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Post by crushy on Dec 12, 2008 16:53:00 GMT -5
I've done on-line research, but only work with one guy that I personally know with actual experience with this particular nerve problem, chronic pain and treatment to burn the nerve(s). However, his is lumbar spine and mine is thoracic which is always a different ballgame. He has sciatica (due to a bulging disk at the lumbar level). I have sciatica due to herniations from T-9 thru T-12. Right now, radio active frequency is the most recent option I have heard about. My only other option is to be opened through the front, have my organs removed and fuse my thoracic spine - which they are less likely to do when there is more than one level, etc. I was told almost 12 yrs ago I was playing Russian roulette with my organs, but I've beat the odds so far. I realize I should be posting to some more medically directed site, but I'm not ready. I think of you as friends and just need to bounce ideas off of you before I go too far. My regular Dr told me yesterday they also do the tail bone area (even after the entire thing has been removed) because the nerves were damaged and are still causing pain even though the full tail bone was fully removed over 2 yrs ago. I've done the steroid injections. They not only did not work, but being in the thoracic spine, require out-patient surgery and recovery because my problems are not in the lumbar spine. I just thank God I had great Neurosurgeons and my cervical fusions have been a great success. I'd do that again. I am going to go in and check this out. I'm assuming having radio frequency burn would more than likely not have some side effects including weight gain due to steroid injections (or 5 w/ NO positive results). Just wondering if anyone has had or knows someone with personal experience with this route because reading about strangers is just not as effective or consoling.
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Post by kittenhart on Dec 12, 2008 17:51:16 GMT -5
I don't know too much about, nor do I know anyone who has had it done, but I would think that how you respond to acupuncture and anesthetic blocks would be at least a little predictive of how well it would work for you (ie/how much of the pain is related to nerve compression and damage and how much is now due to harder to treat learned pain pathways that are by now fully potentiated....good times).
I know I always got excellent relief from both acupuncture and the spinal blocks my doc gave me (he's an anesthesiologist as well as family doc)...and that did turn out to be a good predictor of my level of pain relief once my compression was removed.
I also had a decent amplification of pain mgmt from low dose of amiltriptyline (yes, the tricyclic antidepressant...only 10 mg daily not 500mg like for depression) which seemed to slow nerve transmission without causing too too much in the way of motor side effects and seemed to make the painkillers work better and last longer. You're not supposed to drink on that but, I drank wine almost daily and never had any bad interactions...go figure.
I would think that if amiltriptyline is helpful to you, than the nerve ablation might be similarly helpful and that maybe trying the nortriptyline first as a predictive measure to see might be a good idea?
Hang in there, Crushy, my hero. I know the fusion surgery is brutally risky.
added: Not sure about what now that you've had corticosteroid injections. I refused those. Corticosteroids really make it harder to predict your healing now and how your body will respond.
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Post by crushy on Dec 15, 2008 12:22:39 GMT -5
Of course, kitty, you're one of my major supports because you've suffered too. I can honestly say I wish you didn't have a clue and you were healthy, but this seems to draw us together. I've been on a myriad of medicines, physical therapy, massages, acupuncture, chiropractics, steroid injections, etc over the years. The last radical one (5) I tried, I had to go into out-patient surgery (because of the thoracic part of it) and have the injections that did NOTHING (unless you include hitting some nerve and me waking my family to hand-sawing the legs of my kitchen stools because they were too tall, then later that night breaking out ceramic tile from my kitchen table because I wanted to replace it (looks great now btw) and painting candle sticks in the snow in the dark. My mind is made up. Doing nothing is doing something and doing this something completely sucks. I've done the non-invasive way and I'm still suffering. At least w/ labor pains, you get a breather in between contractions, but this is relentless. I may regret it, but I'm at a point, I'm willing to risk it. Unfortunately, my co-worker's Dr is not on my plan. I admit, I was really set back when he told me he'd only suffered with pain in his cheek and since the first burn, it had moved down to the back thigh for the first time. What??? Mine ends between my toes? I just pray it does something for me because just cheek pain would be a Godsend to me at this point.
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Post by freckles on Dec 15, 2008 23:38:01 GMT -5
I will Pray that you Feel better
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Post by kittenhart on Dec 16, 2008 0:11:43 GMT -5
What kindof other results did your coworker have? From what I've heard it's only semi-permanent and you have to repeat it to get lasting results?
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Post by crushy on Dec 16, 2008 5:05:52 GMT -5
Thanks, Freck. I appreciate that. kitten, you are right. When he first told me about it, I thought it was a one-time thing, but at our office Christmas party, I asked how he was doing and he said he was going in for another round. Then to hear his pain has moved didn't make me feel any better especially considering the fact mine starts and stops at the limits for that condition. I figure, at this point, I am willing to put needles in my eyeballs if I really thought it would help the constant pain in my rear-end and occasional pain in the sciatic nerve. I'm just holding out for that little hypo-spray thing on Star-Trek you get in the neck. I know this thread must sound trivial to some and I know it is, but this pain is really wearing on me (started 12 yrs ago). At least you get a breather during labor, but this is just breaking me down. This is why most of my posts are in the am. I can't sleep a full night with this stupid pain. I know I'm blessed and my problems are not terminal. I feel guilty for complaining, but it just comes out sometimes after being held in for so long. The only thing that seems to help is to do something for those worse off than I am. It's amazing how many suffer silently, but many of us don't even know unless we know the signs. I failed the candidacy of having the disks burned, is there anything left I haven't tried? Help? The Parkinson's medicine doesn't always work and makes me throw up for hours after taking it.
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Post by rocko on Dec 16, 2008 10:13:49 GMT -5
I haven't responded to this thread. Not because I don't care, but because I don't have any knowledge in this area. I will pray that you will find relief.
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Post by amola on Dec 16, 2008 15:03:30 GMT -5
I know this thread must sounds trivial to some and I know it is, but this pain is really wearing on me (started 12 yrs ago). At least you get a breather during labor, but this is just breaking me down. This is why most of my posts are in the am. I can't sleep a full night with this stupid pain. I know I'm blessed and my problems are not terminal. I feel guilty for complaining, but it just comes out sometimes after being held in for so long. The only thing that seems to help is to do something for those worse off than I am. It's amazing how many suffer silently, but many of us don't even know unless we know the signs. i know what you mean. i dealt with my hip pain for 10+ years before finally getting the replacement, and dealing with constant pain just sucks, period. of course, now that my surgery is done, i'm dealing with all sorts of other pains that i didn't have before. hang in there, girl.
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Post by freckles on Dec 17, 2008 22:59:36 GMT -5
I have headakes (I guess I could have a stroke anytime) sometimes I take ibuprophen like jelly beans Ibuprophen is the only thing that helps me Well also Strawberry Soda also makes me feel better sometimes And Choklet or IceCreme Those Ibuprophen jell caps are good BUT, I think they can give to much to fast 2 or 3 in pill form sometimes is better Also a hot bath
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Post by redskyatnight on Dec 18, 2008 12:30:17 GMT -5
I hope you find a solution that works for you. I don't understand all the ins and outs of what you are describing, and making a major decision like this is a big deal. You are going about it the right way, getting as much information as you can and weighing your options. I have no doubt that you will make the best decision for you.
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Post by rd2942 on Dec 18, 2008 15:27:17 GMT -5
Crushy,
I work in healthcare consulting - here's what I found on radiactive frequency:
Radiofrequency Nerve Destruction. Radiofrequencies are being used to destroy nerves involved in the facet joints (or z-joints), which connect the vertebrae. Evidence is still weak on its benefits. A 2003 analysis suggested that it may be beneficial, however, for relief of neck pain and possibly for low back pain caused by problems in the facets joints. Serious infections have been reported with this treatment, however.
Have you talked to your doctor about artifical disk replacement? Basically, the way they replace hips and knees, they can replace disks in the spine...definitely a better option than fusing the thoracic spine...I'll keep posting whatever I can find.
Stay strong, dear.
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Post by rd2942 on Dec 18, 2008 15:30:54 GMT -5
Artificial Disc Technology from Neurosurgical Focus
Disc Prosthesis for Thoracic Disc Replacement Thus far, the majority of research-and-development efforts in artificial disc technology have been focused on the lumbar disc, with only a small percentage devoted to the cervical disc. There has been almost no significant research into prostheses for the thoracic disc. One of the undisputed reasons for this disparity is the relative rarity of thoracic disc disease and, therefore, thoracic disc surgery. This type of procedure accounts for less than 1% of all disc corrective surgeries.[43] However, because thoracic disc diseases do nevertheless exist and many of them require the same type of surgical treatment as that used for lumbar disc diseases, it may be worthwhile to speculate on the applicability of artificial disc technology in treating thoracic disc disease. Many different factors, such as structure, anatomy, function, degeneration mechanism, pathology, surgical approach, and complications of thoracic disc surgery, can affect the applicability of artificial disc technology in the treatment of thoracic disc disease.
Structurally, the composition of the discs in all three spinal regions is fairly similar. However, the thoracic spine has several unique characteristics. In this region the spinal cord is relatively small, yet the ratio of spinal cord to spinal canal is larger than that in other regions. Also, the blood supply is more variable in the thoracic spine, with a particularly vulnerable region between T-4 and T-9. The cross-sectional area of thoracic discs is larger than that of cervical discs, but smaller than that of lumbar discs. The variation in disc height does not follow the same trend along the spine, with midthoracic discs being the highest. The shape of thoracic discs is more circular, whereas that of lumbar and cervical discs is more elliptical.[34] The thoracic spine has a kyphotic curvature, whereas both cervical and lumbar discs are more wedge shaped.[34]
Structurally, it should not be too difficult to transfer artificial disc technology (either total disc prosthesis or disc nucleus prosthesis) from the lumbar region to the thoracic region, apart from the problem of adjusting for differences in size and geometry. The similiarity of shape across the entire length of the thoracic region should entail less emphasis on maintaining normal lordosis than when replacing lower lumbar discs. The greater disc height in the midthoracic region should, in general, make disc replacement easier than in the case of narrower discs. The structural similarity in disc composition should also allow nucleus replacement if annular integrity is not grossly compromised.
The major functions of the thoracic discs are similar to those of cervical and lumbar discs. The compressive load borne by the thoracic discs is lower than that borne by lumbar discs but higher than that borne by cervical discs. Without the support of the rib cage, one would probably expect that thoracic discs would be more susceptible to motion, given their position in the middle of the spinal column. Actually, thoracic disc joints are stiffer, with less range of motion in flexion-extension, than lumbar and cervical joints; this is due to the additional constraining force exerted by costovertebral articulations and the rib cage. The variation in range of motion in lateral bending throughout the thoracic region is not large. The range of motion of axial rotation of lower thoracic discs is similar to that of lumbar discs, whereas that of mid- to upper-thoracic discs is similar to that of cervical discs.[47]
The greater stability of the thoracic disc joint has implications for the applicability of artificial disc technology in treating thoracic disc disease. First, even in degenerative thoracic discs there is less joint instability than in degenerative lumbar and cervical discs. Therefore, in treating thoracic disc pathology, it is not as necessary to reestablish joint stability. Second, the superior stability contributed by nondisc elements such as the rib cage and costovertebral articulation can often better maintain disc joint stability even after disc surgery. For these reasons it is less common to fuse the thoracic disc after discectomy. Because one of the main objectives of artificial disc implantation is to maintain or restore disc function and stability, there will be less need for surgeons to place an artificial disc if they can treat the disease by using current techniques without significantly altering normal mechanical function.
Due to the rarity of thoracic disc disease, the exact mechanism of its degeneration has not been studied as thoroughly as that of lumbar disc degeneration. However, based on structural and functional similarity among discs in all three regions, it is believed that the mechanism of thoracic disc degeneration should be similar to that of lumbar and cervical disc degeneration. The most common result of thoracic disc disease is disc herniation, in which the herniated disc material compresses spinal nerves and causes pain. As is the trend in the lumbar region, the majority of disc herniations in the thoracic region occur at the lower levels (T8-T12), probably due to the fact that the lower thoracic discs bear greater stress than the upper thoracic discs.[1,2] Most herniations occur at either central or centrolateral locations.[27,34] Although symptomatic herniation at multiple levels has been reported in thoracic discs, it is not as common as it is in lumbar discs.
Discectomy is the surgical procedure most commonly used by surgeons to treat thoracic disc disease. Although autograft bone block placement is sometimes used with discectomy, interbody fusion is not a common procedure for this disease because of the thoracic spine's relative stability. For this reason it would be more difficult to use an artificial total disc because it entails more radical surgery. It may be more effective to replace only the disc nucleus with a prosthesis, if it can be easily implanted using current discectomy methods.
Laminectomy, one of the early surgical treatments for thoracic disc disease, was found to produce disappointing results,[15] due largely to inadequate decompressive effect of the posterior approach as opposed to direct removal herniated tissue.[34] Since then, many other surgical techniques have been developed to treat thoracic disc disease, including the following: lateral rhachotomy, first described by Capener;[10] modified costotransversectomy;[22] transthoracic surgery;[33,35] transpedicular surgery;[32] lateral extracavitary surgery;[27] and transthoracic and costotransversectomy procedures.[6] These methods involve the same three approaches used for lumbar and cervical discs surgery: posterior, anterior, and lateral. Therefore, it would be feasible to apply any artificial disc or disc nucleus developed for these three approaches to the thoracic disc.
Recently, minimally invasive spinal surgery techniques have also been applied to thoracic discectomy.[39,40] Video-assisted thoracic surgery, which involves the same anterolateral approach entailed by open thoracotomy, allows surgeons access to the disc spaces, vertebral bodies, paravertebral soft tissues, spinal cord, spinal nerves, and sympathetic chain at all thoracic spine levels. Although the indications for VATS are the same as those for open thoracotomy, VATS offers the advantages of reduced postoperative pain, lower complication rates, and shorter recovery times. If this procedure continues to gain in popularity, artificial disc or nucleus devices that can be implanted by means of endoscopic procedures should have an advantage over those that must be implanted via open surgery.
The last but not the least important factor that can affect the applicability of artificial disc technology in treating thoracic disc disease is the potential risk it may add to currently used surgical procedures. Because artificial disc or disc nucleus devices are designed mainly to improve the long-term results of existing procedures that have known (and relatively low) risk factors and complication rates, it is vital that the use of these prosthetic devices not be allowed to increase significantly these potential liabilities, especially when the clinical benefits have not yet been proven.
Early laminectomy procedures were associated with high rates of paresis, paralysis, or even death. Coupled with poor clinical outcomes, laminectomy was essentially abandoned as a treatment for thoracic disc disease after 1960. The paresis and paralysis rate for anterolateral thoracotomy, one of the most popular procedures for thoracic disc disease, has been reported to be approximately 1%, with no deaths.[39] The total overall morbidity rate associated with the transthoracic procedure -- including pneumonia, atelectasis, pulmonary embolus, postoperative occult compression fracture, deep or superficial wound infections, bowel obstruction, and postoperative seizure -- is only approximately 11%. Another common method of thoracic disc surgery is the lateral extracavitary approach, which is associated with approximately the same overall morbidity rate as transthoracic surgery, with no reported deaths. The morbidity rate for other less commonly used approaches, such as transpedicular and costotransversectomy, is also reported to be in the same range. Due to its brief history, the morbidity rate for VATS has been less well documented. Based on the small number of publications, the overall morbidity rate associated with VATS appears to be reasonably low, but only after a learning curve that is steeper than that required for open surgery.
Overall, the morbidity rate associated with current surgical techniques for thoracic disc disease appears to be low, with almost no deaths.[15] Again, when applying artificial disc technology to the treatment of thoracic disc disease, it is important that the morbidity rate not be increased.
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Post by rd2942 on Dec 18, 2008 15:36:48 GMT -5
I guess it depends on who your physicians are - neurosurgeons, orthopedic spine surgeons? Where in Utah are you? Salt Lake has a very well-known hospital - the Intermountain Spine Institute - maybe you could contact them? Here is the link: intermountainhealthcare.org/services/spine/Pages/home.aspx
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Post by kittenhart on Dec 18, 2008 20:52:44 GMT -5
I don't think they can use artificial discs for multiple adjacent levels...but maybe that was just my surgeon that didn't think it was best for me- each case is different. But there are new disc prosthesis being patented (google it Crushy) and miracles do happen. (Disasters happen too, though....always there in the back of your mind, I'm sure, T.)
I do think they have to approach from the side where the compression is though, which means taking all her organs out and approaching anteriorly...which is why Crushy and everyone else is freaked out about a surgical solution- and why the idea of a less invasive solution is so appealing.
How does a local block affect you...does it give good pain relief?
I know you won't do anything rash out of escapism as you are much too patient of a person...but I worry for you. Hugs.
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Post by crushy on Dec 19, 2008 7:50:31 GMT -5
Wow, Everybody...I can't believe how you've given my thread such consideration, kind words and support. It means the world to me. I'm on my way out to work right now, but will post back later after giving thought to such helpful (more current information).
Thank you so much for taking time to reach out to me.
Crushy
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