major symptom for me, until the last six-eight weeks. I've had terrible back pain in the past, and lost significant function in both legs/ankles/feet. Typically recover some after each surgery, only to lose again, usually 16-24 months later.

A little over a year ago started losing strength in right leg and severe back pain (I part-time teach so 3-4 advil right before four hour class to get through). Also weakness in right leg-I had told my wife I couldn't walk with her anymore-it was like i was walking on one leg and too exhausting (and slow for her). The current neurosurgeon suggested additional fusion in L1/L2, which I nixed due to additional stresses that would be placed on L5/S1. He then sent me to a "deformity specialist" who said I needed to fuse T10-L5/S1. Ditto for another consult with an ortho surgeon with excellent credentials and at a renown hospital system. I said no thanks to all that and walking at a 45 degree angle.

Didn't know what to do when a good friend suggested Egoscue, which I summarily dismissed as crap. He asked me to do it as a personal favor to him. So I did with "less than 0" expectations. Over the past year I have practiced it diligently and regained function back up to previous levels. However, recently I have begun to decline again.

With the additional issues noted, now have significant similar pain in both legs, the worst of which is side and front of lower legs, and into the ankles. barely tolerable at its worst actually causing nausea. Have had twi injections over the past few weeks with little relief.

I am very active, working out every morning either weights/cardio, walk with MLW every morning for 35 minutes at a quick pace. Hit the elliptical a couple of times a week in the afternoon. Pain is not present when exercising, walking, chainsaw working, pressure washing etc. Only when standing or walking after sitting awhile and when driving (accelerator leg).

I have read exhaustively on this forum (and others). My neuro says no way for ADRs. I have two proposals from Intl docs saying no issues with doing. Plenty of testimonials from successful folks. Who is the arbiter? Who can help me judge? How can seemingly smart folks be so diametrically opposed as to appropriateness/likelihood of success of treatment? How long can I wait before this becomes permanent?

In reading the forum posts, I feel like I am on Tripadvisor. "The BBQ was the best I ever had!" "The BBQ was the worst ever!" All very confusing.
I apologize for the length. Any ideas would be appreciated. Next summer very busy and feel like I need to so something soon. Thanks.

annapurna 07-13-2021 10:33 AM

First - I can't give you a guide for making a decision. How you decide to rank different risks and different types of risk is something personal to you but I can point out a few things.

I've never heard of Egoscue before your post. A 5 second glance at the webpage Google found suggested that it's a strengthening and flexibility enhancer; both of which would help offset mild problems and probably stop advancement. Neither of which would be guaranteed to stop advancement of moderate or severe conditions. One of the neurologists explained chiropractic care for torn disk to be "stomping the other side of a jelly donut to get the jelly to go back into it" and that seems to apply here.

In my experience, doctors give different solutions to the same presentation of problems because they're viewing the list of acceptable solutions based on their experience. A surgeon with 1000's of fusions and a hand-full of ADRs completed will lead towards fusion, for example. The only way around this that I've found is to ask the doctor why they recommend something, after having done enough research on my own to be able to tell BS when it's spouted at me. Basically, ADR is disfavored but not unavailable in the US. ADR is favored and can be used in situations where it's not advisable in Europe. Thus, the different answers you get.

The one firm thing that I can say is that leg weakness is definitely a bad sign. Depending on how serious it is, that may be a BAD SIGN. It does mean that the clock is ticking for finding a long-term solution if you want to achieve a full or nearly-full recovery. I don't mean to spur you to an unwise decision that gets you into surgery in weeks but it is time to make decisions and start seriously working in the direction of resolution.

Now an opinion - fusing L5-S1 or anything between L3 and T10 seems to me to be very unwise with the double level fusion in place already. L5-S1 fusion would transfer load to your SI joints and hips. Hips can be replaced but only a limited number of times before the bone damage becomes pronounced. SI joints can't be replaced and the only repair is to fuse them, which speeds damage to the hips. If it were me and, again this is just my opinion, I'd get on at least one Zoom or Zoom-like consult with some of the Europeans who're recommending ADR and ask as many questions as you can to understand their reasons for offering it.

Jag100 07-13-2021 12:13 PM

Annapurna,

Thanks very much for taking the time to respond. Makes a lot of sense. just trying to decide on the dice roll of possibly making things worse or waiting for things to get worse. In all of my reading, I had not come across anything on SI joint issues. Thanks for that nugget.

I read many of your posts prior to setting up my account. Very enlightening.

Thanks again.

Harrison 07-14-2021 11:12 AM

Hey Jag, could you help me better understand: what is the source of your pain? It is possible it's only one level causing 90% of your pain?

Jag100 07-14-2021 12:30 PM

Harrison,

Not sure I can answer that. It has been the pattern that when we fix something, something else breaks. I suppose it's adjacent disk degeneration.

The Radiologist report from the most recent MRI indicates

"At L1/L2" disk bulge and facet arthrosis contribute to central canal bilateral lateral recess and biforaminal stenosis left greater than right with contact of descending nerve roots bilaterally." ,

"At L2/L3 level......pseudobulge from the retrolisthesis and facet arthropathy contribute to central canal, bilateral recess and biforaminal stenosis with contact of the descending and exiting nerve roots bilaterally."

Also, at L5/S1, "pseudobulge from the listhesis and facet arthropathy contribute to the central canal, bilateral lateral recess and biforaminal stenosis with contact of the descending and exiting nerve roots bilaterally."

I assume if nerves are being contacted, each or all could be a source of the pain.

Not sure if that helps.

Thanks for reaching out

annapurna 07-14-2021 07:27 PM

"It has been the pattern that when we fix something, something else breaks."

Watch for that because it could be true for multiple reasons. Any or all of the following could be creating that kind of response:

1) Pain gating - you only "feel" the most severe pain generator and other lesser sources aren't detectable until the most severe is addressed. If this is going on, you should be seeing the damage for the lesser sources on films, etc. Your doctor may dismiss those because you're not feeling pain from them but gating may be blocking that pain.

2) Misloading due to existing damage - I have to talk about this from a mechanical engineering standpoint, even though it's not quite right for a human body. Basically, if part A breaks, your body overuses parts B and C until you can get part A fixed. This means you're creating damage to B & C that you're unaware of until you get A fixed and really try to do something with your body.

3) Misloading due to the nature of the repair - Adjacent level disk disease from fusions is one example of this but hypermobile ADRs also cause problems.

If you're having problems with disk bulges and stenosis, you might be able to self-diagnose a bit by checking the nerve enervation pathways for each spinal level and see where you're having problems with weakness and pain along those pathways. You can find those diagrams fairly easily with an image search on the internet.

Zeegers, one of the pioneers for ADR surgery, was famous for demonstrating with a set of images that the badly damaged disk isn't always the one causing the patient's pain.

Jag100 07-18-2021 08:03 AM

What are "hypermobile" ADRs? What models should I be wary of?

Thanks,

annapurna 07-18-2021 11:26 AM

Quote:

Originally Posted by Jag100 (Post 119155)
What are "hypermobile" ADRs? What models should I be wary of?

Thanks,

That's, unfortunately, a loaded question. Most ADR designs don't have any inherent resistance to physiologically correct motion directions. That is, if a natural disk allows you to move your spine in a certain way, the ADR allows it as well. The natural disk works with all of the soft tissue stabilizing the spine to create a spring effect so that the farther you move in a direction, the harder it is to continue moving.

Most ADRs move freely and don't provide any resistance so all of that spring effect comes from the soft tissue. To complicate it, the loss of disk height as the natural disk degenerates, return to full height post ADR surgery, and the effect of the stretching in the surgery to get the ADR implanted, all leads to potentially weakened soft tissues. That means you can have a situation post-ADR surgery where your facets can end up acting like doorstops and seeing damage. There's a lot of ifs and maybes in there but being careful to not over do it post-ADR surgery until you can start strengthening the soft tissue to protect the facets is important.

To my knowledge the M6 is the only ADR with inherent resistance to motion. It offers that and some degree of shock absorbance at the cost of a lot of other concerns that have been discussed extensively on this board. Personally, if offered two completely equal ADR options, I'd avoid the M6. If offered an M6 vs. an un-needed fusion, I'd use the M6 and just make sure I watch for the concerns that have been noted about it.

randolf 07-22-2021 04:47 PM

Quote:

Originally Posted by Jag100 (Post 119155)
What are "hypermobile" ADRs? What models should I be wary of?

Thanks,

all ball and socket type ADRs tend to be hyper-mobile with little or no resistance to motion. the Spinal Kinetics has this natural resistance. it is also designed like the natural disc with an annulus and a nucleus, so it may tend to weaken like the natural disc. Axiomed Freedom disc is a simpler design that eliminates the annulus and is a true 1 piece unit. the ELP, Elastic Spine pad is also a 1 piece unit much like the Freedom disc, but is made in Europe. the Spinal Kinetic M-6 and the Aiomed Freedom discs are made in the good ol' U S of A. ALL of them are available in Europe, none in the usa. ball and sockets is all we get here. so stay here and get fusions or 1 or 2 ball and sockets. go to Europe and get the natural motion ADRs and maybe create jobs here in the good ol' U S of A, or not. best of luck.

Jag100 07-31-2021 09:17 AM

Thanks very much for this. A lot to chew on and I will diligently research. Thanks for taking the time.


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