Thoracic Fusion Options

[JulieAnnaAK]

Hello, I am so glad I found this site. It appears that there are a few thoracic patients and I am excited to get to know your cases, surgeries & recoveries.

Brief history: L4-S1 PLIF for grade 3 retrololisthsis w/HNP 7/2008, C5-7 ACDF 3/2010 followed by a MVA (T-boned) about 8 weeks after the surgery. I was driving and was struck on the passenger side pushing my car about 10 ft.

After several weeks of agony I finally convinced my NS (pa) to send me for a nerve block & steroid injection. They injected C8-T1 and I felt a little better but not a success. Then a month later we did T3/4 (no success) a couple days later my ordered my first T-Spine MRI. It showed multiple protrusions from T4-L1 with 7/8 torn and 11/12 torn. I then had 2 more injections with the t7/8 TFESI working for a few hours. This is now about November. I met with my NS for follow up and he sent me for a CT scan with Myelogram and spinal fluid test (rule out MS). He then told me when I can't take it any longer he would perform a Thoracic fusion (thoracotomy/ big ugly surgery).

I started into PM for medication and even though I am tired from the meds I was managing well enough. Still working but not very hard. I have had to stop any lifting, carring, all around cut back the activity or I go into bad flares in pain. Recently I fell down (for no reason) and then things started going down hill. I started getting myelopathy in my left leg (this week into my right), extreme nerve pain into my ribs, under my arms (typical ring of fire). I called my ns and they got me in right away. I am always in pain where my bad spot is located. They ordered a new MRI w & wo contrast. My bad disc is worse and now I have end-plate edema on both the T7 & T8.

I had asked my PM to get me a referral for a second opinion. I see my old NS later this month but saw this new NS yesterday. The second opinion is suggesting a XLIF only at the T7/8 spot. I am not sure what my old NS is going to tell me (how many levels). I am doing a lot of thinking. I am pretty sure T4 is also a trouble maker due to the intermitten electric pain I get right in the center of my breast.

I really like the minimally invasive idea (hearing that the thoracotomy patients have a worse recovery than a PLIF patient makes me cringe with the thought of it). I worry that the cage will shift or break.

Any input is greatly appreciated.

Thank you,

Julie

[jsewell]

Julie i feel your pain. Welcome although i am sorry you have to be here. I had lots of horrible thoracic pain and after a few years decided on a fusion. Well it was from T5-T12. It did not solve any problems and all my pain was still there. The following summer i asked for discography thinking it was bad discs. I had already done the MRI which did not show much, some protrusions and other stuff that i forget.
So the discography was positive for T7-8 and T 11-12. These were so painful out of the pain scale from 1-10 i said it was a 20. Some of the others were painful to , but compared to the first one done T7-8 i only rated them a 5. so my wonderful spine doc was searching for a thoracic surgeon to do the Video Assisted Thoracic Surgery with., It was hard and he found a good surgeon but at the end when it got near the surgery date the other surgeon opted out so the surgery was cancelled the day before it was too happen. Many tears were shed on that one. So my doc had the choice of the thoracatomy. I am in the Los Angeles area and my doc decided he should send me to the best of the VATS surgeons right in LA. So i went a few months later and had the VATS on the 2 painful discs. Unfortunately no referral will come from me on one of the worlds bests as he damaged my phrenic nerve which controls the diaphragm muscle and thus controls the lungs. I almost died, he never even showed up at the hospital again and i was there 2 weeks and called up begging him to come and help me figure out what happened.
Anyway all that aside , i still had the horrible pain after the discs were removed, but in the following months it did go away , it just took a few months after surgery to go away. so no big incisions although still a major surgery. It was a success and my thoracic spine horrible pain has not reoccured. That was in december of 2009. The surgeon was DrJohn Reagan in Los Angeles.
Best of luck to you, i know how horrible that pain can be and I wish you speed in getting rid of it.
judy

[mmglobal]

Julie, welcome to iSpine!

I'm so sorry about all your spine problems. It seems that you've done a lot of research and are well informed. I'm glad that you connected with an XLIF surgeon and have that as an option. I would caution you to go to someone with a great deal of XLIF experience. There are pitfalls that may be avoided with high experience, talent and care.

Good luck! please keep us posted - not only about your surgery, but if you could also share your experience as you go through the decision making process, you'll help others who follow.

I've got t-spine problems but the path is not clear. There is no obvious culprit. I'm still doing diagnostic injections. I'm waiting for an ESI that I'll have later this month. After that, I'll probably get a bone scan. (something for you to consider?)

All the best,

Mark

[dshobbies]

Julie,

Though I have no thoracic problems and cannot speak from any experience, I did want to welcome you to the forum. I'm sorry for your pain but glad you found us.

Dale

[jsewell]

Now that Mark has mentioned it , i had a bone scan as well. Found 2 broken ribs!!!
judy

[Aaron]

Appointment at end of September. Will keep site updated on my visit and hopefully he can be a resource for us Tspine patients or any back patients. He would not see me without reviewing Tspine MRI and records so hopefully he saw something.

I am lucky I guess to have narrowed down my main source of pain. It is my herniation T67 and tear at T56. I have had the strangest correlation with these ESI in the area. I have had 3, first nothing, second great, third in middle. But with the second one and third the injection was spread to include tear along with herniation. The nerve pain ( stabbing ) for the most part never came back to the level it was prior and the nerve pain across my back recessed and I literally felt it day by day pulling back to the point between my shoulder blades, and this nerve pain was from neck to lumbar. Almost like the pain branched out from this point, I cannot explain it. Second event I cannot explain is that when my back is hurting from nerve pain and inflammation I often have to crack my thoracic and it cracks very pronounced in the T78 area, but after my injection and for a couple of months until a flair up started it all back, the popping was gone. I dont know if that was a product of inflammation reduction properties of the ESI ( i suspect) or if nerves play a role in ligament function or swelling. Very strange.

After second injection I would do something ( not on purpose) were I would feel that all to familiar twinge saying you f'd up, but instead of nerve pain the next day the twinge would settle down. Did this for a couple of months ,but less and less every month until it did not go away. By no means was I pain free during this, but I experienced some pretty dramatic results, that I nor my PM doc can explain.

The back will make you crazy.

[dshobbies]

Crazy, absolutely. Though is pain for years, I at least knew from where my pain came. You are indeed lucky that you know the two disc sources of your pain as from what I've read, most thoracic patients do not.

Please let us know what your doctor wants to do to fix the problem.

Dale

[JulieAnnaAK]

Thanks for the support. This has been a living nightmare.

Judy- WOW. I am so sorry you have had to go through this. I am glad things are starting to turn around for you. You give me a little hope (light at the end of the tunnel might be the sky not an oncoming freight train that I think it is).

Mark- I am not sold on the XLIF. I like the idea but I am not possitive. I woud prefer to get this all behind me and if that means doing more than 1 level for a better out come in the long run then that is what I may do. This NS said she has done hundreds of XLIF and many in the t-spine. She recently moved up here from the lower 48. I wish I could drive an hour or 3 and find better NS but I can't. My old NS has a very good record and he knows me, but I have to do what is right for me. I may ask for another referral when I see my PM gal next time. My PM had originally thought I should go for a microdiscectomy but they are not NS. That would have involved traveling to another state with a 5-6 hour plane ride and several thousands of out of pocket exenses (I don't have right now).

Aaron- Great news for you I did not feal this way last year when I started on my ESI's. I was doing much better and we felt as if we did find the source at 7/8 at that time (the nerve block wore off too quickly). Things for me have been getting progressively worse since the accident. I have been in a hard flare since mid July. You are right it will make you CRAZY.

Dale- Thanks for the support

My old NS office called and cancelled my appt for 9/26 so I have to reschedule. I feel like my pain is now uncontrolled again even taking around the clock meds. I see my PM late next week again. I really do not want any more medication, I just want to feel better.

I will keep you all posted on what I do and how we proceed.

I will be asking for some input along the way.

[jsewell]

JulieAnna
with me it is usually the frieght train coming. My thoracic spine is wonderful, just not the 2 other areas.
I hope you get a soon apt with your NS that just cancelled, i hate when they do that.
We are here anytime you need us. Where in alaska are you, my son was stationed at Ft Wainwright in Fairbanks for 2 years. Unfortunately , i kept having surgery in the summer and never got to see him there, but oh i wanted to.
judy

[JulieAnnaAK]

My follow up appt with my NS is next Thursday afternoon. It actually got moved up by 11 days.

Julie

[jsewell]

Good Deal Glad it is earlier
judy

[Aaron]

Thoracic micro endoscopic disectomy.

I will be scheduling this surgury in middle of 2012 with Dr. Richard Fessler in Chicago. I saw him earlier in year and even though the visit did not go as planned. I saw him and he did not like the views from my prior MRI so I had to spend an extra day waiting new MRI and to re -see him and unfortunatly he had a serious family matter so he was only able to look at the MRI and relay info to his nurse. She said he felt I was a canidate for TMED based on my symptoms, MRI, and ESI results. She said healing would be 4 -6 weeks and he has done many of them. He is out of the country as he does surguries and teaching in poor countries sometimes, but when he gets back I want to talk with him on some questions only doctor could answer. Kind of curious because every doctor I seen in past said you could not do min. invasive thoracic surgury or that my disc was celephad so they could not reach it that way. So finally an option I will explore some more, need to schedule now as there is a big waiting period.

Bad news is an accident where godchild jumped on back has caused some damage in cervical/lumbar that I am now fighting and thoracic is the least painful for now.
Odd how things work 8 years since back injury, 6 on LTD no options, godchild jumps on back in april 11, finish school may 2011 , lose LTD because going back to work, see Dr. Fessler and recommends TMED procedure ( now I have all the pre existing things with insurance and new STD, LTD), now cervical/lumbar hurting.

To say I am frustrated would be an understatement. I always felt due to the ESI and the fact that I am pain free in morning, if a surgeon could help I stood a good chance of getting some relief. Hoping these new issues resolve.