New to site. My spine is a wreck, could use some serious advice please...

[Ringo]

Not sure where to start. I have had 4 lumbar surgeries, 1 partial disk-ectomy, 3 fusions with rods. One fusion was a re-do (stay away from ibuprofen).

My surgeon says I need work done on my cervical spine. I have multi-levels of concern, disk degeneration and facet joint degeneration with some spinal cord compression. I also have a clay shovelers fracture in there somewhere. I can't take the pain in my neck and head. It has been years now. My surgeon suggested going out of the country for multi-level ADR. Is it done in the country?? Where do I start? My doctor says I won't be satisfied with a fusion at these levels.

I can post more if more details are needed. Can't sleep, too much pain and headache. I'm going to go crazy if I don't do something.

[mmglobal]

Ringo, I'm so sorry that you find yourself in this situation. You can get multi-level ADR done in the US, but getting insurance to pay for it is another story.

What is clay shoveler's fracture?

Does the headache pain correspond with the neck pain? I'm asking because they could be separate issues.

Are your prior surgeries lumbar?

Mark

[theBadCormorant]

Originally Posted by mmglobal

What is clay shoveler's fracture?

Mark

Found this on Wiki Link interesting mechanism for the injury that coined the name


Ringo: sounds truly awful, I didn't quite get your comment "One fusion was a re-do (stay away from ibuprofen)."

And best of luck.

[Ringo]

Finally back at my computer. Not sure how to navigate the website.

I see you found the definition of clay shovelers fracture. Sort of an interesting thing. Must of happened to me somewhere along the line. It was probably from an traumatic injury.

As for the ibuprofen. Ibuprofen is in the NSAID (non-steroidal anti-inflamatory drugs) catagory of medications. They work by reducing inflamation. At least in this area of the country, the standard of care for lumbar fusion (probably any spinal fusion) is to not be on NSAID's in the time frame just prior to surgery and for a long period of time after surgery. The process of how NSAID's inhibit inflamation (subsequently reducing pain) is understood well enough to implicate them in interferring with the formation of bone at the fusion site which requires the inflamatory process to lay down bone. Several animal model studies have shown this and at least one study that involved ketoralac (don't quote me on this stuff because I am no rocket scientist). Basicly, it was dose dependent. I was having trouble after my 3rd lumber surgery (2nd fusion). It just didn't feel right. I was having considerable leg pain, thighs aching terribly bad, etc. Well, at 3 months I was going through my paperwork from the University of Washington where I was considering having my surgery. There paperwork clearly stated to not take any ibprophen before or after surgery because it could interfere with bone formation in the fusion site ie. non-union/pseudoarthritis. Well, I had been taking massive amounts of ibuprofen prior to surgery and following my sugery, my neurosurgeon reorderred it after my surgery and discharged me with it. At 3 months after my surgery, I informed the PA I was taking Ibuprofen and she freaked out and wanted to know who said I could take Ibuprofen. When I told her that "her" surgeon ordered it after surgery, she clammed up so tight you could have heard a pin drop in the room. I was pissed off. I expressed deep concern and they assured me all would be well. Well, it wasn't well. At 6 months my surgeon told me I was fussed and discharged me. Over one year later I am still in a lot of pain and they do a bone scan and CT and I have no bone growth at all at the fusion site. I do have movement of the cage and errosion of the bone within the disk space. I do my research and get opinions and everone gives me a different opinion. One says wait and watch and the other says you risk breaking the rods and your pain is being likely caused from the movement at the site. I decide to have the non-union fixed. I fused at about 6 months after the 4th surgery. This time no Ibuprofen. They used BMP in all my fusion surgeries.

I have had a total of 4 back surgeries. My first surgery was a diskectomy where they had to remove a 1cm x 1cm x 6 cm sized piece of disk from L5-S1. It was removed in several small pieces. Second surgery was about 3 years later (fusion L4-5), third surgery (fusion) was about 15 years later and the fourth (fusion L4-5) was about 14 months after that. My neck is shot and the levels above my lumbar fusions are shot as well. I have what I call mechanical pain in my neck and lower and mid back. I get severe headaches beyond anything I ever immagined possible with stabbing pain at the base of my skull, top of my head and behind my eyes. I get really weird burning pain in my neck/shoulders down my back and back of my legs. When my neck gets hurting bad, my hands feel sort of swollen and numb, I have a little bit of radiculopathy in my left arm. I have nerve damage in my right leg that caused a muscle imbalance and pulls on my knee cap funny. So now that hurts when I use it. My feet hurt to varying degreeds throughout the day... I get miserable. I have tried a few medications but got turned off of them and they don't work that great anyway. I probably will need to go back on something. Get depressed, etc. Got hospitalized.....been there and done that, got the t-shirt. But, getting hospitalized was a good thing and it openned my eyes.

I really talk a lot. I hope your back stabilizes itself and you start to feel better. Thank you for listeing to me yap. Peace, Terry

I

Originally Posted by theBadCormorant

Found this on Wiki Link interesting mechanism for the injury that coined the name


Ringo: sounds truly awful, I didn't quite get your comment "One fusion was a re-do (stay away from ibuprofen)."

And best of luck.

[mmglobal]

Terry,

It sounds like the 'fourth one is a charm' and you are finally fused in your lumbar spine. You mention some pretty lousy continuing pain. Do they believe it to be from the operated lumbar levels?

How long ago was the cervical fracture? I have seen many people with fractured spineous processes in the lower c-spine that were not pain generators.

What are they recommending?

Mark

[Ringo]

I really don't understand my doctors anymore. I think they look at me as the plaque. I struggled working and trying to get help, wasn't able to work much, etc. Wasn't untill I was about to loose my family and everything I owned that I said enough was enough and applied for disability. I stopped work in June 2009, struggled to work for 1 1/2 years and had 2 surgeries. One doctor accusatorily asked me how much narcotics I was taking. Told me I had to stop taking them before he would do surgery. I told him I wasn't taking any. My last surgery improved my leg pain but I still get these feelings of burning that I have had for some time and increase with activity. It is getting worse slowly with just light activity around the house. But doing things is the spice of life and gives meaning to life. My headaches come and go. Changing possitions or lying down doesn't feel right. I basicly can only sleep in one possition. When I get still, I become more aware of the ache/burning in my body but it is more in my legs, neck and head. I saw a neurologist recently and he said my cord looks good and doesn't see any signs of myelopathy. But sometimes I wonder because I feel like I walk funny in the evenings. I can tell my gate changes. Doctors sort of look at you funny when they read you have depression and anxiety. Trouble is most of them haven't a clue about it. I feel like my anxiety and depression is exacerbated by not knowing what is truly going on with my body. It is also natural to worry about what the future will be like. I feel like I get treated like a second class citizen because I ask questions and want to know things. But, they clam up when you ask them and I think it makes them defensive. Like for instance, I get swelling in my legs and I take a diuretic to control my edema (I am a large person but not really over weight, been active working hard my whole life). Sometimes I have difficulty breathing at night, wake up with tight chested feeling and aching pain in chest. I use CPAP machine that was suposed to fix it and it did for some time. I am extremely sensitive to salt and water. If I drank a bottle of gatorade, I feel like I will explode. My eyes will get puffy and I get tight chested and edema will increase in legs. All weird stuff. Something is broke somewhere. Had a cardiologist say something was wrong with my heart but he eventually could not find anything. Sometimes, I feel like it is a conversion disorder type thing that has been caused from stress and pain. But, If is being cause by intermittant pressure in my spine or somehow pressure on my sympathetic nervous system, I would want to know. If it is obvious, the surgeon or doctor will go after it. If it is subtle, they will look past it and tell you to loose weight or get more sleep or less stress. I feel like my stress is built in. Thise edem thing started in around 2005 when it peaked and doctors just blamed it on high blood pressure. I was in chronic pain and working reduced hours and getting the dwindles. I kept telling them something was wrong and they just put me on higher and higher blood pressure medications and prozac, etc. I landed in the ER several times with a low low heart rate and very high blood pressure and burning feeling and pressure in chest, difficulty sleeping because when I when to bed, it was hard to breath. Anytime I can forget about my body is a great moment. That I the way I try to live. Unfortunately, it just comes back to haunt me. I am 52 years old and parts of me definitely are worn out. I have started to feel a slight increase in the mechanical pain in my lower back area which concerns me. I hate the stigma of being disabled. I walk and talk and I am careful what I eat, I get in the pool as much as I can and just keep my body moveing. I volunteer at least 2 times a week and teach math to grade-schoolers. I try to stay on the tylenol as much as possible sometimes I use hydrocodone when I can't take it anymore. NSAIDS are sort of out of the picture because they greatly increase my swelling and edema. Took them for years.

I will send you my radiology reports. Maybe you have opinion. Terry

Originally Posted by mmglobal

Terry,

It sounds like the 'fourth one is a charm' and you are finally fused in your lumbar spine. You mention some pretty lousy continuing pain. Do they believe it to be from the operated lumbar levels?

How long ago was the cervical fracture? I have seen many people with fractured spineous processes in the lower c-spine that were not pain generators.

What are they recommending?

Mark

[Ringo]

Surgeon said he want to take me out of the country to do ADR in neck. Now states I don't have enough neuopathy. I think my strange headaches are my nuropathy. I have a lot of pain generators in my neck. I will type my report into the computer. You seem to have read a lot of them. Maybe you can pass it on to your radiology friends or surgeons. Not sure what I want to do anymore. I hate being disabled but definitely feel like my body needs to stop. I couldn't work anyways because I would colapse. Just that I have the attitude that you keep on keeping on. I am fortunate that I have money coming in now. But, don't like taking money for nothing. Now, I get paid for being in pain and miserable. Terry Sorry for the down load. Hope it dosn't wear off on you.

Originally Posted by mmglobal

Terry,

It sounds like the 'fourth one is a charm' and you are finally fused in your lumbar spine. You mention some pretty lousy continuing pain. Do they believe it to be from the operated lumbar levels?

How long ago was the cervical fracture? I have seen many people with fractured spineous processes in the lower c-spine that were not pain generators.

What are they recommending?

Mark

[Ringo]

I will post a bunch of my MRI/CT of neck and back. Went to a neurologist his words were that my neck really wasn't that bad???? I don't know what to think when I know I get into so much pain from it and have terrible headaches. My legs bother me too. My legs will just ache with activity, sometimes shooting pain but not often. My feet will hurt and my feet go a little numb. I have no Achiles reflex on the right side. I have nerve damage to my right quadracep that was show on a EMG. My GP says my headaches are definitely from my neck. I know enough to know that this stuff is causing me problems. I remember my injuries to my neck and I have lived with the pain with increasing frequency for decades. I screwed my back up in the Military and it just went down hill (starting to ramble on).

I will post recent MRI's. If you feel really motivated, read through them and tell me what you think or your Dr. Bud's think. Remember that song.... Too much time on my hands.... too much time on my hands.... then something else. Thanks, Terry


MRI of neck April 2012
Findings:
The craniocervical junction is intact (that's a relief! LOL)

The C2-3 disc is dehydrated. There is no evidence of significant bullge or herniation. There is no evidence of singificant canal or neural foraminal stenosis.

The C3-4 disc is mildly narrowed and dehydrated. There is minimal retrolisthesis of C3 on C4. There is a diffuse disc bulge. There are hypertrophic uncovertabral degenerative changes on the left. There is moderate canal stenosis. There is moderate to severe neural foraminal stenosis on the left. There is no evidence of significant neural foraminal stenosis on the right.

The C4-5 disc is narrowed and dehydrated. There is a diffuse disc bulge and reactive osteophytic spurring. Threre is bilateral hypertrophic uncovertebral degenerative changes. There is moderate canal stenosis. There is moderate bilateral neural foraminal stenosis.

The C5-6 disc is degenerated. There is posterior disc/osteophyte complex. There is a mild to moderate canal stenosis. There is moderate bilateral neural foraminal stenosis.

The C6-7 disc is degenerated. There is a broad-based central to the left subarticular disc protrusion. There is mild to moderate canal stenosis.

The C7-T1 disc is dehydrated. There is a mild anterolisthesis of C7 on T1. There is a diffuse dis bulge. There is not evidence of significant canal stenosis. There is mild bilateral neural foraminal stenosis.

Impression:

1. The C3-4 disc is mildly narrowed and dehydrated. There is a minimal retrolisthesis C3 on C4. There is a diffuse disc bulge. There are hypertrophic uncovertebral degenerative changes on the left. There is moderate canal stenosis. There is moderated to severe neural foraminal stenosis on the left.

2. The C4-5 disc is narrowed and dehydrated. There is a diffuse disc bulge and a reactive osteophytic spurring. There are bilateral hypertrophic uncovertebral degenerative changes. There is a moderate canal stenosis. There is moderate bilateral neural foraminal stenosis.

3. The C5-6 disc is degenerated. There is posterior disc/osteophyte complex. There is a mild to moderate canal stenosis. There is moderate bilateral neural foraminal stenosis.

4. The C6-7 disc is dehydrated. There is a broad based central to the left subarticular disc protrusion. There is mild to moderate central stenosis.


MRI of neck December 2013

At C2-3 there is a mild disc bulge slightly indenting the thecal sac which is unchanged. Ther ei s a normal foramen and mild facet hypertrophy.

At C3-4 there is a broad-based disc protrusion flattening the anterior thecal sac with moderate foraminal stenosis bilaterally and mild central canal stenosis. There is no change in the interval.

At C4-5 there is a broad-based disc protrusion flattening the anterior cord with moderate to marked foraminal stenosis on the right and moderate on the left. There is mild to moderate central canal stenosis and no change in the interval.

At C5-6 there is a broad-based disc protrusion /osteoophyte complex with moderate foraminal stenosis bilaterally. There is flattening of the anterior thecal sac and mild central canal stenosis. No change noted in interval.

At C6-7 There is a broad-based disc protrusion more prominent to the left with slight impact on the anterior cord. There is moderate to marked foraminal stenosis on the left and moderate on the right. There is mild to moderate central canal stenosis. No changes are see at the interval.

At C7-T1 there is a mild disc bulge and mild foraminal stenosis. The upper thoracic cord and cervical cord appear normal in size, contour and signal. Vascular structurees in the neck show farily good flow void. Thre is some tortuosity of the left vertebral in the foramen at the C4-5 level.

Impression:

1. Grossly no change from prior examination.
2. Mild central canal stenosis at C3-4. There is moderate framinal stenosis.
3. Mild to moderate central canal stenosis at C4-5. There is a disc protursion with moderate to marked foraminal stenosis on the right and moderate on the left.
4. Mild central canal stenosis at C5-6. There is a disc protrusion with moderate foraminal stenosis bilaterally.
5. Mild to moderate central canal stenosis at C6-7. There is a disc protrusion with slight impact on the anterior cord and moderate to marked foraminal stenosis on the left and moderate on the right.


Bone scan of neck June 2012

IMPRESSION:

1. Increased activity in the facets bilaterally at C4-C5 and C5-C6 most significantl othe left at C4-C5, likely representing degenerative facet disease.
2. Increased activity at C4-C5 and C5-C6 anteriorly , likely representing degenerative disc disease. Also, increased activity in the left Acromioclavicular joint, likely degenerative.


CT of lower back June 2012

Findings:

Minimal left convex curvature is present. Slight retrolisthesis is noted at L2-3, L3-4. No compression fracture is identified. Fusion hardware is present at L4-5 with paired transpedicular screws, rods and interbody spacer. Bone loss is noted at the the inferior L4 and L5 vertebral bodies. L5-S1 posterior fusion hardware have been removed in the interval.

T11-L2: No posterior disc bulge or protrusion is present. Mild bilateral facet arthropathy is noted. Canal and foramina are patent. Findings are stable.

L2-3: Mild broad-based posterior disc bulge and mild to moderate bilateral facet arthropathy, ligamentum flavum hypertrophy are present. Mild canal and minimal bilateral foraminal stenosis are noted. Findings are stable.

L3-4: Mild broad-based posterior disc bulge and mild to moderate bilateral facet arthropathy, ligamentum flavum hypertrophy are present. Mild canal and bilateral foraminal stenosis are noted. Findings are stable.

L4-5: Steak artifact from adjacent hardware partially obscures adjacent structures. Right hemilaminectomy and partial facetectomy are noted. Soft tissue prominence is present in the right foramen/lateral recess indistinct from the right L4 nerve root causing severe stenosis. Severe bilateral facet arthropathy is noted. Central canal is patent. Mild left foraminal stenosis is seen.

L5-S1: Partial left facetectomy is noted. Bilateral laminectomies are seen. Right facet fusion is present. Canal and foramina are patent.

IMPRESSION:

1. L2-3 mild disc bulge and mild to moderate bilateral facet arthropathy, liga mentum flavum hypertrophy. Mild canal and minimal bilateral froaminal stenosis. Stable.

2. L3-4 mild disc bulge and mild to moderate bilateral facet arthropathy, ligamentum flavum hypertrophy. Mild canal and bilateral foraminal stenosis. Stable.

3. L4-5 stat post fusion, right hemilaminectomy, partial right material and/or granulation tissue in the right forament/lateral recess indistinct from the L4 nerve root causing severe stenosis. Severe bilateral facet arthropathy. Ratent canal. Mild left foraminal stenosis.

4. L5-S1 interval removal of fusion hardware. Partial left facetectomy, bilateral laminectomies. Right facet fusion. Patent canal and foramen.



MRI lower back September 2011

This is the impression notes about L4-5 just prior to surgery. Other wise it is about the same as the CT.

2. L4-5: Magnetic susceptibility artifact partly obscures this level. Moderate spinal canal stenosis slightly incresed due to severe facet spondylosis with bilateral facet joint effusion, ligamentum flavum thickening, a 7 mm synovial cyst within the right ligamentum flavum, and a small broad-based bulge or limited disc protursion. Lateral recess narrowing may impinge on the right L5 nerve - unchanged. Stable 15mm synovial cyst along the posterior margin of the left facet joints (these were bilateral because they use to asperate both of then and inject them with steroids and lidocaine) poor visualization of the neural foramina which may be moderately narrowed on theright but unchanged.

3. L3-4: Moderate narrowing of the thecal sac due to congenitally short pedicles, a small posterior bulge greater to the left of midline, and moderate facet spondylosis with ligamentum flavum thickening and prominent dorsal epidural fat - unchanged.

Originally Posted by mmglobal

Terry,

It sounds like the 'fourth one is a charm' and you are finally fused in your lumbar spine. You mention some pretty lousy continuing pain. Do they believe it to be from the operated lumbar levels?

How long ago was the cervical fracture? I have seen many people with fractured spineous processes in the lower c-spine that were not pain generators.

What are they recommending?

Mark