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  #1  
Old 09-09-2010, 01:57 AM
Zymergist Zymergist is offline
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Posts: 16
Default Termites I tell you.....

Damn.

When I was younger I never thought my 19" tree trunk of a neck would be my weak link. I am 5’9.5” tall and 240lbs. I could stand to lose 40lbs, but that would put me completely lean with my build. I spent 15 years in the auto repair industry, and would not have been surprised at lumbar spine issues, but with all the stupid lifting I have done that has never been a problem (I know how lucky I am on that part). About 8 yrs ago the thumb, index finger, and 1/2 lengthwise of my middle finger on the right hand went numb. Spent 3 mo with the WC system till I got an MRI and a spine doc. I thought the diag was C4-5, but I cant find my old paperwork now. As I am a heavy frame build and way above the normal curve on strength my doc at the time opted to go non surgical with drugs and PT. Worked great at the time, but ended my career as a mechanic (was declared 39% perm disabled as my job involved regularly bending, overhead work, lifting 50lbs, and periodically lifting 100+lbs).

Now I am having different and worse symptoms for the last 6 weeks. Progressed from tension in the R-Shoulder and got worse (see sig). Started treatment with drugs and home traction, but have always had poor results with the over the door traction units. Got a ProNex pneumatic traction unit. The traction provided temporary relief for as long as I was on it, but that was all. The symptoms continued to get worse and I started PT. A strength test shoed my right hand 5% weaker than the left instead of the normal 20% stronger. Traction (Home or at PT) stopped helping and even started stimulating symptoms. HAd an MRI a week ago and saw a neuro surgeon today, He put me on a second Medrol Dosepac and a soft c-collar for a week but is expecting surgery (fusion). My referral was to Dr Christopher Uchiyama (chief of neuro surgery at Scripps Green in San Diego) but he had no apts till the end of oct, so I was scheduled with DR Justin Renaudin who has been practicing over 40 years and is no longer performing surgery. While he seems quite competent, he seems to think I would not be ADR candidate based on the fusion. I of course will be getting other opinions and trying different therapys.

I want to look at ANY options before I consider ending up with a double cervical fusion. I will be sending my MRI to the Laser Spine center in Scottsdale AZ for the free evaluation they offer and aggressively looking at other options. I am scared for my future as a physicaly active person. I have a 19 mo son I look forward to backpacking with as well as doing lots of other active things, and I dont want to have to think about not being able to things with him.

So, anyone have a recommendation in the Southern CA area to tent a tree trunk for termites?

(Sorry if I am a bit disjointed, as I am sure anyone here understands I am a bit freaked out)

Thanks
Jason
__________________
Congenital fusion C5-6
"Notable" herniation C6-7 with bone spurs - Fused 3/3/2011
Degeneration at C7-T1, non symptomatic yet...
Mild herniations C3-4 and C4-5

Numbness R-Hand - Gone withing 48 hrs of surgury
"Hot-Wire" pain R-Shoulder through elbow and hand - still controlled with Nurontin, expected gone in a few weeks.
intermittent tingling and electrical jolts R-Arm - Gone after surgery

Last edited by Zymergist; 09-09-2010 at 02:47 AM.
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  #2  
Old 09-09-2010, 09:23 PM
Toebin's Avatar
Toebin Toebin is offline
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Hi Zymergist and welcome to the ADR Boards !

One place that comes up often for So Cal and that I have a little experience with is the Spine Institute down in Santa Monica. They do lots of ADR procedures as well as fusions and other less invasive procedures. I bet they would give you a decent termite inspection. You could find out if a full tenting was needed or perhaps just a local treatment would work.

I did the home traction thing to and found it never did much of anything other than when I was sitting directly under it. I eventually ended up having a 2 level fusion, which actually in my case worked out the best for everyone. My surgeon worked out of both a private practice up by my home and with the Santa Monica Spine Institute... so I had the input from both areas. And because I was part of a clinical trial I am followed up by the guys down in Santa Monica even now.

The important thing now is to get all your tests together so you can let the second, third, fourth opinion doc see what's going on. AND it's really important to find out the exact cause of your pain. Is it disk generated? Is it nerve generated or is there another cause.

You will find there are several here on the boards that have a wealth of information. As you come up with questions don't hesitate to ask them. We'll try to get them answered !!
__________________
Hyperparathyroidism-CURED! Aug08, lets see if I can grow bone now!
DDD for as long as I can remember.
Myofacial Pain Disease
Severe Vitamin D Deficiency
Spinal Fusion C5-C6, C6-C7 - May 2007
Multiple epidurals, L 3/4/5 & S1
L 3,4,5 & S1 herniated/bulging disks-under control for now.
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  #3  
Old 09-10-2010, 12:50 AM
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jss jss is offline
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Posts: 1,411
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Zymergist,

Condolences. Many insurance companies pay for "off-label" ADRs now days. If you are a candidate for medical reasons, I would strongly encourage you to research and pursue the ADR.

I have two cervical fusions from back before they did ADR in the US. Those two fusions caused me to need two more fusions eight years after the last one. Instead I went to Spain for ADR in an attempt to arrest, or at least inhibit, the deterioration of the wet noodle that I have in place of a cervical spine.

Good luck, Jeff
__________________
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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  #4  
Old 09-10-2010, 02:54 AM
Zymergist Zymergist is offline
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Posts: 16
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Thanks Toebin, and I am definately going to be talking to different docs. In talking with my PT, who is a DPT, who I trust as he deals with sports therapy as well as reahb (as well as my own impressions...) what the MRI shows will pretty definately lead to being cut on. The question is going to be by who and what procedure.

Just curious, how thick is your neck? I was thinking about the neck structure and the geometry of traction, and after talking with my PT I think I am going to try and prototype a pneumatic prone device that will hold the shoulders, provide an adjustable arc under the neck, and pull the neck over the arc so the traction is in the proper curvature rather than pulling the curve straight. I think part of my problem is I done realy get a streatch till over 30lbs of force, and that pulls me out of the stock head restraint at the office. Any thoughts are welcome!
__________________
Congenital fusion C5-6
"Notable" herniation C6-7 with bone spurs - Fused 3/3/2011
Degeneration at C7-T1, non symptomatic yet...
Mild herniations C3-4 and C4-5

Numbness R-Hand - Gone withing 48 hrs of surgury
"Hot-Wire" pain R-Shoulder through elbow and hand - still controlled with Nurontin, expected gone in a few weeks.
intermittent tingling and electrical jolts R-Arm - Gone after surgery
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  #5  
Old 09-10-2010, 03:03 AM
Zymergist Zymergist is offline
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Join Date: Sep 2010
Posts: 16
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Thanks Jss,
Fusion is my absolute last resort as I dont want the domino effect. I figure laser or another minimal procedure that will hold me for 15 years is well worth it. ADR is my next choice if I am qualified for it. I feal your pain on the insurance, I have an HMO so am probably pretty stuck. If I can hold out till feb, my insurance open enrolment will be up and I can switch to a POS plan (no full PPO offered).

Good luck on your insurance!
__________________
Congenital fusion C5-6
"Notable" herniation C6-7 with bone spurs - Fused 3/3/2011
Degeneration at C7-T1, non symptomatic yet...
Mild herniations C3-4 and C4-5

Numbness R-Hand - Gone withing 48 hrs of surgury
"Hot-Wire" pain R-Shoulder through elbow and hand - still controlled with Nurontin, expected gone in a few weeks.
intermittent tingling and electrical jolts R-Arm - Gone after surgery
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  #6  
Old 09-10-2010, 01:06 PM
Toebin's Avatar
Toebin Toebin is offline
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Join Date: Jul 2007
Posts: 193
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Quote:
Originally Posted by Zymergist View Post

Just curious, how thick is your neck? I was thinking about the neck structure and the geometry of traction, and after talking with my PT I think I am going to try and prototype a pneumatic prone device that will hold the shoulders, provide an adjustable arc under the neck, and pull the neck over the arc so the traction is in the proper curvature rather than pulling the curve straight. I think part of my problem is I done realy get a stretch till over 30lbs of force, and that pulls me out of the stock head restraint at the office. Any thoughts are welcome!
Hmm, my neck isn't really thick and I am by no means a big burly muscular type person. Pretty much a middle aged female who's spine has just decided it's worked long enough and has begun degenerating instead. Lots of factors are contributing to that though and I am by no means a good example to follow...lol

For me traction was never going to solve my pain. I had too many osteophytes poking into the spinal column and too many nerve roots directly compressed due to herniated disks and general bone disease.

But I understand your desire to try different traction devices.. so often I felt if I could get someone pulling my head and someone else at my feet.. that the pain would subside a bit, if they just pulled hard enough.. my husband and I used to joke that I needed a "rack" .. and that would solve all my problems...

Like I said.. finding the cause or generator of your pain is very important. Spine disease is actually quite complex... is it more disk disease or bone disease... ? Getting to the bottom of that question will help guide the eventual treatment of your problem and the solution to your pain.

Everything from ADR/Fusions , micro diskectomies, lazer surgery and even fibrin injections are possibilities. It all depends on your individual disease process.

It sounds like your really trying to research it all and I wish you well in that process. Understanding the cause of "your" disease is vital to the outcome.
__________________
Hyperparathyroidism-CURED! Aug08, lets see if I can grow bone now!
DDD for as long as I can remember.
Myofacial Pain Disease
Severe Vitamin D Deficiency
Spinal Fusion C5-C6, C6-C7 - May 2007
Multiple epidurals, L 3/4/5 & S1
L 3,4,5 & S1 herniated/bulging disks-under control for now.
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  #7  
Old 09-14-2010, 01:35 AM
Tyler's Avatar
Tyler Tyler is offline
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Join Date: Jul 2010
Posts: 85
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Hey Zymergist -

I'm a fellow Southern Californian who just spent the summer with docs in San Diego and LA - and elswhere. Although one suggested a less-invasive approach (e.g. foraminotomy), most believed it would not likely solve the underlying problem if compression of the disc spaces is already severe as it was in my case - and can also negatively impact the surrounding region because posterior access (while attractive in many ways) also involved affecting part of the facet joint to gain access and space - something that could come back to haunt later on.

Another consideration that moved me to more rapid action and ultimately ADR is that for reasons that aren't really known, weakness in the arms caused by impact to the cervical nerves is of even greater concern than pain from a long-term perspective because the associated nerve injury tends to be much less reversible than if it were just pain, or if it were in the legs.

I've also since met a lot of folks, and talked to a number of docs (nine different surgeons in California and Europe), who relate the potential shortcoming of waiting or going too slowly with fixing something such that adjacent structures (e.g. facet joints) are already affected - and it then becomes very difficult to effectively treat the situation in a way that really works because there are then multiple problems not just one.

I agree that surgery should generally be treated as a last resort - but, where weakness and other indicators are already significant, I wanted to move through the earlier 'resorts' pretty quickly if they really didn't solve the situation (as opposed to pushing it off).

In my case, the problem was addressed before any substantial 'collateral' damage had developed, and I woke up from ADR surgery literally cured - the nerve completely bounced back, I had regained all sensation and had no significant pain. It'll soon be three weeks since surgery, I have no remaining pain for the first time since a cycling accident in May, and have been off of pain meds for almost the entire time since the procedure.

Attached are threads on the surgical outcome and one with some of my reasons for going with the disc I ultimately chose:

http://www.adrsupport.org/forums/f47...6-tyler-10743/

http://www.adrsupport.org/forums/f51...istance-10767/

Of course every patient's different - and it definitely takes an effort to meet with the docs and press through it - but absolutely worth it.

If I can be of help in any way, please don't hesitate to ask.

Best,
Tyler
__________________
2010 Cycling accident tripped up an old motorcycle injury
C5-6 and C6-7 disc degeneration, foraminal compromise with indentation of nerve roots causing arm pain and weakness
Aug-27-2010: 2-level ADR (C5-6 & C6-7) with Spinal Kinetics's M6-C by Nick Boeree, Nuffield Wessex Hosp., Eastleigh, UK
Completely off of pain meds since a few days post-op and symptom-free; have returned to cycling, climbing and all other activities (but staying off the motorcycle)
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  #8  
Old 09-14-2010, 03:07 AM
Zymergist Zymergist is offline
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Posts: 16
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Quote:
Originally Posted by Tyler View Post
Hey Zymergist -
<Snip>
I've also since met a lot of folks, and talked to a number of docs (nine different surgeons in California and Europe), who relate the potential shortcoming of waiting or going too slowly with fixing something such that adjacent structures (e.g. facet joints) are already affected - and it then becomes very difficult to effectively treat the situation in a way that really works because there are then multiple problems not just one.

I agree that surgery should generally be treated as a last resort - but, where weakness and other indicators are already significant, I wanted to move through the earlier 'resorts' pretty quickly if they really didn't solve the situation (as opposed to pushing it off).

<Snip>
Thanks Tyler!

I had already read your story and am impressed with how aggressive you were able to be.

Just had my second apt today with the first neuro. The second course of steroids have helped quite a bit, the numbness in my fingers is starting to lessen and the waves of pins and needles are less random. I seem to have some of the strength and fine motor coordination back as well. The Doc gave me a 50% probability of surgery within 5 years, but his thinking on surgery is fusion due to my existing fusion, and the indicators for surgery are unbearable pain and/or severe loss of strength/function. Yea he is fired, but he got me an apt with the next doc a month earlier than I could otherwise. Not that hopeful for the opinions that will come from this, but going through the steps within the network first.

I see my PT as my best resource and sounding board as to my condition so far, but here are my preferred courses in order:

>A miracle (not going to turn blue here....)
>A micro arthroscopic clean up of the bone spurs
>A clean up of the bone spurs and the disc protrusion (poss Laser)
>A clean up, reshaping of the disc and artificial nucleolus replacement (I don’t know exactly where they are with this, but the Biodisc cross linked protein polymer sounds good.)
>An ADR (probably leaning towards ProDisc, as a Tek Diver the M6 raises a few questions for me relating to captured space and bubbles)
>Fusion as a last resort

I have an HMO at the moment so my options without going out of pocket are going to be limited. My open enrolment starts in Nov and goes into effect in Feb, so I am going to work on the PT and see if I can stay in decent condition. My logic is that a less severe procedure that does not solve the problem could be followed up by the next level of procedure if required, and if a clean up will buy me 10 yrs the tech will be that much better. I want to stay as conservative as I can, but I am definitely not willing to wait for more severe nerve damage and other deterioration effects. If I end up out of pocket, well it is what it is and I can work to pay it off.

Jason
__________________
Congenital fusion C5-6
"Notable" herniation C6-7 with bone spurs - Fused 3/3/2011
Degeneration at C7-T1, non symptomatic yet...
Mild herniations C3-4 and C4-5

Numbness R-Hand - Gone withing 48 hrs of surgury
"Hot-Wire" pain R-Shoulder through elbow and hand - still controlled with Nurontin, expected gone in a few weeks.
intermittent tingling and electrical jolts R-Arm - Gone after surgery
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  #9  
Old 09-14-2010, 11:35 PM
Tyler's Avatar
Tyler Tyler is offline
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Join Date: Jul 2010
Posts: 85
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Hey Jeff,

It sounds like you're moving through it! Just be careful about the arm weakness. Not only every surgeon I consulted but the neuroskeletal specialist who does epidural steroids and even a sports chiropractor I worked with were all very concerned about weakness as indicating neuropathy that may not reverse - especially in the case of the arms. In fact, all of them recommended against waiting if weakness persisted, even if it wasn't yet severe, since patients can sometimes end up being left with that same severe weakness even after surgery.

I also had positive relief from steroids, but it didn't last - and again even the doc that focuses on epidurals in his business recommended moving on, especially in view of arm weakness.

One last suggestion is to really thoroughly evaluate any proposed minimally-invasive approaches with other docs. I had the same 'keep it as long as you can' outlook - and so they always sound preferable, but if they leave a problem only partially corrected, the surrounding situation can be made worse for subsequent treatment. Again almost all of the docs I talked to, including academics as well as docs that practiced a number of different approaches, advised against any interventions in the neck that wouldn't almost certainly solve the problem because it can affect adjacent structures and there are complications from going back in. The docs that I and others regarded most highly in the field were even more opinionated on this point from having dealt with the complex situations created by prior treatments that were inappropriate or insufficient. So I was right with you in your thinking, but not only might you not get 10 years or even a few years in the meantime but half-way procedures can make the situation worse.

Talking to more docs helped me - as did pressing the competing suggestions with other docs. Again it takes time and perseverence but it's your future at stake.

Keep us posted and best of luck as you progress!

Best,
Tyler

ps - I think the diving concern should technically not be an issue. I posted a comment on that thread hoping the other writer will remember who had technical details because I can't remember them - but if I find them again I'll pass them on.
__________________
2010 Cycling accident tripped up an old motorcycle injury
C5-6 and C6-7 disc degeneration, foraminal compromise with indentation of nerve roots causing arm pain and weakness
Aug-27-2010: 2-level ADR (C5-6 & C6-7) with Spinal Kinetics's M6-C by Nick Boeree, Nuffield Wessex Hosp., Eastleigh, UK
Completely off of pain meds since a few days post-op and symptom-free; have returned to cycling, climbing and all other activities (but staying off the motorcycle)
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  #10  
Old 10-17-2010, 07:58 PM
Zymergist Zymergist is offline
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Posts: 16
Unhappy

Well, things are moving along towards surgery. I saw Dr Uchiama and have also gottena second opinion from DR James Bruffey. James Bruffey - Scripps Health - San Diego I had some aditional imaging done to check visualization of the C6-7 area and due to my build it does not look good. Neither Dr would be comfortable with placing an ADR due to the visualization problems. My age, the unknown wear factor, and small disc space which would cause distraction problems along with the almost gauranteed insurance denial due to preexisting adjacent fusion finished sealing the deal on that one. So I am down to my least desirable option, fusion.

LSI was quite flip about my diagnosis and said a laminectomy and foraminotomy were the way to go and not get a fusion even though my images show all the compression is at the front of the spine. They got fired quickly.

I got in to see Dr Bruffey very quickly due to the professional relationship of a family friend who was trained as a PA to assist in spine surgery and graft harvesting, and is now a medical device rep. Dr Bruffey is actualy recommending that both C6-7 and C7-T1 be fused as C7-T1 looks almost as bad on the MRI as the disc above. He feels that only doing one level the probability of having to go back in within a year is better than 80%, and that repeated surgery would lead to a lower probability of success and increase the posibility of complications. He is using the Globus Coalition implants (hybrid PEEK spacer with attached plate) and very strongly recommends using hip graft bone to pack the implant. What he says makes sense, and is being backed up by review of the information by friends in related medical fields.

Dr Uchiama was talking about using a plate or cage procedure, though I would probably need a custom cage due to dimensions in my neck. He also wants to do a hip graft with the cage but would be comfortable with a cadaver graft with the plate. I have gotten feedback from other sources that a cage without a plate is a bad idea and not stable enough to heal well and quickly.

Both Drs come with top recommendations from other trusted Drs, so now I need to choose neuro vs ortho.

Either way I will be going into the new year with a fresh scar.
__________________
Congenital fusion C5-6
"Notable" herniation C6-7 with bone spurs - Fused 3/3/2011
Degeneration at C7-T1, non symptomatic yet...
Mild herniations C3-4 and C4-5

Numbness R-Hand - Gone withing 48 hrs of surgury
"Hot-Wire" pain R-Shoulder through elbow and hand - still controlled with Nurontin, expected gone in a few weeks.
intermittent tingling and electrical jolts R-Arm - Gone after surgery
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