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    Old 02-02-2006, 05:40 AM   #1
    dboberle
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    Extreme Pain

    All of this sounds terrible. I am in extreme pain all the time but dr. has said I have nothing surgically wrong. Does anybody have similar situation and what are the Dr's doing for you?

    Exam: MRI Spine LUMBAR W /O+W/ CONTRAST


    L5-S1:
    metallic artifact emanates from the disk
    space, consistent with previous fusion. No disk displacement
    is present. There is mild spondylosis involving the left and
    right endplates extending into the neural foramina bilaterally
    and causing biforaminal narrowing.

    L4-5:
    disk desiccation is present and a mild diffuse annular
    disk bulge. The AP stacked diameter measures 10 mm. No spinal stenosis
    is present, and the neural foramina are patent.

    L3-4:
    disk desiccation is present at disk narrowing. A vacuum
    disk phenomenon is seen as a linear area of signal loss within the
    nucleus pulposos. There is a mild diffuse annular disk bulge
    indenting the epidural sac. There is no stenosis, and the
    neural foramina are patent.

    L2-3:
    disk desiccation is present as well as a vacuum disk
    phenomenon. A minimal annular disk bulge is noted, which
    mildly indents the ventral subarachnoid space. No evidence of
    neural impingement. There is narrowing of the left lateral recess
    secondary to the disk bulge as well as associated left-sided
    spondylosis. There is a small vaccum disk phenomenon present.

    L1-2:
    disk space narrowing is present and a vacuum disk
    phenomenon as well as a disk desiccation. There is a diffuse disk
    bulge indenting the CSF. There is no spinal stenosis or evidence
    of neural impingement.

    IMPRESSION: 1. Multilevel disk degeneration with disk space
    narrowing and bulges at L1-2, L2-3, AND L3-4. No central spinal
    stenosis at any level. There is stenosis of the left lateral recess at L2-3
    due to asymmetric endplate spondylosis.
    2. Diffuse annular disk bulge at L4-5, not producing spinal stenosis.
    3. Status post interbody fusion at L5-S1. Mild bilateral foraminal
    narrowing due to endplate spondylosis but no obvious neural impingement

    X-ray report:

    There is a mild curvature to the upper lumbar spine convex to the right at L2.
    There is 2 mm retrolisthesis of L1 on L2 and of L2 on L3 in standing neutral position. These each reduce to 1 mm in flexion. At L1-L2 there is a increase in the retrolisthesis in extension, and there is no change at L2-L3.

    MRI C-Spine

    C1-2:
    Unremarkable

    C2-3:
    A Mild 2 mm broad based posterior disc bulge is present. In addition, an asymmetric posterior osteophytic ridge is present as asymmetric uncovertebral joint hypertrophy effaces the left paracentral and foraminal regions of the thecal sac.

    C3-4:
    Unremarkable except for minimal uncovertebral joint hypertrophy.

    C4-5:
    A broad based 3-4 mm posterior disk bulge is present. Bilateral neural foraminal encroachment is noted at this level, slightly more severe on the right, due to combination of the uncovertebral joint and articular facet hypertrophy. The AP dimension of the thecal sac is reduced to 9-10 mm at this level.

    C5-6:
    A broad based 3 mm posterior disc bulge is present which minamally effaces the ventral thecal sac. Relatively little convertebral joint hypertrophy is noted, and there is no evidence of neural foraminal encroachment. The AP dimension of the thecal sac measures 11 mm at this level.

    C6-7:
    A broad based 3-4 mm posterior disc bulge is present. Posterior disc extension is most conspicuous in the left foraminal region resulting in
    asymmetric left sided neural foraminal encroachment. Relatively little uncovertebral joint hypertrophy is noted. The AP dimension of the
    thecal sac measures 11 mm at this level.

    C7-T1:
    Unremarkable

     
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    Old 02-02-2006, 07:46 PM   #2
    zoey1
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    Re: Extreme Pain

    Have you been refered to a rhumatologist or a nurologist yet, and or checked your inusrance plan to see if you can get one in your plans area?
    If you have arithus it can be a massive contriubuting factor to extreme pain and can be treated and managed, pain can contriubute to nerve ending situations that nurologists can help with as well .
    Do not ignore the pain because that one doctor did not take you seriously. Keep checking things out till you find out what is wrong and who is willing to help you. Sometimes it takes lots of different approaches to get any Releif
    But help can be gotten if you take the bull by the horns and keep going to see these folks and find out root cause of troubles.
    Do not give up and keep at it till you find someone that will help give you answers.
    At this point i see several speicalist because they all have there area of expertise but only by being persitant did i get answers and help.
    Much luck to you and do not give up ! There is help out there

     
    Old 02-03-2006, 06:48 AM   #3
    feelbad
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    Re: Extreme Pain

    See an ortho for full evals on all of your symptoms.what docs have seen so far and what have you been told as far as for your future and any immediate treatment plans?have you actually been told just what that vaccum thing is all about?I had a freind who had this going on in one of his low back discs but for the life of me i cannot seem to recall just what or why it happens?or what the standard treatment was with him.But you do need someone to really do a comprehensive workup on all of your symptoms and the possible pain generators.I really would highly recomend an actual neurosugeon if there is a need at some point for an actual surgery done on the c spine level,really.There are alot of heaveliy innervated ares that are present inthe c spine that are not further down anywhere else within the spine and cord.i personally would never let anyone but a neurosurgeon touch my c spine but i have extensive issues with mine.
    but seeing that ortho for the eval is rather vital for you to really know just what the major problem areas are,how it is actually affecting your motor and sensory functions and then come up with a good treatment plan which could just be some sort of physical therepy and or a surgical procedure of some sort.Also getting that second read on your actual MRIs would be in order.any good knowledgable ortho surgeon and neurosurgeon wants you to bring in your actual films with you when you come in so they can see for themselves what they feel the biggest problem areas may be.one thing that many people really don't understand is that ANY radiology report done on any sort of rad films is only as good as the radiologist who is doing the interpretations.having someone woth like ten to fifteen years of solid experience in interpretting films is going to be wayy much more thorough and knowledgeable than someone who is like brand new and fresh out of school or with even just a few years of actual experience.you know what I mean?
    I have had to have over 15(total) MRIs and Cts over just the last few years and I can tell you without a doubt,the person who is actually making the report makes a huge difference in just what is or is not actually noted.I had one MRI done on my c spine at the usual radiology place I go to for all my rad needs and one that had to be done at the actual hosp before my surgery and the differences in the reports and all of the many things that were actually noted in the rad place compared to an actual hospital rad were really quite shocking actually.There is one particular rad at the place I normally go to who I now actually request whenever possible to be the one to do the interpretation of all of my MRIs.he is the most detailed rad i think I have ever had reads done by and has like 25 years of experience.and it shows.
    just always remember that just because something is stated in a rad report,doen't always mean they are always completely and totally right.i had one rad tell methat yes my fusion had indeed occured andthen another one like four months later(because I was still havinghorrible symptoms)tell me he was pretty sure it was not.it took a simple flex and ext x ray to tell them that it most definitely was not and i would need a hardware placemnet surgery.so there ya go.Just make sure to always bring your hard films to all appts with any speacailists so they can see for themselves what THEY feel about what is in that report and what was actually not noted al all in some cases.

    Depending on your pain levels,this could either be handled by your primary or better yet,a good pain clinic.they really can offer you the best alternatives for pain control.some are actual therpies some are med options and some are specific types of injections.you just cannot get all of this with any primary doc.most surgeons of any sort ,in most cases,will not Rx you anything til after they have actually done some sort of surgery on you.This isn't ALWAYS the case but it is in most.
    the mainthing here is that you find out just what the actual issues are that are of the biggest concern and any sort of treatment options availiable toyou.I would avoid having any surgery at all unless it is really truely the last option and other things have offered you no help.having any surgery comes with lots of risks,espescially when it is being done anywhere near the spinal column and cord.you can end up much worse after a surgery than you ever were before it,trust me on that one.I went into my fusion way too quickly as I just wanted thatquick fix and get on with my life.well,I did not get back on track after that at all.and after the hardware placement,i was screwed for life.my NS actually placed the hardware and did not actually(were not able to because of scar tissue build up just over only 9 months time)visualize just where all those spinal nerves were before he tightened up the screws and post op and up til I had to have my last most devistating surgery,had horrible levels of pain.it wasn't til my new NS who was going in to try and remove a glob of blood vessels that had formed inside my cord,saw my c 7 nerve root kind of wrapped around something that was actully impinging it up against the back wall of the c 7 vertebrae,that I really knew just what had happened at what was causing the horrid pain I had been having .once he did the lamenectomy that removed that back piece off of the c 7 vert,that part of the pain was just gone.unfortunetly for me,the pain that came from the actual spianl cord damage that was mostly unavoidable,was and is like ten times worse than that was.I now long for that kind of pain back if it could replace the hell I am living in now.My pain doc has been a big lifesaver for me,really.

    sorry to have rambled there.I do think some second opinions on you and your films are definitely in order though,a good ortho and a full eval with a good look at you films will tell you alot about just what you are dealing with here.and getting to that pain doc will also help tons in trying to keep some sort of control over the pain,really.I don't know how I would even be functioning right now without mine.Good luck and please keep us posted on what you actually find out,K?

    just remeber,surgical intervention should be only used as the very last resort,not the first choice,ever.I learned THAT in the hardest way possible.
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 02-03-2006, 10:14 PM   #4
    dboberle
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    Re: Extreme Pain

    Thank You both for your reply's.
    I am currently seeing a pain management specialist who now says he thinks I am a surgical candidate. He has performed several blocks and three Pulsed Radio Frequency Rhizotomy's. RFR's gave me considerable relief for about 2-3 months. Blocks only lasted 1-2 weeks. I saw a neuro surgeo and he said I have nothing surgically wrong with my neck but has ordered Bone Scan, Dexa scan and 2 EMG's on Lower and upper extremities. Have worked same Job for 26 Years but am only 44 years old. Family Dr has been treating me for 15 years and He has said he would like to see me quit working and Go on Social Security disability even though it's hardly enough to live on. He has never had a patient go on SSI so he's not sure I will be accepted. With the Scans that I have had and Documentation of problems for 15 years what do you think my chances are of Getting SSI?
    Don't know what way to turn.
    Mr. Pain

     
    Old 02-04-2006, 07:13 AM   #5
    feelbad
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    Re: Extreme Pain

    SSI and SSD are two different things.SSI is only given really to people who are pretty much at the poverty level but ssd is what most people apply for,getting it awarded is a whole other stroy.I went thru this a bit over a year ago.for me,the process actually went fairly quickly,even with a turn down at the first attempt,I was eventually awarded benefits and the whole process took about 9 months,unfortunetly there are many many people out there who are very much deserving of benefits who are still waiting and have been waiting for years.It is all very highly individual and really boils down to just what you can still do and cannot do,not always with what your actual Dx is.Go on up to the disability boards and check out some threads or post some questions.they really are a helpful bunch who I relied on heavily during my wait.

    You know,from what you have stated here,really,it sounds like you have been actually 'overtreated"?some pretty radical stuff.rhizotomys would scare the hell outta me only because of the possible complications further down the road when nerves start to regrow around the scar tissue.Has any of your docs mentioned this as a possibile reason for some orf your pain?i would most definitely get a second opinion before doing any more surgery.surgery itself can cause a huge host of major complications and can also cause its own trigger of specific pain syndromes.this is what happened to me.just be very careful about what you decide to do.do research on your specific conditions and possible non surgeical treatment options before going under that knife again.

    what actual meds are you currently taking and dosages?What IS your pain actually like(what does it 'feel' like) and where is it at with regard to body parts?is it constant or intermittant?Just some questions that would help alot in giving you adviceMarcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 02-04-2006, 02:46 PM   #6
    wimpette
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    Re: Extreme Pain

    dboberle -
    marcia has given you a lot of good advice. Firstly try to define your pain - neck, back, arms, legs, what makes it better or worse and what medications you are taking in addition to what helps and doesn't. Many hospitals now have spinal centers and cases are discussed regularly amongst all the specialists involved including radiologists, orthop. spine specialists, neurosurgeons, pain docs etc. If you link up with a good pain management doctor and/or spinal surgeon (orthopedic or neurosurgeon) you should be able to find someone to reevaluate your pain and how to manage it.

    MRIs and CT scan reports vary greatly as Marcia has indicated. A good specialist will look at the scan and not the report and often get additional opinions from a neuroradiologist.

    Whatever the outcome, try not to consider surgery as the answer and cure to your problems. Surgery in itself has complications and can lead to additional pain issues. In your case you should think of it as the last resort and only after several opinions.

    Good luck,
    W

     
    Old 02-04-2006, 09:35 PM   #7
    dboberle
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    Re: Extreme Pain

    Currently on 100mg Oxy daily and 40mg Vicodin. Handles the pain most of the time but if I do any Bending at all I get into so much pain I can';t stand it. Been on meds for 4-5 years now. Dexa scan and Bone density scan, Dr has said is to find out the condition of my Vertebre so they can determine what type of hardware to use for fusions. L5-S1 fusion that I had 6 years ago has broken and will need re-fused. Emg on lower extremities has shown the amount of damage to spinal cord at L5-S1 and shows Bilateral Radiculaphy. Upper EMG has shown no nerve damage in Neck but showed Moderate to severe carpel tunnel in both arms. I am not sure of what I want at this time except need to quit working so I do not have to bend anymore. I can Tolerate things if I do not have to bend. The blocks that I have had over 6 years for diffrent types of things. Rhizotomys have helped tremendously with pain down both legs and Buttocks. Could not stand the pain even on all the meds before those.
    What a mess. Afraid to quit working knowing I may not be considered disabled by SSI. But can't stand the pain if I do work.
    Thank You for your respone,
    Tired of Hurting

     
    Old 02-05-2006, 03:59 AM   #8
    zoey1
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    Re: Extreme Pain

    I would still encourage you to see a Rhumatologist
    Arthuis can be a contruibuting factor and there is alot of help out there even if they find it in the back/spine area.
    I know doc hunting sounds nuts but in this case there are a variety of treatments that can possiblity assist with your situation
    In all honesty surgery was my last option and 1 1/2 year latter i still feel it was not a good option for me because i had other issuses.
    Though i was presented with horrid choice i also got 3 other opinions that said it would be worse if i hadn't had the surgery.
    Please look at other alternatives............I am glad you are seeing a pain management specialist they can give relief and one of the few docs that can manage severe pain on a on going time frame
    Please keep us updated on search and times of releif and what you found out ok>>>>>?????

     
    Old 02-05-2006, 07:22 AM   #9
    feelbad
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    Re: Extreme Pain

    All you can do is to start the app process and then start gathering up your medical records.like I said before,it is not actually what you have been diagnosed with that matters,it is your level of mobility and disability that determines your daily living and the impact on it that they really look at.It never hurts to try,really.If you go to www.ssa.gov you can even start the actual process online.this is what I did.it is pretty simple.just kinda in depth at times.just make darn sure that you make copies of every scrap of paper of the application that you fill out and actually send in as sometimes,they will keep sending you these same exact forms to fill out,again.It saves a ton of time and hassle,believe me.i did not do this until later in the process and many many times,I could have just kicked myself for it.you wont know if you are eligible if you never try.it IS worth the shot.like I stated before,go up to the disability boards with any questions,they really really are helpful.good luck,marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 02-05-2006, 09:00 AM   #10
    wimpette
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    Re: Extreme Pain

    From your response sounds like the real pain issue you are dealing with is from your failed spinal fusion. One way surgeons determine whether a further fusion will help the pain is to have you wear a back brace that stabilises things and will improve the pain if the failed fusion and instability contribute to it. It will also help you prevent bending in the wrong way at work and also help you in that way. Again, it sounds like a team approach is the best way to decide what's best but certainly a brace at work might help the pain somewhat.
    Before my repeat neck surgery in addition to selective nerve root blocks I also tried a neck brace to see if it improved my symptoms before the decision to operate was made.
    W

     
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