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  #11  
Old 03-25-2011, 11:04 AM
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banhorn banhorn is offline
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Hey guys,

I don't want to create a flame war between conservative treatment and ADR in my first post here!

I've done physio in the past and will continue to do it while my back hurts - nothing has helped me as much as time and yoga, I might add.

The only thing troubling me right now is that I haven't seen any improvement in 6 months this time around and the radicular symptoms are getting worse. That's why I began looking into ADR.
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July 2011 - L4/5 M6-L, Courtesy of Mr. Nick Boeree
http://backup.muellhorn.ca
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  #12  
Old 03-25-2011, 02:23 PM
longroadahead longroadahead is offline
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I have seen 3 physical thearpist since I started having backpain. 2 of the 3 said they didn't think they would be able to help me. One of them thought so but after a few months I was still the same.

Everyone is different but I don't want to go the PT route again before surgery but think everyone should at least try it first...
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2008 Back pain stared (M, 37, 5'11", 185#)

2009 MRI, Bilateral SI Joint Injection, PT, L4/5 Bi Lateral Facet Injection

2010 Acupuncture, Discogram, L4/5 and L5/S1 Bi Lateral Facet Injection, PT, L3/4, L4/5, L5/S1 Fibrin Sealant Injections

2011 Right leg pain started mainly with movement of the leg.
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  #13  
Old 03-26-2011, 12:02 AM
annapurna annapurna is offline
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Quote:
Originally Posted by annapurna View Post
I'm not going to touch the argument about conservative care vs. surgery. Even if you're dead set on surgery, though, a good solid core strengthening and flexiblity regime buys you time, gives you the most you can get out of your life while you're working to get surgery, and makes your recovery time shorter after the surgery. A few years back, Bertagnoli replaced every disk in one gentleman's c-spine with a mix of ADRs and fusions. The man had worked hard to remain fit and it paid off with a recovery time in weeks. I don't recall the exact time but he was up and about within some number of weeks, definitely less than two months.
Laura corrected me. The person had every disk in his L-spine, not c-spine, even strengthening the argument for being in good shape at that start of your surgery.

Mind you, it's pretty unlikely that you'd even be here reading these posts if you're the kind of person who could be entirely repaired by PT. My advice: continue pursuing surgery and use PT to improve your quality of life until you have your ducks in a row for the surgery. If things go the way they typically go, you'll have at least a month or two of PT under your belt, so to speak, by the time you get to your surgery/no-surgery decision point. See if the PT is helping then and make an informed decision. The other important thing is to not look at PT as something you have to go to a therapist and get your PT appointment or else it doesn't count. Don't let those PT appointments crowd your life to the point where you don't have time to live. Get exercises, stretches, whatever from the therapist and do them faithfully at home and just use your appointments to add or subtract from those based on what's working and what isn't.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #14  
Old 04-05-2011, 01:18 PM
jgoods jgoods is offline
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Hi Brett,

Just read your post and can sympathize with your condition. I've had back troubles for about 8 years now, but for the last 2 years it has been getting progressively worse (ie 1 day not bad followed by 2 days of pain). Like you, I'm currently chasing my 15 month old child around which aggravates it a lot and have been trolling this site for possible ADR surgery.

Also, I'm caught up in Ontario medical system and the Doctors seem to not know how to approach back problems. After getting an MRI was told to keep doing pilates and hang in there! Thanks, tell me something I don't know. One thing I was wondering was, do you have a positive straight leg raise test? Mine is negative so a surgeon won't even see me even thought my feet are numb.

One more thing I wanted to mention; in 2005 I had a really bad disk herniation that they wanted to operate on (I was living in the U.S.); but instead I tried two ESI done with a fluoroscope. My pain went from a 10 to a 1 and it lasted for 3 years until I injured another disk. They were about $650 each, but I don't think they do them in Canada, not sure though.

I would be very interested in learning what you decide do since I'm in the same boat.

Good Luck

John
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L3/4 - Disk desiccation with left paracentral herniation that compresses the left L4 nerve root within the lateral recess.
L4/5 - Disk desiccation with an annular tear, disc height loss & a broad based central disc herniation that compresses the descending L5 nerve roots bilaterally.
L5/S1 - Disk desiccation with a central disk herniation and annular tear that has led again to bilateral lateral recess narrowing with potential compression of the descending S1 nerve roots.
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  #15  
Old 04-05-2011, 02:58 PM
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banhorn banhorn is offline
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Thanks for the reply, John!

I've got my appointment with our spine specialists from the UofC on Friday. I'll see what they have to say and keep you guys posted. My leg raise test was terrbile in November, but it has gotten better while taking gluco/chondroitin etc... I'm not sure how it's working, but my pain is a little less after ~2 months of taking it. I'm taking something called "animal flex" - some crazy body builder supplement that I read about. It's got the gluco/chondroitin/msm in it along with some natural anti-inflammatories. I'll ask the doc this friday about the ESI injections to see if they are applicable to me.

As a side note, I applied to be part of the Mesoblast Phase II clinical trial for invertebral disc repair (stem cells) - but was rejected today because my stenosis is slightly larger than 3mm. So close!

Too bad. For any of you out there wondering about Mesoblast, keep your eyes peeled for the Phase III trial next year. I'll be posting on here as soon as I hear anything. It will be their pivotal trial with a larger patient list and a little more lax on the requirements to get in.

I decided to blog my journey (as Mike did) through this back in Feb... Probably a boring read for most of you that are old hats at this, but I'm trying to document everything I come accross just in case it might help anyone else (especially us canucks).

"Backup"
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July 2011 - L4/5 M6-L, Courtesy of Mr. Nick Boeree
http://backup.muellhorn.ca
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  #16  
Old 04-06-2011, 01:07 AM
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banhorn banhorn is offline
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Sorry, Annapurna... missed your post. I'm sticking with the daily PT excercises for sure, but it's been tough seeing no improvement since November. I need to look into the Mckenzie PT stuff too, as aluded to in an earlier post.

Thanks again guys for your insights.
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http://backup.muellhorn.ca
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  #17  
Old 04-14-2011, 12:01 AM
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banhorn banhorn is offline
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Well, my meeting here in Calgary wasn't as helpful as I had hoped.

It was a combo physio/doc/excercise therapist assessment and got off to a great start. The physio assessment was very thorough and he was very nice and listened well. We re-established my issues with flexion and extension, twists, numbness, tingles and pain. My leg raise tests increased back pain exponentially as expected (more right than left) and he remarked about my limited range of motion. The physio then took a quick look at my MRI, noted the bulge and brought in the spinal triage doc to go over my history and scans. He also also noted the bulge, my symptoms and the hypertrophic changes of my joints, the disc degeneration and all the the nerve root compression as a result. Obviously a fan of conservative treatment, he told me to continue my limited exercise repertoire and that a fusion now would result in ~3 more surgeries over my lifetime to relieve the degeneration on adjacent levels. According to him, you only operate when the leg pain/numbness/tingles exceeds the back pain. He said I’m destined to live with my current (and worsening) level of pain for the next 20 years, when they will likely pursue a 3 level fusion. As such, I am not a candidate for any surgeries yet, but if the leg symptoms stay or progress, I will need something. He didn’t indicate what kind of a "something" that would be or if/when I should even follow up with him. When I asked him specifically about laminectomies and ADR, he replied:
1) Laminectomies will just create more tissue growth than before and make everything worse
2) ADR will not help any of the pain I’m feeling because he felt it is mostly related to the facets.

Needless to say, I left the consultation a good deal more confused.

I've spoken with Mr. Boeree and Dr. Clavel who indicated my facets are only slightly degenerated and are just on the larger side of normal. Both agree my pain/tingles/numbness are direcltly related to the disc degeneration/bulge. Both agree that I'm a candidate for ADR and my local spine doc tells me they are wrong and that I'm destined to just suck it up for 20 years until they fuse my entire lower back. Who am I supposed to trust? My heart wants to trust Mr. Boeree, but man... this fellow in Calgary really shook my confidence. Is the doc in Calgary really looking out for my best interest or is that the answer of an overburdened public system that only deals with the most serious cases? Are the docs in Europe just out to make a buck? Is it folly to be pursing ADR? I'm going to phone Mr. Boeree next week to go through the Calgary results.

John, I honestly thought our healthcare system might be able to help, but I was speechless when the doc told me that. They also told me there was no way they'd reimburse me for a foreign surgery of this nature... A long shot, I know - but I had to ask again for us canucks.

I'm worried that if I do pull the trigger on the surgery, my follow up coverage in Canada will be poor because the docs told me to just suck it up in the first place.

I posted some shots of my MRI as well online if anyone is inerested and I'm working on gathering some more shots of the facets (I didn't even know what they were until recently).
My Diagnosis « "Backup"

This is kind of a weird and dark question - but does pursuing an "elective" surgery like this generally negate any existing life insurance or critical illness insurance policies? I would hate to leave my family financially exposed in a worst case scenario should I move on the surgery.
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  #18  
Old 04-14-2011, 08:30 AM
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Jstuckey Jstuckey is offline
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My personal opinion on a few things:

1. We've all been there. It's a subject that every person on this website seems to lack: a quick, easy decision that stems from multiple opinions that agree. I had 5 different recommendations (fusion only to 3 level ADR only, and everywhere in between)
2. As a medical professional myself, it's hard to recommend something you really aren't experienced in doing. If you had the training, support staff and facilities, and reimbursement: you'd probably be providing it yourself. ADR is not a new, crazy surgery. Professionals recommend what they know and believe in at the time.
3. Read your insurance policies, but I can't imagine have elective surgery for any reason (cosmetic, sex change, whatever!) would be a reason to deny payment if things went south. There are usually clauses regarding suicide, drunk driving, war.... but not surgery.
4. Keep working toward an answer that is unique to you. It has taken me around 6 months to make and feel good about a decision. (Nick Boeree for me, by the way. If you go that route, I have some housing info cheaper and more comfortable than a hotel).

Best wishes.
United in hope for a mobile, pain-free future,
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Joey Sue - 50 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick! Still doing great.
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
http://healthyback2011.blogspot.com/
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  #19  
Old 04-14-2011, 09:47 AM
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jss jss is offline
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Brett (and John),

Condolences on your terrible dilemma.

I don't know if you should go with what the Canadian doctors are telling you, or if you should go with what Boeree and Clavel are telling you. I can tell you that in reading these forums that I have never seen a kind word written about the Canadian medical system where spine issues are concerned; and what I've seen posted about Boeree and Clavel has been almost universal praise.

My situation was so much easier; six opinions, five of them were identical; a two level ADR. Clavel did my cervical ADRs, and I've been able to resume all activities that are not contra-indicated by the fact that two of the strongest structures that hold my head to my body had to be removed for ADR. BTW: when I was in Barcelona for surgery, I was one of two foreign patients that Clavel had at the time. The other guy was a Canadian lumbar patient who could not get treatment within the Canadian system.

Would it be possible for you to visit a US ADR surgeon? Or better yet, multiple ADR surgeons? They would probably come down somewhere between the Canadian and European surgeons; probably closer to the Europeans. I would strongly ditto Joey Sue's words; accept trash talk about ADR only from a surgeon that has some experience with ADR. If I were to tell you that Chevrolet's were terrible cars, but I'd never actually even seen one ...

Good luck, Jeff
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #20  
Old 04-20-2011, 08:44 AM
jgoods jgoods is offline
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Hi Brett,

I was catching up on the posts and saw your update, sorry that it didn't go that well, but I'm not that surprised. My doctor here in Toronto told me a surgeon wouldn't even see me without a positive straight leg test and if he did get me get me in (about 6-8 month wait) he would only want to fuse the two or three levels; standard approach. No thanks! Thus my options are limited to pilates and/or massage which will never solve the underlying problem, but won't hurt and will most likely help even if I get and ADR so I keep doing them.

As for the ADR, although OHIP won't pay for it my accountant told me you can get 25% back from CCRA when you file your taxes, it's not a lot but at least it's something. As for your decision to have it done or not, I'm in the same boat although I suspect my pain level is far below yours at this point. I do believe that the Canadian doctors are only going to recommend/push surgery or care that they are familiar with. I do have concerns about follow up care when one returns from an ADR, but maybe some of the other Canadians who have come back from having ADR could comment.

Have you ever contacted the Texas Back Institute? They have been on my "radar", but I haven't talked to them yet. The main thing with them is that they do everything, not just ADR's and they are quite close to us. Not sure about cost, but if your self pay I think there rates are competitive to the Europeans. Just my $0.02! Hang in there hope some of my rambling helps.

John
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L3/4 - Disk desiccation with left paracentral herniation that compresses the left L4 nerve root within the lateral recess.
L4/5 - Disk desiccation with an annular tear, disc height loss & a broad based central disc herniation that compresses the descending L5 nerve roots bilaterally.
L5/S1 - Disk desiccation with a central disk herniation and annular tear that has led again to bilateral lateral recess narrowing with potential compression of the descending S1 nerve roots.
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