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David 06-28-2005 08:51 AM

For anyone who is interested, here are my reports (thanks for the suggestions for going directly to radiology / medical records at the hospital to get them):

[I will get them scanned and on my website later today]

#1: Fluoro Only. No report.

#2: Information 722.1, herniated nucleus pulposus. Low back pain. Diskogram. Lumbar spine. Two views.

I have two spot views obtained with portable unit in the operating room. It disclosed the patient to be status post contrast material injection at the L3-L4, L4-L5, and L5-S1 disk spaces. Further evaluation of the disk spaces will be performed with CT or fluoroscopy time. Clinical service required fluoroscopy time to perform the above mentioned procedures and manipulations.

#3: CT lumbar spine. Clinical History: Chronic back pain.

Findings: The examination was performed following a diskogram. Contrast has been injected into the L3-L4, L4-L5, and L5-S1 disks.

L3-L4: Unremarkable.
L4-L5: There is extravasation of contrast into the anterior epidural space through a defect in the posterior mid-annulus.
L5-S1: Contrast protrudes through a defect in the posterior mid-annulus.

Impression: Small central disk herniations at both L4-L5 and L5-S1.

*sigh*. Livin' the life!


Rein 06-29-2005 08:38 AM

So has anyone suggested discectomies at those two levels yet?

David 06-29-2005 08:54 AM

Not yet. To be honest, it has not been suggested, nor even considered at this point.

My previous ortho immediately suggested fusion (I was pushing for surgery), mainly because he wasn't familiar with ADR yet (although he did admit that, in his opinion, I was a perfect candidate for ADR).

My followup appointment with my neurosurgeon is 14-JUL, at which point in time I will see what his new suggestion is (his original suggestion was 1 level ADR @L4-L5, provided a 2nd discogram / CT scan confirmed the 1st discogram, which it didn't)

I am also in the process of getting a second and third opinion from Drs. Z and B.


"To maximize effectiveness, open discectomy is reserved for people who are experiencing buttock and leg pain or weakness that is persistent, severe and/or disabling. If your back or leg pain is not at that level, open discectomy may not be advisable for you and you can possibly do as well with conservative treatment or less invasive therapies."

----> based on that description, I would say that perhaps a discectomy is not in my best interest (in my case, no buttock pain, no leg pain, no numbess in my legs). Although, in all fairness, that is open discectomy, not endoscopic nor laser discectomy


After doing some quick reading about discectomies, I would say that I am neither for nor against it. I do recall reading some poster's .sig files that indicate previously (failed) discectomies that then led to ADR sugery.

I guess the plus side to a discectomy is that if it fails, I can still have ADR. If I have ADR, then discectomy is no longer possible (but unlikely that it would be needed).

It does looks like disectomy is a lot less invasive than ADR though.


Rein 06-29-2005 06:05 PM

I'd assumed (obviously, very incorrectly) that you were suffering from typical buttock/leg pain from leaking nucleus pulposa. If you don't have that pain you're one of the lucky few and your situation (in my humble opinon) certainly doesn't warrant discectomy, as benign as that procedure may be.

I've written on discectomies before on this forum, mainly concerning the fact that they are inevitably followed by total disc collapse (after an indeterminate length of time) and are only a stopgap measure to relieve radiculopathy before fusion or ADR.

If you *were* to undergo discectomy, there is no reason in the world, nowadays, for it *not* to be the microendoscopic version (even if you require multiple levels, in which case they would likely opt for multiple incisions rather than a single open procedure - it really depends on the extent and location of leaking). I underwent that procedure for my L5-S1 rupture and the incision was 1 inch long. I could have walked out of the hospital the same day except for the delay caused by my surgeon having to perform emergency brain surgery during my morning slot. I sincerely hope you don't degenerate to that level before obtaining ADR, as the pain from nucleotic material impinging on the spinal cord, after it gets into gear, is really nasty. Once the onset occurs, there's just no position into which one can maneuver to escape its clutches. Imagine sulphuric acid inserted into the top of your buttock through a hollowed-out screwdriver... I spent about 48 agony-filled, sleepless hours before I finally got got my sorry butt to the emergency room and was hooked up to a morphine drip (all my visitors called me Mr. Giggles after that one).

If you do feel pain starting as I've described, don't follow my dimwitted example and wait too long...

You are correct - if you obtain ADR (and no nucleotic material has leaked out beforehand) then there's no reason or need for discectomy because whatever is left of the nucleus is removed during the ADR procedure (and that's all the discectomy achieves, really - removing leaked-out material which compresses and irritates spinal nerves).

David 06-30-2005 08:54 AM

thanks for the info. I am very curious to see what my neuro now recommends, since a one level ADR is no longer a viable option.

I am presuming that he will recommend either ADR / fusion or fusion / fusion (and probably not a discectomy), which is why (as I have mentioned) I wanted Zeeger's and Bertagnoli's opinions as well.

If a 2 level ADR is my best option, the I won't hesistate to go to Germany to have it done.


bmills 06-30-2005 03:58 PM

David, does the MRI show DDD at both levels? Did you feel concordant pain at both or one level?


David 06-30-2005 04:30 PM

DDD at both levels: I believe so, yes. Please feel free to go look at the MRI yourself (link in my .sig file),.

Concordant pain at both levels: All I know is that my most recent discogram indicated pain at both levels. My neuro didn't give me a gauge for how much at each level, and my next appointment isn't until 14-JUL.


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