Spine Patient Society Forums

Dr Pimenta Response

Gilbert P — Thu, 09 Sep 2010 00:24:02 GMT

Well

Dr Pimenta finally responded after manyl emails.

Gilbert,

I got his review over your exams. Apparently a 3 levels degenerated discs L4-5; L3-4; L2-3 that would need surgery.
Just by looking to the exams and not seeing you is hard to tell what to do, but it seems that he could be performing a TDR at L2-3 and another L4-5 but fusion at L3-4.
The best way now for you to plan what to do is to contact him directly at his e-mail: and plan the appointment with him.

He never mention my L5-S1 which would need a fusion? I sent him a email with many questions

I am getting closer :caffeine:

Gil:coffee:

Spine Stablization, Strengthening, Fitness Books -- Which have you read?

Carson — Tue, 07 Sep 2010 18:32:48 GMT

I'm looking for good books on spine health and strengthening and wanted to ask what you all have read, are thinking of reading and what you would recommend in way of Spine Fitness books.

Whether they are books on core strengthening, yoga, swiss ball workouts, pilates, etc, I'm curious as to what you've read, what you recommend and what type of exercises are best keeping our spines stable. Thanks.

Greetings fellow spine patients!

Greatgreebo — Tue, 07 Sep 2010 14:44:10 GMT

Obviously I'm new. I've had a L4 L5 ALIF on June 1, 2010. I have Degenerative Disk Disease...meaning, nobody can figure out why my spine went from okay to terrible in such short peroid of time. The neurosurgeon told me I had stage one end plate degeneration at my L4 L5 so it had to be fused.....he said he wasn't worried about the L3 L4 right now because it was only a stage three endplate degeneration (what ever these things means?!?)
I'm a 41 YO Female-field biologist and wildland fire fighter, but I've not had any injurys. It 'just happens sometimes' I've been told by a few doctors. Initially, when all the pain started I was told it is in my head, I needed a psychiatrist, I was just trying to get drugs, I was far to young to have back problems (I look much younger than my 41 years) etc.....They told me about acupuncture and deep tissue massage and I ate Ibuprofen until my stomach bleed. Finally, I got a doctor to listen, he ordered an MRI and had it sent to the head of OHSU Neurosurgery who took one look at it and was like "holy cr@p!!! you need surgery right now!!' (apparantely I didn't need a shrink or yoga.....the problem was real!) I was angry at the time :mad: but now I'm just tired.
The reason I tracked this weeksite down:
I was lucky enough to spend the night at the Oregon Health and Science University Hospital just this weekend so they could 'run some tests'.....The pain was SO bad I couldn't breath by the time I got there:caffeine:. I was doing great on week 10 after the surgery but something has gone horribly sideways since then. My PT thinks my L3 L4 is now having major problems due to the strain of having the joint below it welded together. I expected this to happen since my L3 L4 was not in great shape.

so---what is stage one versus stage three endplate degeneration? is it normal to have IMMENSE pain in the joint above the fusion? Will the pain stop or is this a forever cycle I'm on?
whimper.........
Greatgreebo

Tapentadol Eases Osteoarthritis Pain (CME/CE)

Justin — Tue, 07 Sep 2010 13:43:50 GMT

(MedPage Today) -- The centrally acting, extended-release analgesic tapentadol provided effective pain relief in patients with knee osteoarthritis, but with fewer of the gastrointestinal side effects seen with oxycodone, a phase III study found...

Tapentadol Eases OA Pain (CME/CE) (click here for the full article at MedPage Today)

Cervical spine surgery vs lumbar spine surgery

Jack-of-all-trades — Tue, 07 Sep 2010 02:31:36 GMT

I was curious if there was anyone who has had disease repaired by surgery at both of these levels. How did thet compare recovery wise, pain wise, or any other wise you deem good to know. I had l5-S1 fused last December. So fasr better than expected but not perfect. I was able to get off opiates.

Ihave two bad cervical levels I have known about for some time. Just over the last 3 months it has gotten to the gotta have some relief. I have an appointment with my neurosurgeon in 2 weeks.

Dr Yeung

Gilbert P — Mon, 06 Sep 2010 18:16:59 GMT

:hello:

Has anyone heard of Dr A. Yeung and his son Dr C. Yeung? In Phoenix
They preform MISS with Endoscocip surgical technique.
I am sending my profile to them for $250. will do a consultation. I can only try

Thanks

Gil :coffee:

Where to start?

Cindylou — Sat, 04 Sep 2010 04:01:39 GMT

Hi everyone,

This could be kind of long, so I am going to apologize right now, up front. Not sure where to start so I will just dive in.

First my cervical: I have had ongoing cervical issues for years but have managed to keep them at bay with injections and cauterization of my facet nerves about once a year. While I was doing the x 2 right sided lumbar facet blocks, (per my insurance requirements preceding rhizotomy) I was also doing the cervical facet blocks on right side, x 2, on the off lumbar weeks. This morning was my second one. I got about 100% relief for a few hours, just like 2 weeks ago, but right this minute is another story. Pain is bad. I started looking over a cervical Cat Scan I had done from 3 years ago (I'm pretty sure I had one done a year ago, but cannot find it to save my soul). Here is a summary of my neck from 07: There is multi-level, moderate cervical and upper thoracic disc degeneration with moderate disc space narrowing @ C 4-5, C 6-7, moderate Schmorl's node type of deformities anteriorly @ T 1-2 and C 7-T1, with straightening of the cervical lordosis. At C 6-7 there is mild central canal stenosis with diffuse posterior bulging and retrolisthesis. There is severe foraminal stenosis seen on right at C 6-7 with broad based right lateral intraforaminal disc bulge, right sided uncinate spurring and right sided C 7 nerve root impingement. C 4-5 reads pretty much the same. There is an incidental note of a small intraosseous hemangioma within right C 5 lateral mass. And this is from 3 years ago. Yuck. I am just praying that insurance covers the cervical right sided rhizotomy and I get similar, long lasting, relief results because I just cannot cope with surgery on my neck. A year ago I met with a surgeon when the pain got real bad again and he recommended surgery, but.....I just am trying not to go there since I also still have significant, unresolved lumbar pain. I guess my question at this point is.....is there anything in the above summary that indicates I shouldn't keep putting it off? I realize we are all lay people (Justin almost the exception!) but still wanted to pick your brains.

On to my lumbar: I am so fatigued and tired of all the pain. And just so discouraged. I recently discovered that I had a sacral stress fracture that was not evident before my right SI Joint Fusion. Not sure what caused it, (the surgery? Dunno.) but it was never brought to my attention either. :mad: I also discovered on a Cat Scan record from this past Febuary that all the bone cement has not been removed in the S 1-2 area, where my surgeon did my ALIF and lami 2 years ago, and had to go back in, remember? And yet I clearly remember him telling me when he went back in that he removed it all. ?? WTF? In a nutshell, the lumbar Cat Scan from 02/10 of this year says I have moderate hypertrophic changes noted on margins of L 6-S 1, facet joints and contributes to moderate subarticular recess stenosis and S 1 nerve root impingement. There is also moderate, bilateral facet degeneration at each level of my 3 Prodiscs. There is a transitional L 6 vertebra with partial sacralization and ankylosis of a moderate sized left L 6- S 1 accessory articulation. I have a complex L 6-S1 facet joint that appears to be related to extensive calcification or ossification of the ligamenta flava and facet joint capsules bilaterally, and to hypoplastic or dysplastic facet morphology. There is also an incidental finding (or is it?) of moderate cysts bilaterally at S2 and a moderate sized perineural cyst on the right at S1. And this is a Cat Scan from Feb of this year. I am so discouraged. I just don't know what to do. I'm waiting and hoping insurance approves the right sided lumbar facet rhizotomy, but something tells me that may not touch all my pain generators. My low back pain has gotten so severe but pain management doesn't think an MRI is warranted since this lumbar Cat Scan was in Feb of this year. I can see their point. Should I just look at the....can't recall the medical name, a pain stimulator being installed in my body....I know that's not the right name, but the thing that is a last resort other than a pain pump. My heart is so heavy. Thanks for listening. Cindylou

The Multifidus Muscle - Key to Spinal Stabilization?

Carson — Fri, 03 Sep 2010 19:02:43 GMT

The Multifidus Muscle - Key to Spinal Stabilization?

January 12, 2009

Recently, researchers at UC San Diego used laser to measure the strength of the multifidus, a small muscle in the back. The results, published in the Journal of Bone and Joint Surgery, may influence the future of medical science as it relates to back pain and spine surgery. The research was supported by the Department of Veterans Affairs Rehabilitation, the National Institutes of Health and DePuy Spine, a device manufacturer.

Up until now, the thinking has been that because the multifidus is very small, it isn’t important to back health. Size aside, the multifidus has a very unique design that lends stability to the spine and keeps the individual upright. The researchers in this study concluded that the special design provides a scaffolding for the vertebral column. They identified short stiff muscle fibers packed inside a long finger-like covering, and said this particular construction is responsible for the extra strength and support the multifidus gives to the spine.

A small 2006 posture study published in the European Spine Journal, found that in people with back pain, the multifidus is working to the max well before the spine is vertical. In study subjects who didn’t have back pain, the multifidus was able to continue contracting until the trunk was erect.

Also the sarcomere, or the area where muscle contraction happens, is much smaller than in other muscles. But when the multifidus is put on a stretch, as when you bend forward, it actually gets stronger. This is unlike most muscles which, when lengthened, lose their strength. Something different is at work in this muscle!

"Our research shows that it’s actually the strongest muscle in the back because of its unique design," states Richard L. Lieber, PhD. Lieber is the director of the National Center for Skeletal Muscle Rehabilitation Research, a professor and Vice Chair at UCSD’s Department of Orthopedic Surgery, and a senior research scientist at the VA in San Diego.
These findings may influence the future of spine surgery, according to Steven R. Garfin, MD, professor and Chair of Department of Orthopedic Surgery. Garfin says this is because the way surgery is currently performed may actually disrupt the multifidus, which, in turn, may disrupt the spine’s ability to maintain upright posture.
Minimally invasive spine surgery usually results in less interruption of and trauma to soft tissues than traditional back surgery.

Some rehab specialists who work extensively with back exercises already knew about the special capacity of the multifidus muscle. Physical therapist Jim Johnson, for example, offers an exercise program for chronic back pain sufferers that is based on the multifidus. He believes that the multifidus plays a role in almost all non-neurological back pain.

High Quality Ergonomic Chairs

cmak — Fri, 03 Sep 2010 10:51:28 GMT

I've been doing a bit of research to find the most comfortable, ergonomic, and some-what affordable chair. So far it seems that they do run from $500 -$2000. Just wanted to see if forum users have any themselves. Input, feedback, and pix would be much appreciated:) Here are some I have found
ergonomic chairs | office chair
for my car: http://www.recaro.com/us/product-are.../overview.html
Thanks
Cmak

HELP! question about evaluating x rays...

davemmevad — Fri, 03 Sep 2010 01:44:57 GMT

Hi All,

I'm now 6 months post op from ACDF at c5-7. Just got a set of follow up X-rays done, and I'm concerned because they look exactly like the ones done 2 weeks post op - the grafts are surrounded by dark areas (that I was told would compress and fill in). Am I being paranoid? or am I reading this correctly as meaning I'm not fusing yet. Seriously, I went back and checked the date on the film ... NOTHING looks like it has changed.

Thanks
Dave

Fusion and disc replacement

Styxius — Thu, 02 Sep 2010 20:55:58 GMT

Just left my doctors office and the verdict is surgery. He wants to do a fusion at L5/S1 and disc replacement at L4/L5. L3/L4 is in a degenerative state but no pain yet and would prefer not to fuse L4/ L5. However, he does not think Humana will pay for an artificial disc. As an alternative he will do a two level fusion L4 to S1 with dynamic stabilization at L3/L4. Does anyone have any experience with Humana (florida) and their policy with approving back surgery?

Desperate for Relief....

KBear — Thu, 02 Sep 2010 17:51:09 GMT

This has way too much TMI, so read on if you can handle that......

Okay, I'm open to just about anything at this point. I am beyond constipated (to the point that I have thought about going to the hospital, but dang I just can't suck up my pride for that). I have a short list of medications I can take while pregnant, which aren't powerful enough or make me vomit (Milk of Magnesia- ughhh). Anyhow, I am drinking juice (V8 Fusion, Apple juice) like it's going out of style (it can cause diarrhea), eating lots of fruits, take in plenty of fiber and water. I eat Activia when I can; but once again the morning sickness makes it not that appealing to me. I'm looking for anything natural that may help me. I have even tried Miralax, which isn't on my approved list, but like I said, I'm desperate. I'm hoping I don't have a blockage or something, but I really don't want to go to the doctor. It is so bad that I am having a hard time even passing gas, the juice is helping, but I am blowing up huge from it. Any ideas???

Triumph Lumbar Disc -- Biomechanical Evaluation of a Posterolateral Lumbar Disc Arthroplasty Device

Justin — Thu, 02 Sep 2010 17:03:46 GMT

Spine. Volume 35(19), 1 September 2010, pp 1760-1768

Biomechanical Evaluation of a Posterolateral Lumbar Disc Arthroplasty Device: An In Vitro Human Cadaveric Model

Kikkawa, Jun MD*; Cunningham, Bryan W. MSc*; Shirado, Osamu MD�; Hu, Nianbin MD*; McAfee, Paul C. MD*; Oda, Hiromi MD�. Author Information: From the *Orthopaedic Spinal Research Laboratory, St Joseph Medical Center, Towson, MD; and �Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan. � 2010 Lippincott Williams & Wilkins, Inc.

Study Design. This in vitro analysis defines biomechanical properties of the Triumph Lumbar Disc (TLD) for posterolateral lumbar disc arthroplasty.

Objectives. To quantify segmental kinematics afforded by the TLD, determine whether intervertebral positional changes of the device affect spinal kinematics, and compare kinematics following TLD reconstruction with historical CHARIT� data.

Summary of Background Data. As an alternative to arthrodesis, total disc arthroplasty serves to restore the biomechanical properties of the spine. However, there are kinematic and clinical concerns regarding posterior lumbar column destabilization and reconstruction using motion-preserving technology.

Methods. Seven human lumbosacral spines were biomechanically evaluated under the following conditions: (1) Intact; (2) Unilateral facetectomy; (3) Facetectomy and discectomy; (4) TLD-posterior; (5) TLD-central; (6) TLD-anterior. Centers of intervertebral rotation (COR) and intradiscal pressures were compared at the operative/adjacent levels.

Results. In axial rotation, L4�L5 range of motion (ROM) increased to 110% � 15.3% following unilateral facetectomy and 134.3% � 26.9% following facet/discectomy. Implanting the TLD in 3 positions�posterior, central, and anterior�demonstrated no significant differences in ROM (P > 0.05). Trends were similar in flexion/extension and lateral bending. The neutral zone increased under the facet/discectomy condition and TLD reconstructions compared to the intact condition (P < 0.05). CORs were dispersed at the operative level following destabilization. TLD in posterior and central positions restored loci to near the intact condition, whereas the anterior position produced more diffuse CORs. Adjacent level intradiscal pressures decreased in flexion�extension following destabilization and reconstruction.

Conclusion. Axial rotation ROM following TLD reconstruction (central position) was 131.5% of intact, compared to historical controls for the CHARIT� device (162.0%). This indicates that lumbar disc arthroplasty performed using a posterolateral approach may offer biomechanical advantages over the anterior approach. Moreover, this approach may minimize surgical complications and allow simultaneous decompression of the neural elements. Intervertebral positional changes of the TLD were not shown to affect spinal kinematics.

I'm back!!!! (Three Level Cervical Artificial Disc Replacement)

pochofeo — Wed, 01 Sep 2010 03:51:20 GMT

Hello everyone. I had my surgery on Friday and am now home feeling relatively good. I underwent a three-level cervical adr in Orlando, FL. The surgery was performed by Dr. Robert Masson Minimally Invasive Spine Surgery, Back Surgery, Artificial Disc Surgery, Carpal Tunnel Syndrome Surgery | NeuroSpine Institute | Central Florida and Orlando. Along with the disc replacement were removal of osteophytes and some repositioning/alignment of vertebrae. The surgery lasted approx 2 hours. Dr. Masson is really quite impressive as is his entire staff.
Within an hour of regaining consciousness I was moving around and speaking. Symptoms such as paresthesia, numbness, claudication, radicular pain, weakness seemed to have disappeared.
The pain from the procedure is another matter. For two days I had intense muscle tension pain and especially pain when swallowing. Within two days that has subsided somewhat. At the moment issues are: swelling of the incision which has me a bit worried; muscle pain and the desire to really give my neck muscles a good stretch which I will not do of course; and a general discomfort with the position of my head and neck when I sleep. Apparently my head is now screwed on at a slightly different angle. So I�m getting used to that.
Someone in the forums made a comment a few months back about how the insurance companies want people to believe that they are not covering this procedure when in fact they are. For over a year I did not submit a request to my insurance, UHC, since I assumed it would be rejected based on the feedback I got. Since my insurance was about to expire and I was switching to a different company I figured why not submit a preapproval request for something �crazy� like a three-level procedure. I wasn�t even waiting for their response when the Dr�s office called to say they had approved the whole thing. The rest is history.
I have amassed a pretty good amount of information about procedures, Doctors, etc. If anyone is interested in this or anything else I can do to help please let me know.

Thank you all so very much for your support. This forum is invaluable.

Frank

M6-L (lumbar) Artificial Disc Replacement Available in Europe

Marti in Benicia — Wed, 01 Sep 2010 00:05:10 GMT

Hello all. I just learned that Spinal Kinetics lumar version of the famous M6-C disc -- the M6-L -- is now approved and commercially available in Europe. They have over 1,000 in patients with excellent success.

The very first one was implanted by Dr. Nick Boeree in Eastleigh, Southampton (UK). I have names of 3 other surgeons with M6-L experience, too.

FYI -- The M6-L will not be available in the US; you have to go out-of-country to get it/them.

No, I don't work for the manufacturer. I've had so much success with my two M6-C discs that I want others to know about the lumbar version. (Marti@CongerResources.com)

For the person(s) who mistakingly thinks I might be a device, surgeon, or procedure -- of course I'm not! Information is power for those who don't know about yet another device option and serveral provider options; this is more information.