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Chronic Pain or Chronic Misdirection - LAVERITA

Started by EZEKIEL on 08/23/2014 8:26am

Hello forum readers and members,

I am reaching out with hope that others with multi segmented spinal compromise will share their successful treatment and surgical experiences with me. I have performed extensive spinal research and I have been privileged to have spoken to numerous orthopaedic and neurosurgeons throughout the world. There has been significant differences in surgical approach because of the wide range of affected levels in my spine with contributing diseases. What complicates matters is the surgical approaches themselves and of course what the surgeon him or herself is capable of.

Living in Ontario Canada really leaves patients amidst the controversy of unfounded diagnoses because of the lack of surgical innovations. Beyond being labelled with “chronic pain” there seems to be very little hope of surgical intervention because of the extensive limitations. I am and have been on a surgical wait list for over seventeen months now. Before that I had waited over sixteen months just to see an orthopaedic spinal surgeon. After addressing one spinal segment the doctor proposed posterior fusion from T3 to L1 with a possible osteotomy. I have been familiar with the surgical limitations here in Ontario for some time now. So I was not taken back when I asked if there was anything else he could possible do and he replied “Unfortunately we still perform spinal surgery very archaically here in Canada”. Rather I felt a sense of respect and honesty that to date I had not received by others.

Sure, there are options that I can pursue abroad, however, the cost factor of the surgeries that I require are simply prohibitable. Being afflicted for over three years by extensive regressive spinal imperil I experience severe vertebral spine pain complicated by upper and lower limb radiculopathy and pain. I experience weakness in my arms, hands, legs and feet and the pain at times is inhumane. I am no longer able to drive and walking any distance has become intolerable and simply no longer possible. I am on 2700mg. of Gabapentin, 40mg., Baclofen and the 3 doses of Tramadol 37 / 325mg daily and yet the cocktail seems do very little to alleviate the severe pain that I experience daily. Arthrotec was removed from the current medications that I take because of the heart attack I had back in April. If anything it may have helped a little in regards to the fragmented sleep that I experience. Although heavy narcotics have been recommended by several doctors I do not think it is a solution.

While early findings of my lumbar spine back in mid 2011 were extensive the overall findings post MVA in the fall of 2011 have been paramount and the repercussions, immeasurable. I am not certain how this has all become. Back in September of 2010 my G.P told me that I had a perfectly normal spine for someone my age…I welcome anyone wishing to share their multi-level / multi-segmented spinal afflictions. I am curious as to your diagnoses and prognoses and surgical or non-surgical procedures and treatments that may have helped in the reduction of pain and an increase of spinal motion. I have posted my updated my diagnostic reports to encompass all relative diagnosis and findings.

EZEKIEL
CERVICAL SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

There is straightening of the spine with loss of normal cervical lordosis seen due to paravertebral muscle spasm. There is evidence of grade one retrololisthesis of C2 over C3 and minor retrololisthesis of C5 over C6. Multilevel dehydration and desiccation is seen. The nuchal ligament is hypertrophic at the C6 and C7 levels.

At C2-C3 level, minimal bulging indents the ventral thecal sac. Canal and foramen remain patent.

At C3-C4 level, central shallow herniated disc measuring 5mm in transverse and 2.5mm in AP dimension, indents the ventral thecal sac. There is a superimposed bulge with annular laxity with bilateral uncovertebral joint hypertrophy, this is marginally worse on the left side resulting in mild left foraminal stenosis.

At C4-C5 level, central herniated disc measuring 7mm in transverse and 2.5mm in AP dimension, indents the ventral thecal sac. There is a superimposed bulge. Canal and foramen remain patent. There is bilateral uncovertebral joint hypertrophy.

At C5-C6 level, there is a large herniated disc / osteophyte noted, measuring 12mm in transverse and 3mm in AP dimension in contact with the spinal cord. There is mild canal stenosis (AP dimension is 9.5mm). There is some lateralization to the left side and likely in contact with the left exiting C6 nerve root. There is mild to moderate narrowing of the left lateral recess consequent compression of the left descending C7 nerve root can be expected. Bilateral uncovertebral joint hypertrophy is present.

At C6-C7 level, a disc bulge is seen indenting the ventral thecal sac. Canal and foramen remain patent. The nuchal ligament at the C6 and C7 vertebral level is hypertrophic.

At C7-T1 level, there is no bulge or herniation. Canal and foramen remain patent. There is a small 3.5mm per neural cyst seen in relation to the exiting right C8 nerve.

EZEKIEL
THORACIC SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

The vertebral bodies from T6 to T11 show elongation of the antero-posterior dimension. Note is made of mild compression fracture deformities of T7 and T8 vertebral bodies. Schmorl’s Nodes are seen at multiple thoracic levels including T6-T7, T7-T8, T8-T9, T9-T10, T10-T11 and T11-T12 levels representing endplate micro fractures. There is mild disc desiccation seen at the T2-T3, T3-T4, T9-T10 and T10-T11 levels. There is moderate disc desiccation from T4-T5 to T8-T9 levels. Mild reduction of disc height is seen from T6-T7 to T10-T11 levels. Type II modic endplate changes are seen at the T11-T12 level. There is evidence of mild dextroscoliosis at the apex, approximately at the T9-T10 level. There is moderate degree of anterolateral osteophytosis seen worse on the right side caudal to the T3-T4 level.

At T1-T2 level, there is annular disc laxity causing mild left foraminal stenosis. Minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.

At T2-T3 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis. No canal or foraminal stenosis.

At T3-T4 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.
No canal or foraminal stenosis.

At T4-T5 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.
No canal or foraminal stenosis.

At T5-T6 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. Mild endplate sclerosis is seen. There is mild facet arthropathy. There is mild to moderate anterior and posterior marginal osteophytosis.

At T6-T7 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is mild moderate anterior and posterior marginal osteophytosis. There is mild costo-transverse joint arthropathy seen.

AT T7-T8 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is moderate anterior and posterior marginal osteophytosis. There is mild costo-transverse joint arthropathy seen.

At T8-T9 level, central herniated disc noted measuring 6mm in transverse and 2.5mm in AP dimension producing mass effect on the spinal cord and demonstrates spinal cord flattening and borderline canal stenosis. Mild loss of joint disc space is seen. There is moderate endplate sclerosis. There is moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T9-T10 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T10-T11 level, There is moderate endplate sclerosis. There is mild to moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T11-T12 level, shallow herniated disc indents the ventral thecal sac. There is moderate endplate sclerosis. There is mild to moderate facet arthropathy seen causing mild to moderate right and mild left foraminal stenosis with the disc / osteophyte seen in contact with the exiting right T11 nerve root.

OTHER DIAGNOSIS IN PART
OF THE
THORACIC SPINE

1) SCHEUERMANN’S DISEASE

2) DISH (DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS)

3) SUSPICION OF A.S UPPER AND LOWER THORACIC SPINE REVEAL SYNDESMOPHYTES. A DEDICATED CT SCAN OF THE THORACIC SPINE IS REQUIRED

EZEKIEL
LUMBAR SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

There is disc desiccation from L2-L3 to L5-S1. Mild reduction of disc height is seen from L2-L3 to L5-S1, most marked at the L5-S1 level. Shallow schmorl’s nodes are noted from L2-L3 to L5-S1 levels. Dextroscoliosis is noted with the apex at approximately at the L4-L5 level. Note is made of minimal grade one retrololisthesis of L1 over L2. Grade one retrololisthesis of L2 over L3 is not appreciated measuring 4mm. There is grade one retrololisthesis of L4 over L5. Multi-level spondylolisthesis with evidence of ligament instability. Mild degenerative changes at both sacroiliac joints. Note is made of L5 segments sacralised to the ala of the sacrum.

At the L2-L3 level, there is an annular disc bulge seen. There is a superimposed far right paracentral herniated disc with associated annular tear. There is mild to moderate right and mild left foraminal stenosis with disc / osteophyte seen in contact with the exiting right L2 nerve. Canal is patent. Moderate endplate sclerosis is present. There is mild to moderate facet arthropathy / ligament flavum hypertrophy noted. There is moderate anterior and posterior marginal osteophytosis in conjunction with spondylolisthesis and spurring.

At L3-L4 level, bilobed annular disc bulge is seen with bilateral intraforamen extension. There is a shallow left and right parietal disc herniation present. There is mild to moderate foraminal stenosis with disc / osteophyte seen in contact with both exiting L3 nerves. There is no canal stenosis but the disc is also in contact with both descending L4 nerves. There is mild to moderate endplate sclerosis present. There is moderate anterior and posterior marginal osteophytosis. There is moderate facet arthropathy / ligament flavum hypertrophy seen.

At L4-L5 level, annular tear is visible. There is a central herniated disc measuring 10mm in transverse and 2.5 mm in AP dimension that indents the ventral thecal sac. The canal is patent. There is a superimposed bulge with bilateral foraminal stenosis and mild left lateral stenosis. Corresponding compression of the bilateral L4 exiting nerve can be expected. There is mild endplate sclerosis with minimal anterior and posterior marginal osteophytosis. There is moderate facet arthropathy / ligament flavum hypertrophy.

At L5-S1 level, diffuse disc bulge is noted. There is a superimposed left paracentral disc / osteophyte herniation noted. There is mild to moderate bilateral foraminal stenosis and left lateral recess stenosis. Corresponding compression of the bilateral exiting L5 nerve and left traversing S1 nerve can be expected. The canal is patent. Mild endplate sclerosis is noted. There is mild to moderate facet arthropathy / ligament flavum hypertrophy.

OTHER DIAGNOSIS IN PART
OF THE
LUMBAR SPINE

1) BILATERAL SACRALIZATION OF THE TRANSVERSE PROCESS

2) SPINA BIFIDA OCCULTA

3) DYSPLASTIC (FALSE ORIENTATION) OF THE RIGHT SUPERIOR ARTICULAR PROCESS
OF THE SACRUM

4) BILATERAL SACROILIAC DISEASE

5) OSTEOCHONDROSIS OF THE FACETS AND SPINOUS PROCESS

6) MILD SCOLIOSIS

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