New member - 32 w/ L5/S1 discogenic pain
 

Hi all,

I apologize in advance if I ever talk above anyone's head - I myself am a physician and unfortunately having to be a patient way too much lately. See the gist of my situation in my signature... probably misdiagnosed for a while, right now unable to work due to combination of pain and employer's unwillingness to let me work w/ my restrictions.

Have many dr friends and saw an ortho spine last week at Hopkins... he recommended fusion vs ADR depending on result of facet joint injections. my pain dr is one of the few in the country doing biacuplasties and I'm in the process of scheduling that.

Wondering if anyone out there has had one? Being medically savvy I'm a little leery of having an unproven procedure, but for discogenic pain either fusion or ADR is at best 70% efficacious and obviously has significantly more risk. Biacuplasty is FDA approved but very very few insurances cover it. I have very good insurance which does cover ADR (Aetna), but they consider biacuplasty "investigational", as the randomized control trials are just starting. The initial studies are pretty promising and there were no significant adverse outcomes.

As mentioned in my title, I'm only 32 and don't want to start down the road of back surgery just yet. Used to be very active and now am just above a couch potato :(

Doc,

Sorry about your pain, I hope we can help you with your next steps. In no particular order, some responses to you questions and concerns:

- Patients from all over the US and world pass through this community. Most are considering motion preservation procedures, but many are disqualified (rightfully so) because of severe arthritis, spondy, etc and opt for spinal fusion.There are appr. 20 docs of various fields that are members here too.

- Please take a look at the topic called ADR Risks, Complications, Disqualifications in Arthroplasty Central. Also, if you’ve not already seen my presentation at SAS, you’ll find a nice summary of the continuous survey of ADR patient outcomes; it includes other germane issues like complications, insurance, diagnostics, etc.

- When you can, please tell us a bit more about your spinal history; include that in your signature too.

- If you search the forums on biacuplasty, you will find a number of relevant topics, like this one.

For what it's worth, IMHO, the weakest area in spinal orthopedics (and for that matter, medicine) is in diagnostics! Within this community, there are many members who have DDD with comorbidities that are not “necessarily” linked; but the ones with fibro or other autoimmunity conditions do not do as well post-operatively as others. I'd like to hear your perspective on this...

Hope this helps get you started…lots to read here!

Thanks Harrison, see my signature for my history... not as long and colorful as some i've seen on the site, but i am only 32!! i've had ortho issues here and there my whole life thanks to being active and hypermobile. i'm currently unable to work in my job (ER doc) b/c of this problem and am going to have to reconsider my career to avoid a life of chronic pain.

i read that thread on biacuplasty - my insurance doesn't cover it either like i said before... i am fortunate that my doc will have baylis donate the kit and should be able to have most of the cost written off by having it done at the hospital where i work(ed) and am still on the medical staff. being a doc does pay off sometimes! my pain doc has done a lot and says he has had very good success (at least 80% "success") in young pts w/ 1 level discogram proven pain generator w/o loss of disc ht and otherwise normal spine. so i will keep everyone posted... looking at another 3 months out of work after this is done :( thank god i was saving to buy a house!

i am lucky in that i don't have any significant comorbidities, except for some depression/anxiety premorbid but much much worse due to all of this... ie no fibro or other chronic pain. my mom does have fibro and lots of OA so i hope i'm not headed down that path! it does make recovery difficult and i'm working hard to not be on chronic narcs b/c i do think it affects the brain in ways we don't understand well. there are also some theories that chronic pain permanently affects the SC and brain, which may account for less than optimal outcomes in pts w/ chronic pain. again, my goal is not to have chronic pain and i'm willing to redo my life to avoid it. in my line of work i see the most burned out chronic pain pts and would do anything to avoid that type of lifestyle. i'm known to surf, raft, hike, swim, bike... and want to get back to those things!

Doc,

That's a terrible story for anyone; but especially for someone that's only 32! I'm sorry that I can't address any of the questions that you pose. This is the first I've heard of biacuplasty. Please keep us informed on your progress through that procedure.

Good luck, Jeff