sahuaro: C5/6 Prestige ST January, 2008

[sahuaro]

SURGERY DATE:1/24/08

AGE AT SURGERY DATE:59

SURGEON: John Regan, M.D.

SURGERY LOCATION/CLINIC: Century City Doctors Hospital

DEVICE(s), LEVEL(s): C5/6 Prestige ST

COST = about $35,000
AMOUNT BILLED:
INSURANCE ALLOWED: zip! denied as "experimental/investigational"
OUT OF POCKET: total
TRAVEL:
EXPLANATIONS?


ONSET OF CERVICAL PROBLEMS, DATE OF INJURY, CAUSE, ETC...: car struck by SUV in right front wheel, tried to maintain control by fighting steering wheel--2/6/01; c5/6 extruded, with foraminal and central stenosis bulge at c6/7, both rotator cuffs torn and ligament in right wrist torn resulting in surgeries on both shoulders and wrist.
The shoulder and wrist injuries were not immediately diagnosed and the neurologists and neurosurgeons were at a loss to explain why the extrusion was to the left while I complained mostly about symptoms in my right hand and arm. Once the surgeries were done and I had gone through rehab (and this took 3-4 years!), it was clear that I was having radiculopathy on the left--arm pain, tingling and numbness in index finger and thumb, loss of dexterity, and loss of muscle strength ("give away weakness"). My back and neck muscles were in chronic spasm (guarding) and I had loss of range of motion in my neck. At the urging of my orthopedic surgeon, I consulted with a neurosurgeon who wanted to do a 2-level fusion, saying that by the time the adjacent disks deteriorated because of the fusion, cervical ADR would be approved. I was put off by his flippancy about my neck and repeated surgeries but this was the first I had heard of ADR and my self-education through the web began! That is how I learned about Mark; Mark sent my records to both Dr. Bertagnoli and Dr. Zeegers and both agreed that I would be a candidate for 2-level ADR. But I was not ready to commit to surgery and did not want to go to Germany.
By the spring of 2006, 2 years after my left shoulder surgery, it was clear that my left (dominant) arm was weaker than my right and that it could not be attributed to the surgery both because of the time that had passed and because of the extensive and ongoing rehab program. I consulted with another local neurologist who insisted that I had carpal tunnel syndrome despite the fact that his own nerve conduction studies ruled that out and my orthopedic surgeon had rule it out. A few months later, I consulted with yet another local neurologist: EMG/nerve studies for the first time showed a clear pattern of radiculopathy.
With Mark's help, I was able to consult with a neurologist and with Dr. Delamarter and Dr. Regan in LA in January, 2007. What I took away from those appointments was that my nerves were "getting tired" of being impinged but that I could still wait to have surgery. In the ensuing months, my symptoms worsened and I had two episodes of feeling something move in my neck. My primary care insisted that I have another EMG/nerve study, which again showed radiculopathy; the neurologist insisted that the nerve damage was permanent and that surgery would not help. I returned to Dr. Regan in September, 2007, who indicated that things were becoming unstable and it was now time for surgery--and since my symptoms correlated with c5/6, he would do a one-level ADR or three-level fusion.
I would also like to include that somewhere in this process, Mark was able to set up an incredible 3-way phone consult with Dr. Baumbach, who, despite the language barrier, was able to explain to me what was going on with my neck in ways that my local docs could or would not do.
And--Mark asked to observe my surgery to watch the implantation of the Prestige ST--and reported to me that EMG monitoring during the procedure indicated significant improvement once the nerves were released. This was very important information, given that the neurologist here had insisted the damage was permanent.

PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...):3 ESI's with little to no effect, ongoing weekly (at times 2-3 times/week) physical therapy including traction, home traction, weekly massage, prescribed exercise regimen with a trainer/PT tech.

PRE-OP MEDICATIONS:because I need to be clear-headed to work, I could not take heavy-duty meds although each doctor I saw immediately grabbed his/her prescription pad; at most I would take high dose Ibuprofen as a rule

PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...):repeated MRI's; nerve conduction/EMG studies, extension/flexion X-rays

PRE-OP NEUROPATHIES (what, where, & degree of pain, numbness, tingling, sexual/bladder/bowel symptoms, etc.): symptoms were variable with occasional "good" days but as an average, level 8: arm pain, numbness and tingling in my index finger and thumb which at times spread to my entire hand and forearm, loss of dexterity, significantly decreased range of motion in my neck, chronic spasm in neck and upper back muscles. Could not sit for more than 2-3 hours at a time (limiting my ability to work) and could not drive for more than 15-30 minutes (with a couple of episodes of the steering wheel slipping from my grip!)

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)see above)

TIME POST-OP AT ORIGINAL POST HERE:
5 months
DESCRIBE YOUR SURGICAL EXPERIENCE: surprisingly easy: hospitalized for about 24 hours; energy level variable for the first couple of months

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 improvement, 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.

Don't forget the detail update section below!

DATE UPDATED:6/22/08 FUNCTIONALITY: 5 SATISFACTION: 5 [6 WEEKS POST-OP]--severe shoulder pain relieved by PT

DATE UPDATED: 6/22/08 FUNCTIONALITY: 5 SATISFACTION: 5 [3 MONTHS POST-OP]--by 4 months, muscle spasms finally, finally alleviated, range of motion is great, arm strength all but imperceptibly restored: PT discharges me for the first time in 7 years!!!!

DATE UPDATED: 9/3/08 FUNCTIONALITY: 6 SATISFACTION: 5 [6 MONTHS POST-OP]

DATE UPDATED: 1/23/09 FUNCTIONALITY: __6_ SATISFACTION: __5_ [1 YEAR POST-OP]

DATE UPDATED: 1/23/10FUNCTIONALITY: __6_ SATISFACTION: _5__ [2 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [3 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [4 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [5 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [6 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [7 YEARS POST-OP]

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

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

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?]):I have essentially returned to my life--I can sit for long periods without pain, electrical zingers or distracting tingling , which means that I can work. I still work out in the gym with a trainer to maintain arm strength, but at this point, the concern about arm strength is more related to my rotator cuff surgeries and the orthopedic surgeon's telling me that this is what I needed to do forever. I am still getting weekly massages as my trapezius muscle still spasms at times. I do have some tingling/numbness in the tips of my index and middle finger of my left hand (as opposed to the tingling/numbness in the entire index finger and thumb pre-surgery); this has diminished over the year but I still experience it and don't know whether it is related to problems with C6/7 or represents another issue entirely. At any rate, it is not as disturbing as the pre-surgery symptoms. And I do have some "popping" in my neck at times, which raises anxiety about what is going on. I am not constantly dropping things (or, things are not constantly dropping out of my hand); I no longer have problems writing and holding a pen. My PT did a quick re-evaluation a couple of weeks ago and found no weakness in my left arm and hand and even superiority on the left over the right in some tests; my upper back is no longer in constant spasm so that it felt like a "block of concrete." I am able to stand upright and enjoy the restored 1/2 inch of height.


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


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

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

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

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

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