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Old 05-21-2010, 12:00 AM
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Tatonka_usn Tatonka_usn is offline
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Default Thoracic spine surgery options?

Was curious if there is any literature/personal experience out there with spinal surgeries being done at the mid levels of the thoracic spine? The vast amount of data/information out there (naturally) appears related to either cervical or lumbar issues/procedures. Having done a bit of research for my other "issues", it would appear that the middle area of the spine moves the least, but is also the conduit/conductor of problems moving from one end of the spine to the other. In evaluting some of my current symptoms (which most likely go back quite a while and have been overlooked), I'd hazard a wager to say that there is some sort of damage up around the T7/8 level (though I have no studies to back up my hunch, yet). If this is the case, are there any palatable options? I'm gathering ADR would be a no-go, due to location/anatomy, but would some sort of fusion be a fallback? Are discectomies done in this area? Just curious, if worse comes to worse....

Thanks!
Alan
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4/07:LBP + radiculopathy=severe L5-S1 herniation , 7/07:Micro-D, 08-09:Reherniation, 09-17: periodic residual symptoms (conservative modalities to maintain "stability" = prolotherapy, ESI/nerve blocks/facet injections, chiro, massage, phys ther), 7/17 pain in neck/right shoulder radiating into hand (no trauma involved), 7-10/17 Conservative treatment to date include physical therapy/dry-needling/facet-injections (C4/5 to C6/7). Researching surgical options should progression continue.
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Old 05-26-2010, 08:26 PM
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Tatonka_usn Tatonka_usn is offline
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Default Frustrated X2

It's been a while since I've done much of an update, but I had two recent events which have left me fairly exasperated and in need of a good venting:

1) After much effort, I was FINALLY able to see the surgeon who did my discectomy at Walter Reed nearly 3 years ago. This Doctor is pretty much the tops in Army neurosurgery, and my wife and I were both thrilled at compassion, skill, and bedside manner way back when. The fact that my outcome has been less than hoped is more related to my own genetics and luck than his ability in the OR. For months (since back on the East Coast) I'd been hoping to get a consult to see him for the deterioration in both my neck and lower back. The referral went in for my neck first, though my plan was to discuss both while I had him as a captive audience....in hopes of getting some sort of corroborating opinion about my gradual decline and ADR candidacy.

Unfortunately, after waiting an hour past time, he wound up spending less than 10 minutes with me discussing my issues (without so much as an examination). He wrote off the bulges in my neck as non-operative, asking if I'd done any PT for it yet (yes). Ok, so a consult for physical medicine was his answer (sure, why not....again). When finally getting around to my lumbar issues, I brought up the fact that my last two consults have both determined that loss of disc height at one level made me a good "candidate" for an ADR (but that I should keep trying conservative measures as long as possible). We had a very frank discussing about ADR, and he was blunt with me that he'd lost confidence in the technology as it now stands (this from someone who, up until recently, had used the Charitee). He didn't discount the fact that future advances would make the technology appealing/viable (ie try to hold off as along as possible), but that there was too much money tied up in the studies which led to FDA approval of the current crop of ADR technology (I'm paraphrasing, as he pulled no punches about his beliefs regarding certain doctor's vested interests).

As such, he ruled out ADR for me....subtly implying that fusion would be the way to go. I asked him if there was anything I can do to mitigate my current slide, and he said no. The kicker, and what really rocked me on my heels, was his pronouncement that 1) I should hold off as long as possible (no brainer) and that 2) I'd know when I was ready for surgery, in that I would essentially be unable to get out of bed/function at all. While I appreicate his candor, and certainly am not in ANY rush for surgery, the mindset that I have to be fully incapacitated before action is taken strikes me as a bit extreme. It's as if he is willing to consign me to likely permanent nerve damage by holding off as long as possible. Yes, there is a fine line/gray area, but I was taken aback. I'm not sure when his perspective changed from compassion to coldness, but must assume I'm small potatoes when it comes to all the combat related casualties he sees on a regular basis. Regardless, I left completely flustered....

2) In an attempt to do something/anything to arrest my current decline, I made the grievous mistake of going back to chiropractic as an alternative course of treatment. I've posted in the past that I've been to 3 or 4 practicioners over the past few years, ranging from great (my cousin) to clueless. Unfortunately, I don't appear to have learned my lesson from previous forays, and decided to try a local guy near my house. He appears knowledgeable and personable, and I was impressed by the fact that he was a physical therapist as well (combining a more holistic approach). Unfortunately, in 4 sessions his adjustments have left me significantly worse than when I began. Despite my vocalized concern, he did a rotational/torque adjustment on my lower back each session, and I'm under the firm belief that is has exacerbated my protrusion at L5-S1 (to include increased LBP, coupled with pain down the back of both legs and difficulty sitting -- a completely new symptom).

It was my own stupidity for not being more assertive, as I KNEW I should have stood my ground. That said, being frustrated, in pain, and grasping for any "out" I thought he knew what he was doing (and that the adjustments would at least not make things WORSE). I cancelled my appointment today, and plan to go in tomorrow to let them know my condition and intention to discontinue visits (at least temporarily). I'm sure they'll be sympathetic, but in the end the joke's on me. I hope to g-d this is only a temporary flare-up of the muscles, etc....but given the extent/location of pain I can tell something significant has occured. Fortunatley, I'm due for another follow-up MRI the end of next week (which will let me know what exactly is going on), but get the feeling it will be of little consolation.

My apologies for unloading this on you all, but I've grown tired of moping around here and griping to my better half. She has the patience of a SAINT with me, but I know it must wear on her over time. I appreciate the fact that there is a community of fellow sufferers out there who can empathize with my plight. Thanks for listening!

Alan

P.S. As of last Friday I began taking cymbalta to help with neuropathic pain (as was recommended by my cousin, a well respected Pain Management Doc). She believes that I am suffering from depression as well (figure that!), and that the drug will assist with both symptoms. I'm still not sold on her approach, seeing this as a "chicken & egg" scenario: does the pain cause depression (my take) or does depression lead to pain (her take). Regardless, I've heard mainly good things about the drug, even if I'm leery of taking things which mess with brain chemistry. If any of you are familiar with this (or have taken it), I'd appreciate any feedback (so that I can know what I'm getting myself into). Thanks!
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4/07:LBP + radiculopathy=severe L5-S1 herniation , 7/07:Micro-D, 08-09:Reherniation, 09-17: periodic residual symptoms (conservative modalities to maintain "stability" = prolotherapy, ESI/nerve blocks/facet injections, chiro, massage, phys ther), 7/17 pain in neck/right shoulder radiating into hand (no trauma involved), 7-10/17 Conservative treatment to date include physical therapy/dry-needling/facet-injections (C4/5 to C6/7). Researching surgical options should progression continue.
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Old 05-26-2010, 09:43 PM
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Harrison Harrison is offline
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Hi Alan, I merged your previous topic about thoracic surgeries with this one. Sorry no one responded; but you are right -- thoracic surgeries are rare, difficult and risky. The ones we have read about within this community were primarily due to to trauma or infection. As you know, many problems can refer to the T spine, but may not originate there. What did the previous imaging of the T spine show? Any abnormal pathology?!

Sent you a PM, got yours, talk to you soon. Hang tough, brother! Off to bed soon...

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