Visit with Dr. Coufal

[jsewell]

Jim i have only just read this thread and none of your others if they are out there.
I had some horrible pain in my thoracic region that kept getting worse, only relieved by me laying on the floor with my legs up. (it was pretty embarrassing to my kids at the airport one day) Any way i knew it was time to get something done. the MRI and cT did not show much of anything. Of course the thoracic is the most stable area . I won;t go into the whole story , but the deciding factor in the diagnosis was from a discogram which i suggested. It is a good test . It is the reason i am out of pain from my thoracic spine.
Judy

[Maria]

Per pre surgical protocol re diagnostics Orthopedic Spine Surgeons in CA that I've seen order discograms. I've had 3.

Neuosurgeons order myelograms. I've had 2. I leaked spinal fluid both times and ended up in the hospital for a week post procedure with severe h/a. No blood patch given per each Neurosurgeon's decision.

That was as far back as 2006. I don't know if that's changed at all with regard to the difference between Neurosurgeons and Orthopedic surgeons pre surgical diagnostics so you may want to check that out for yourself.

Good luck with getting the ball rolling again re insurance BS.

[Jim M2]

Judy,
So the L4-5 is the disc in question. On the first office visit Dr. Coufal pointed out there was strength lost in my left foot (holding the foot up) which usually maps to L4-5. On a follow up visit after new imaging came in he felt like the L4-5 had good height. He didn't want to deal with it. He is willing to explant the Charite at L5S1 and convert it to a fusion. I certainly wouldn't mind doing a discogram to get to the bottom of it. I'm certainly not in a position to make demands of an outstanding surgeon like Dr. Coufal but I'd certainly like him to give more consideration to the L4-5.

Maria,
Both PMs told me discograms give suspect results plus they can cause damage to healthy discs. They are seldom performed anymore. If I could get a discogram I hope they would agree to test only one level. I know the healthy levels give a baseline of sorts but I don't want damage to L3-4 and above.

[Maria]

Even back then I didn't have the disc above L3 tested (or rather a test healthy disc). L3 had an annular tear and on first discogram was not concordant for pain. L4 and L5 already had surgery and were both painful with L5S1 being the worse (It wasn't tested the first time because the OSS that did that one said he "knew" it was shot).

2nd time L5S1 was included because I was told it had to be.
3rd time it was L3, L4, and L5 (so discs that were shown on MRI to be problematic) but trying to find out if L3 was painful or not...

First time I had pretty significant pain even after the procedure but 2 days later felt much better than I had in quite a while which lasted a month at least.

2nd time I got Marcaine in the disc spaces post procedure.
3rd time I got an ESI directly after the procedure.

I've not sought any surgical spine consultations (thankfully) since 2005. I wonder if discograms are still being obtained prior to various spine surgeries in Europe? Anybody?

[Jim M2]

Maria,
I'm glad you mentioned the Marcaine in the disc spaces post procedure. The last time I had a discogram I was very agitated afterwards. If I am successful making my case for a discogram I'll negotiate the Marcaine up front. I have an appointment with my PM doctor one week from today (5/20/14).

[Jim M2]

For a number of different reasons I've decided to cancel the ADR explant for now. I want to study my situation longer and possibly have some more diagnostics. I'll start another thread to get everyone's input on my evolving symptoms.

[Maria]

Sounds very reasonable to me especially with a degree of concern or doubt regarding pain generators (or any part of the proposed surgery). Good luck Jim.