help me failed surgery

[sanbittu]

I am writing to you the complete history of my spinal problem. Please let me know the details of how will your new technology be able to assist me.
many doctors have prescribed immediate lumbar fusion pl advise on ADR and other minimal invasive procedures where they are done in India or abroad and the costs estimated so that i do not take any other drastic step
Please mail me at sanbittu@hotmail.com
Thanking you,
Sandeep

latest MRI April 26, 2005
Clinical profile:
Backpain radiating left lower limb
Procedure : MRI of the lumbosacral Spine was performed using multiplanar , multiecho sequences . Screening of the whole spine was also performed
Findings
Alignment of lumbar vertebra is normal. Laminectomy at L4-and L5 noted.
Small osteophytes are seen at posteriointerior endplates of L4 L5 vertebrae
The L4 -5 and L5 – S1 intervertebral discs are dessicated.
L4 L5 bilateral facetal arthropathy and ligamentum flavum hypertrophy is noted. Small osteophytes are seen from the middle end of facet joints. There is a mild diffuse anterior epicural soft tissue compressing the thecal sac. There is bilateral lateral recess stenosis with compression of bilateral traversing L5 nerve root. A focal posterior central area of enhancement indenting the thecal sac could possibly present small scar tissue
L5 – S1 bilateral facetal arthropathy is seen. Left paracentral enhancing minimal scar tissue is noted. The left traversing S1 nerve noted is impinged.

Rest of intervertebral discs are normal in contour and signal intensity.
No pre or para vertebral soft tissue thickening is seen. The spinal cord ends at L1 level and is normal in contour and signal intensity.
Screening through cervico – dorsal spine reveals mild cervico spondylosis
Screening through bilateral hips joints is unremarkable.

Impressions.
1) Bilateral facet arthrosis with medial osteophytes are narrowing the lateral recesses with compression of the traversing L5 nerve root. There is associated anterior epidural compression from mild disc / scar tissue.
2) Facet arthrosis with small left paracentral enhancing scar is causing left S1 nerve root compression in the lateral recesses.
3) Laminectomy at L4 and L5 levels

MRI August 30, 2003
Cervical spine:
• Anterior osteophytes are seen at C4, C5 and C6
• Right posterior lateral annular bulge at C5-C6 is causing mild thecal compression
• Posterior longitudinal ligament is mildly thickened.
Canal measurements:
C1 1.4 cms
C2 1.3 cms
C3 1.2 cms
C4 1.2 cms
C5 1.1 cms
C6 1.2 cms
C7 1.2 cms

Impression
1. CERVICAL SPONDOLYSIS WITH MILD HYPERTROPHY OF POSTERIOR LONGITUDINAL LIGAMENT.
2. RIGHT POSTERIOR LATERAL ANNULAR BULGE AT C5-C6 IS CAUSING MILD THECAL COMPRESSION

LUMBAR SPINE:
• Alignment normal
• Laminectomy at L4 an L5 noted.
• Vertebral bodies and posterior elements show normal signal characteristics.
• Articular facets and facet joints are normal
• Foraminal perineural fat planes are normal.
• No paraspinal mass.
Intervertebral Discs:
L4-L5 disc show loss of hydration with a central and left paracentral disc extrusion causing severe thecal and left L5 root compression. Rest of intervertebral discs are normal. Conus Medullaris is normal. No intradural mass. Lumbar Spinal cord shows normal signal characteristics.

Canal measurements:
L1 1.3cms
L2 1.1 cms
L3 1.0 cms
L4 1.0 cms
L5 1.1 cms

Impression
1. LARGE CENTRAL AND LEFT POSTERIOR LATERAL DISC EXTRUSION L4-L5 CAUSING SEVERE THECAL AND LEFT L5 ROOT COMPRESSION.
2. LAMINECTOMY AT L4 AND L5 NOTED.











However….
I cannot bend for shaving and cannot sit on floor for long
Sitting on the Computer Chair causes severe neck strain with tingling on the last 2 fingers of my left hand
The back has to be aligned by pushing it inside till it clicks / crackles else the pain is unbearable.
Even in cold climate I perspire whenever the pain is the maximum i.e. before clicking the vertebrae of dorsal spine
I feel compression on the left leg, which makes me believe that it is on the sciatic nerve
I have to use a number of pillows to raise the left side position in the sleep posture
When I sleep with my stomach down, I have to place number of pillows below both my shoulders
Occasionally after night sleep my left ear gets so numb and I am unable to control my urine at that time
I now have severe headache continuing from my dorsal spine till the top of my skull leaving the forehead area.
At times my feet become completely cold and numb due to prolonged sitting
I am unable to work longer than 1 hour as I get severe fatigue and sweat and spasm on the lumbar area. After this I am unable to even stand sit or sleep once the spasms have started .
I am unable to sleep on my left side due to numbness on the ear region and if by mistake I do sleep on that side I get hypnotic sleep and am unable to get up from my sleep
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Background & History of my case:

1991: Before operation
MRI was done on OCT 12 1991- LUMBO-SACRAL SPINE. The report is as follows..
The LUMBO-SACRAL SPINE was examined by means of 5.500 mm thick slices in the sagittal and 7.00 mm thick slices in the axial planes. Both T1 and T2 weighted images were obtained. The lumber vertebral bodies are normally aligned and of normal signal intensity. The intervertebral discs also reveal normal signal intensity. There is protrusion of the L4-L5 intervertebral disc with resultant compression of the thecal sac and left exiting nerve root. Conus Medullaris and Proximal Cauda Equina reveal normal signal intensity. There is no fracture dislocation or bone destruction. No abnormal pre or para vertebral soft tissue mass is seen. The sagittal diameter of the bony lumbar canal is as follows.
L2-L3 13.00mm
L3-L4 14.00mm
L4-L5 12.00mm
L5-S1 11.00mm
Impression
Left Posteriolateral protruded disc with compression of the thecal sac and exiting nerve root at L4-L5 level. Lumbar canal stenosis.

There after I was operated on Oct 19 1991

The operation procedure was as:
Diagnosis: PID L4-L5 and L5-S1 with L5 and S1 root compression left side
Operation: Total laminectomy L4 and L5, Discoidectomy L4-L5 and L5-S1 by Dr K D Shah under GA by Sunil Khandwala.
Findings:
L5-S1 disc was bulging laterally and was pressing the root @ L side. It was soft
L4-L5 disc was bulging and pressing the root @ L side.
Roots were horizontal
Histopathology -report both discs were prolapsed intervertebral discs

Post operation there was reduced pain but severe weakness of back muscles as well as legs. There was also severe numbness in right thigh, as I had slept onto that side during my hospitalization.

1992:
But after six months pain started increasing and sought further medical examination.
The advice was CT scan of SI Joints
The findings and report dated 21 Dec 1992 are as under:
Evidence of laminectomy is noted in the lower lumbar levels, with a Schmorl’s node at the inferior end plate of L5.Both SI joints are normal. There is no evidence of erosions or abnormal Sclerosis. Surrounding soft tissues are normal.
Conclusion: Both SI joints appear normal

1993:
Even the pain continued to rise with some sort of paralytic attack I had in 1993 where I couldn’t get up or sit down due to acute stiffening and pain in the lower back. I was in half standing half sitting position for about half an hour. I was hospitalized and given plenty of steroids to alleviate my condition.

I was told to undergo nerve test, which reported on 15 Dec 1992, that: The only abnormal electrophysiological findings was ‘Absent left H-Reflex-left S1 sensory Radiculopathy’

1996:

Still my condition kept on worsening with increasing pain in upper back and neck too and I again went for MRI on 10 Dec 1996 of MR lumber spine and dorsal spine.
The findings were:
Lumber spine
MRI of the lumber spine has been performed using T1 and T2 weighted images axial and sagittal planes. The patient is status post laminectomy at L4 and L5 with discectomies at L5 and L5-S1 in 1991. There is congenital narrowing of the lumber canal at the levels of laminectomy. Recurrent left sided, Centro-lateral herniations are seen at L4-L5 and L5- S1. At L4-5 , there is significant indentation of the thecal sac and left nerve root as it exits the thecal sac. Both lateral recesses are narrow at this level. At L5-S1, there is a small-herniated disc, which indents the left S1 nerve root as it exits the thecal sac. The more proximal discs appear normal.
Conclusion:
Status post discectomies at L4-5 and L5-S1.
There is congenital stenosis of the lumber canal at L4 and L5 with lateral recess stenosis, as well. Recurrent left centrolateral disc herniations are seen at the levels of discectomy. The L4-L5 disc compresses the exiting left sided nerve root.
Dorsal spine
MRI of the dorsal spine has been performed using T1 and T2 weighted Images in Axial and sagittal planes. The alignment of the dorsal vertebrae is normal.
The D5 and D6 vertebrae are congenitally fused. The intervertebral disc between them is rudimentary.
The fused posterior elements are mildly expanded and indent the posterior epidural fat. They do not encroach on the thecal sac and its contents. The dorsal cord visualized nerve roots appear normal.
Conclusion:
Congenital fusion of the D5 and D6 vertebrae.

2003: The condition nowadays is:
I can walk slowly but not fast
I am able to use motorcycle and drive it with caution
I am able to use the car also
I play a few games of Volleyball sometimes on weekends.
I play cricket with a runner’s help
I play carrom regularly till I am too tired and the back becomes stiff, so I feel
Professionally I am a teacher and an expert in Mathematics for “O” level Examinations (pre-college)
My profession leads me a give lectures for long durations to my students