queenofhearts Prodisc L4/5, L5/S1 November 2003

[iSpine-Admin]

Originally Posted by queenofhearts on January 6, 2004

SURGERY DATE: November 25, 2003

AGE AT SURGERY DATE: 41

SURGEON: Dr. Rudolph Bertagnoli

SURGERY LOCATION/CLINIC: St. Elisabeth Hospital, Straubing, Germany

DEVICE(s), LEVEL(s): Prodisc L4/5, L5/S1

COST = approx. $29,800 euros
AMOUNT BILLED: same
INSURANCE ALLOWED: unknown - haven't yet heard back from my insurance company
OUT OF POCKET: all of it at this point
TRAVEL: airfare only
EXPLANATIONS?

Sent the bills to my insurance company along with justification and medical necessity information. They already have a notebook I sent them earlier in the year. Waiting to see if they pay or send denial letter - if denied, I'll be going through their appeal process.

ONSET OF LUMBAR PROBLEMS, DATE OF INJURY, CAUSE, ETC...:

First back problems started in March 1988 while in labor with my son. On and off sciatic problems since then - I'd overdo it and be down for a month or so about once a year. Musculoskeletal pain was only diagnosis until Fall 2002 - MRI showed severe DDD in lumbar spine with a collapsed disc at L5/S1 causing foraminal narrowing. Facet hypertrophy also observed L4/5, L5/S1 on right side.

PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...): ESI, diagnostic facet injections, 3 rounds of PT

PRE-OP MEDICATIONS: anti-inflams, vicodin, percoset, oxycodone without tylenol

PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...): discogram - Feb. 2003 - showed L3/4 to L5/S1 as pain generators, all discs had annular tears, even what was left of L5/S1

PRE-OP NEUROPATHIES (what, where, & degree of pain, numbness, tingling, sexual/bladder/bowel symptoms, etc.): Predominantly low back pain - constant burning sensation across low back with pain shooting into right hip area and down mostly right leg to knee level. Closer to my surgery date pain in right foot also.

PRE-OP CONDITION (Please include %leg pain/% back pain, pain levels, type of pain, ability to work and function, disability status, etc.... be direct, but be as verbose as you need to):

85% back pain, 15% leg pain. Ability to work in law enforcement compromised - went on light duty Jan. 2003. I could still do household chores but at a price - cleaning house would put me down the next day, and mowing my lawn was completely out of the question for the last year. I was able to work a desk job and could sit at length, but wouldn't be able to stand up straight after sitting. I could only sleep on my right or left side - laying on my back caused a sharp increase in pain levels. Social life non-existent - life mostly consisted of my chair at work, my recliner and bed at home.

TIME POST-OP AT ORIGINAL POST HERE: 6 weeks

DESCRIBE YOUR SURGICAL EXPERIENCE:

Dr. Bertagnoli's discogram showed L3/4 to NOT be a pain generator, hence the 2-level procedure. Woke up in ICU (due to pre-existing cardiac condition). The worst pain I felt was hip pain from the distraction process, worse on the left side. I stood briefly a few hours after surgery, but walking was limited due to the monitoring equipment (IV's in each hand and a central line in my neck also). Using morphine pump and was given additional pain meds as my hip pain was about a 9. Additional meds caused my BP to drop to about 70/30, but corrected with medication. I noticed from the moment I woke up that the constant pain across my low back was GONE!

Walked on the second day, and continued walking after being transferred back to my room. Still on morphine pump until 3rd day - then switched to oral meds. Hip pain still pretty bad, but I was able to walk - actually left the hospital for a couple hours 5 days post-op!

Day 6 an x-ray was taken of my hip to rule out any additional problems. Day 7 am - Dr. B noticed subsidence of my top L4/5 end plate - 2mm on the right side. Day 7 afternoon - taken back to OR for vertebroplasty procedure (bone cement placed in L4 and L5 vertebra - large needle through my back into the bone). Subsidence most likely caused by my osteoporosis condition, although I was within the numbers Dr. B uses to go ahead with surgery. I'm now on Fosamax, Vit. D and calcium for it.

Days 8-10: Major increase in central low back pain, most likely from second procedure. More pain in left hip and leg. Pain on morning of Day 10 (Friday) was well over a 10, and I could do nothing but lay in bed, sweating, shaking and barely able to talk. Additional IV pain medication was given until I had ESI and other injections that afternoon. Thankfully the injections helped significantly otherwise I would have been put back on the morphine pump and wouldn't have been released to go home the following Wednesday.

RATE FUNCTIONALITY / SATISFACTION AT INTERVALS BELOW:

FUNCTIONALITY:
1. Very poor: much worse... disabled after surgery.
2. Poor: worse after surgery.
3. Neutral: No improvement, or improvements offset by new problems.
4. Fair, some improvment, limitations are still serious.
5. Good, substantial improvement, some limitations.
6. Excellent: no limitations.

SATISFACTION:
1. Very sorry I had the surgery.
2. Somewhat sorry I had the surgery.
3. Too soon to tell, or I'm ambivalent about the surgery.
4. I'm somewhat glad I did my surgery.
5. I'm very glad I did my surgery.

FUNCTIONALITY: _5__ SATISFACTION: _5__ [6 WEEKS POST-OP]

FUNCTIONALITY: _6__ SATISFACTION: _5__ [3 MONTHS POST-OP]

FUNCTIONALITY: ___ SATISFACTION: ___ [6 MONTHS POST-OP]

FUNCTIONALITY: ___ SATISFACTION: ___ [1 YEAR POST-OP]

FUNCTIONALITY: ___ SATISFACTION: ___ [2 YEARS POST-OP]

6 WEEKS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ECT... (discuss surgery induced symptoms [leg pain?]):

I have now been off pain meds for two weeks, and have zero back pain during most activities. Sitting causes some increased pressure in my low back, but nothing serious. Walking and standing also feel pretty good. Still have some residual pain in left leg, mostly from knee to ankle with some discomfort in hip that is relieved by using ice packs. Leg muscles and hamstrings feel rather tight, but are getting better everyday with stretching. Pain levels are low enough to be considered "discomfort" rather true pain. The pain I had before surgery is gone.

My subsidence problem was halted with the vertebroplasty and the only limitation it might cause is bending side to side - I might be able to bend to the right further than the left, but that limitation may also be out of my own range of motion - I'll find out more during PT.

I'm back to work (light-duty), my cardiac condition will be assessed and treated further in February, and PT will start probably in March.

3 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]): Occasional discomfort in low back (tight feeling - mostly muscles), but no pain. Hip and leg distraction symptoms are mostly gone. Lower leg is still a bit hypersensitive, but not painful. I occasionally take ibuprofin for discomfort, but haven't taken any pain meds since sometime in early January. My next follow-up with OSS is March 8, and I'll be getting a date when I can return to my normal job (sometime in April). As far as physical activities, I can do most anything I want, but try to take it a bit easy since I'm still healing a bit. I've even been horseback riding with no problems. Still working on getting the cardiac issues fixed, but that should happen sometime in March.

6 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

1 YEAR POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

2 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

Waiting for an update from queenofhearts.