New Here, need some answers guys

[SandyW]

Can't believe so many have moved from other site! Terry and Justin will be so generous in answering questions and handing out hope, opps sorry, didn't mean to slight the rest - Kathy, Melody, Gil, CindyLou, Adrienne, Todd, Eddie G, Steve44, Bob, sahuaro, chuck, etc. (notice some of you are not newbies) who are so very, very thoughtful.

Will fill out surgery outcome page and signature soon. But in the meantime a brief history. Cervical ProDisc 4-level C3-7, April 7, 2008, Dr. Bertagnoli, Germany at age 67.

Actually met Mark in the lobby of the Hotel Theresientor in Straubing prior to my surgery. His wife and a client were awaiting surgery so he was quite busy. However he took the time to talk to me and assure me that I was in good hands and offered his help at any time. Not real important, but he told me about Skype, loved it. Am very glad to be a part of his dedication.

Now, I don't understand my MRI from 12/2007. Didn't ask enough questions, knew I didn't want fusion. Am going to see spine doctor at Cleveland Clinic finally for a much needed follow-up (Dr. B had to refer me) and want to be able to ask some intelligent questions. Looked up terms, got some thoughts from other site, but need the explanation from the "experts."

"There is some mild straightening of the normal cervical lordosis without focal subluxation. Overall spinal canal diameter is somewhat small, suggesting an element of congenital stenosis.

There is generalized multilevel disc desiccation and degeneration, mainly involving C3-4 through C6-7.

At the C2-3 level, no focal disc protrusion.(Had a discogram in Germany prior to surgery, no pain whatsoever, Dr. FM said dye went in and out, could the procedure have caused the disc to rupture? Decision made to do 4 adr's instead of 3.) There is some mild left-sided degenerative foraminal stenosis.

At the C3-4 level, there are endplate osteophytes and some degenerative changes in the facets. The sac measures 9 or 10 mm in AP dimensions. (What is AP and what does 8, 9, 10 mm dimensions mean?) There is asymmetric osteophytic foraminal narrowing more on the left.

At the C4-5 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac which measure 9 or 10 mm in AP dimensions. There is some osteophytic foraminal narrowing, greater on the left.

At the C5-6 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac, which measure about 8mm in AP dimensions. There is asymmetric osteophytic foraminal narrowing, greater on the left.

At the C6-7 level, there are endplate osteophytes indenting the anterior aspect of the sac, which measures about 9mm in AP dimensions. Exit foramina are only slightly distorted.

At the C7-T1 level, no major abnormality." (was there anything in MRI that said adr?, I didn't ask, just took advice, fusion or replacement, although film showed disc's making indentations on spinal cord, anything that might suggest why I have more pain now than pre-op? Not sorry I had adr's, couldn't stand the thought of fusion, but am wondering why the pain)

[mmglobal]

AP is anterior/posterior.... the dimensions are the diameter? of the canal in millimeters.

Your C2-3 sounds like my C3-4: http://www.ispine.org/forum/ispine/6...y-results.html

I'm so sorry that you are experiencing more pain. I have a client who's in the same boat as you after a series of cervical fusions.

Say more about your pain... neck, arm, back? Dull ache? Sharp? Electric? Nerve pain?

[SandyW]

Mark, I moved this from another site to my post asking for help.

I am sooo confused. Dr. Fenk-Mayer recommended 3 cervical replacement discs - no discogram on C4-7. However she informed me that I might need a 4th so would do a discogram prior to surgery on C3-4 only. I had no pain because the dye went in and out, no pressure, no pain nada. Why are you saying that the test is painful? Was C3-4 ruptured? not buldging? The other disc's were making a dent in my spinal cord, that's why I thought surgery was recommended. I posted earlier that I need some questions answered, so if you all have time I'd love to hear from you. Sandy

Your answer Mark:

If there are obvious structural problems at 3 levels, especially with spinal cord involvement, then there is no need to do discography on them. There is no "take it or leave it" decision to be made... they are going even if they are not painful. However, you can have these structural issues that need to be addressed, and they may not be your pain generators. If there is a disc next to the obviously needing replacement levels that is bad, discography there will keep them from leaving a disc that is causing substantial symptoms.

Ok, I understand why they didn't bother doing a disco on C4-7, had not choice there. And I read your post on your discogram. But what does it mean when the fluid runs in an out of your disc, my C3-4. Why was that level replaced?, it didn't hurt. I too was dreading this, in fact I asked Dr. FM if they would just go ahead and do the 4 and forget the discogram. LOL I trust that I needed the 4 levels, am not questioning this, just would like to know what was wrong with that disc. Don't know why I didn't ask questions then when I was surrounded by experts!

My pain pre-op was less than my pain now. I'm 9 months post-op, am taking tramadol, zanaflex, tylenol and ativan at bedtime. This combination doesn't get rid of the pain, doesn't make me sleepy, don't sleep well at night. I'm concerned, that's why I'm asking questions. There are so many people still in pain, that have tried so many things, it's mind boggleing. Thought if I understood my MRI it was a place to start.

Even though I'm not disappointed in my 4 prodisc-C's, I don't think there is a better surgeon for mulitples than Dr. Bertagnoli and I don't think I would have fewer difficulties with fusion AND I'm still mobile. I wanna be pain free!!!

Not being able to find a doctor here who will see me is difficult - guess surgeons don't like to do follow up, unless they do the surgery. I finally ask Dr. B to call Dr. McLain at the Cleveland Clinic (who I have seen multiple times prior to surgery) and that worked. I have an appointment on the 22nd. Hopefully between a spine doctor and their pain management department, I'll get some answers. I would like to ask intelligent questions, I've never felt so overwhelmed. Anything has to be better than my poor family doctor who tries to help, but isn't well-informed concerning ADR's.

Mark, wow didn't know you were having more surgery - cervical now. You two make a good pair! Was surprised to hear all your concerns since you see so many surgeries. Always more difficult when it's YOU. When is surgery scheduled? You aren't going to be with a patient too, are you?

You will be in our thoughts and prayers, Sandy

[mmglobal]

You didn't copy the "I'm not a doctor" qualifiers... please take everything I say with a grain of salt.

Discography has many different ways to show pathology. The pain we are trying to generate by pressurizing the disc can only be generated if the disc will hold pressure. If there is a substantial annular tear so the contrast just runs out, then the opportunity to generate the "pressure" pain is not present. However, they can see the pathology... they can see the contrast immediately run through degenerated-looking tissues, through the tear and into the canal area.

With such an annular tear, it's possible that the level is painful due to chemical irritation of the spinal cord or exiting nerve roots. They can't be certain. It's a crap shoot... more levels? risk leaving a pain generator? I've seen the decision go both ways and it depends on the intuition of the doctor.

It's also possible that your pain is not coming from the ADR's or those levels, but from the surrounding musculature. I don't think that pain free is a reasonable expectation after a 4-level surgery. Some get it, but they are lucky. Sorry, but I'm not a sugar coat it kind of guy. We certainly don't expect things to get worse. Hopefully you'll experience substantial improvement as your body gets used to your new alignment.

All the best,

Mark

[SandyW]

Mark,

Sorry about not copying "I'm not a doctor" qualifiers. I would never take the advice as though it is coming from a doctor, but do like to hear from people who have experienced/witnessed the same. Am beginning to understand AND you are cheaper, easier to reach, and quicker getting answers from - that what's so great about the site. Thank you.

Don't like what you're saying about 4 levels, but sort of thought that the case. Just want you to know I'm going to be one of the lucky ones. I'm a fighter, just not patient.

Sandy (thanks for fixing my name)

[Justin]

Hey Sandy,

I'll have a read through your post later today...I'm running around like a mad man now...

I didn't want to leave you hanging.