Functional Restoration Program

racergaldar · #1 (**permalink**) 11-27-2008, 12:36 AM

I decided to go for the Functional Restoration Program instead of spine surgery for now. I'll be evaluated weekly and if its not successful, then as a last resort I'll have surgery. I finally got the QME approval for a discogram and the IA said they wouldn't appeal it, so if I need it, its there.

So my question is what type of success or failure has anyone had who did this program? and what were/are your diagnosis? What sort of success should I expect or not expect?

Also, I'm a jocket (race skis and motorcycles) and play about just any sport (especially golf). If I do end up getting surgery and am a candidate for ADR, I will have the ADR. If not, I'm screwed because I won't do fusion. I want to be able to play sports again and I'm wondering if the FRP will be worth the time (8 weeks, 6 hours per day, 5 days a week). Its been 10 months since my injury, already had 3 epidural bilateral injections with minimal help. Also exhausted all PT. Not a candidate for laminectomy or any of the other "ectomy" so its either this program or surgery.

I have L5 chronic radiculapathy, MRI shows:
L3-4: disc is midly narrowed and desiccated with 2mm of circumferential disc bulging and mild bilateral foraminal narrowing.

L4-L5: Dis is desiccated and moderately narrowed. 3 mm of circumferential disc bulding and a right paracentral 4-5mm disc protrusion which mildy effaces the ventral subarachnoid space. Borderline central canal stenosis is present with AP dimension in the midline of 9mm. Both lateral recesses and neural foramina are moderatly narrowed, greater on the right side. Minimal facet arthropathy is present.

L5-S1: The dis is desiccated but normal in height. Moderate left facet arthropathy is associated with asymmetric anterolistheses on the left side of 2mm. The left neural formen is moderately narrowed.

mmglobal · #2 (**permalink**) 11-27-2008, 11:08 PM

What dermatome does the radiculopathy follow? Sounds like L4-5 is substantially degenerated, while L5-S1 is not. It seems unusual that you have the facet and listhesis called out on L5-S1 in the presence of a still tall disc.

If your symptoms are coming from L5-S1, you may not be a candidate for ADR there, but I would hope that a decompression surgery would stand a chance at relieving the radiculopathy... but with the instability noted... how long will the system last?

Yours will be an interesting case to follow.

Have a great Thanksgiving! All the best,

Mark

johnb · #3 (**permalink**) 11-28-2008, 02:41 AM

Do your symptoms correlate with the MRI findings? Have you had nerve studies done? My spine started acting up at early age and it took awhile to find the right PT, but he was night and day better than the three I used before. I'd be interested to see how you feel at the end of your regiment. Over the years, had to curtail some physical activities but I was just to young for invasive spine surgery considering my symtoms weren't awful unless I did something to stupid to aggravate them.

John

Maria · #4 (**permalink**) 11-28-2008, 02:25 PM

To see if you'd improve your symptoms with this program. I don't want to be negative because I really have no answers tho it does seem like you've exhausted conservative measures to date and I just wonder why this program wasn't the first thing that was offered vs. the last in terms of conservative treatment. I would wager to guess the answer is cost.

Your lifestyle sounds so active that I would have to wonder about relief of symptoms with this program and returning to a semblence of your level of activity.

Please keep us posted as it will be very interesting to hear how you progress and I agree with your plan in terms of exhausting your possibilities before heading off to surgery (probably because that's what I would do but again every individual makes their decision re surgery/other). Wishing you the the absolute best.

racergaldar · #5 (**permalink**) 11-29-2008, 01:00 AM

Mark: What do you mean by dermatome? What is that?

I had an EMG that showed chronic L5 chronic radiculopathy.

The reason why we didn't do the program 1st is that I was hoping the injections and PT would solve the problem sooner, but after exhajusting all those, it didn't. two spine surgeons recommended the Discogram/CT but WC denied it. Finally got the QME report recommending it, so i could go that way if I chose to (IA is not going to appeal QME report). However, the EMG was excruciating so I know the disco will be 10 times worse and fear the pain may not go away for a while - maybe there is a risk that it will permanently make my pain worse.

While waiting for all this happen I did more research on FRP and came across a paper written about a 26 year old female whose MRI results showed the disc protrusion was completely gone (it showed her MRI images) 14 months after completing the program. Although she didn't have disc degeneration like me, I was hoping that since in 2004 I had disc degeneration I was still able to do the activities I enjoy. So as a last ditch effort, maybe if the FRP may reduce/eliminate the disc extrusions that it may be enough to return to my normal activities. I figure that if I don't do the program first and go directly to surgery, I'll always wonder. I'm not confident that ADR would solve my problem.

My major complaint is that it feels like someone (a giant) is holding in part of my body in their hands and is trying to break my back (picture trying to break a pencil in half). I get right leg/knee pain, numbess and tingling, off and on. Feels the the injections may have helped the leg pain, but now its worn off and its back now. I noticed this the other 2 injections as well. Sometimes I also feel numbness in the middle of my back. (does that answer the question about correlation with MRI)?

ACOEM Guidelines do recommend FDR, so I'm pretty sure it will be approved. I'm expecting an answer by the end of this week (they've (UR) been good about responding within 14 days).

I told my dr. I would commit to the FDR and hold off on the disco, but before I actually start I wanted to get some feedback from everyone so I can feel better about my decision instead of not wasting 8 more weeks of my life and going directly to surgery. Its hard to tell exactly where it's coming from, I'm don't know to the full extent of what the MRI shows, but since it does show issues with more than one level, I'm not confident I'm a candidate for ADR anyway. If that be the case, then the only other choice is the FRP (unless someone can convince me that fusion won't limit my range of motion.). I'm having a very hard time now accepting my current limitations and probably the only thing that has prevented me from diving into severe depression is Faith. I don't know how long that will hold out, but just for today it helps me get through each day.

Any thoughts would be appreciated.

racergaldar · #6 (**permalink**) 11-29-2008, 02:10 AM

I also had several epidurals and nuceloplasty in 2002 through 2004 was good until I fell in 2008. Total Epidurals most on right side:
1 on L3-4,
1 on L4,
5 on L4-L5, (Includes 2 bilateral in 2008)
4 on L5-S1, (Includes 2 bilaterial in 2008)

The nucleoplasty was done on L3-4 and L4-5. They tried to do both on the same day, but L4-5 was too painful and they couldn't do it until 2004. If I used the location of the epidurals for indication of problem areas, it looks like
L4-L5 is the winner.

If L5-S1, why wouldn't I be an ADR candidate?

When I had a 2nd surgical opinion, the PA used what looked like a vibrator (keep it clean!) with a round pad on the bottom. She pushed this in my lower spine and I felt the internal pressure on my disc. She called it a cheap discogram and I told her if you do that again, I will tell you exactly where the pain/pressure was located and we won't need an expensive discogram.

racergaldar · #7 (**permalink**) 11-29-2008, 02:32 AM

Correction: Initially couldn't do L3-L4 nucleoplasty and it was aborted until 2004.

If the dr. couldn't get near the L3-L4 nucleus because I couldn't tolerate the pain, why would the majority of injections back then and now predomantly at L4-L5 and L5-S1. Seems like it should have been the lower discs that would have been the problem.

johnb · #8 (**permalink**) 11-29-2008, 04:42 AM

I've always thought chirogeeks website contained a good description with graphics to boot. Untitled Document

Additionally, there is another poster here that was a non surgical success. Perhaps you can glean some info from her story that will be useful.

http://www.ispine.org/forum/ispine/3...t-surgery.html

John

racergaldar · #9 (**permalink**) 11-29-2008, 07:31 AM

Even though it was from a chiro (LOL) This was good info. (sorry, I have reason to believe that a chiro caused the first injury

As far as dermatome; definately L5; right inside knee and shin. seldome anymore down the buttocks. Sometimes feels like my left ankle is broken when I can't stand on it. That stuff I can handle and tolerate; its the back breaking pain that knocks me to my knees. But these symptoms have disappeard for a while but has returned. Initially, I didn't think the epidural helped, now I believe the epidural made the difference bedtween tolerable and not tolerable.

Maria's story is very similiar to FRP. The program I will be doing is Bay Area Pain & Wellness Center: Functional Restoration Program Overview

johnb · #10 (**permalink**) 11-30-2008, 07:07 AM

Yeah, I know what you mean. There are different types of chiro's but the one I saw many years ago told me to never let a chiro manipulate my spine due to my specific issues which I thought was pretty telling. I've read you should never let one "crack" your neck. I read a story about a lady who had a stroke as the vessels that go to your neck get violently stretched in the process.

Love the graphics and he seems very committed to sound research. I understand he is working on getting into medical school to become a doctor of osteopathy.

Best of luck with your program and I commend you on your commitment to the hardwork approach.

John

racergaldar · #11 (**permalink**) 12-05-2008, 08:42 PM

I just received the approval to begin this program; I'll provide updates on any progress for anyone who may need info in the future.

RE: California Worker's Comp;
The program is 8 weeks, and WC can only approve 4 weeks at a time which is fine with me. If there is no indication that there is beginning to be some improvement, we should know by then and will be able to determine whether to continue or cut our losses and move to surgical options.

Maria · #12 (**permalink**) 12-08-2008, 09:46 AM

Glad the authorization was given for the first 4 weeks and good luck with the program. I'd be very interested in hearing about how the program is structured and how you progress with it.

racergaldar · #13 (**permalink**) 12-10-2008, 10:15 PM

Check your email. I had Mark forward you the curriculum. (only have pdf format)

Maria · #14 (**permalink**) 12-11-2008, 06:05 PM

Thank you for having Mark email the info to me. It looks very much like a program I participated in back in '93 and was successful with for a period of time. It was a 15 week program and all participants had to live in at the hospital except for me as I lived nearby. No one was to do anything else but attend the program (not work) so I had to request the time off and I was so glad that it was allowed and I still had a job to return to afterwards.

Good luck with all~ Maria