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I have to go see my GP for my annual meeting and will discuss 2nd opinion sources with him then. But, for now, I'm going to go back and get a conference with the doctor at the pain clinic where the medial block procedures and ablation were performed.
Yes, do that. Good luck. Try and get one opinion each from an orthopedic spine surgeon and a neurosurgical spine person. They both do spine fellowships, but their residency training and board certification is different, and they sometimes have slightly different opinions about how to do things. I would say see only a surgeon who specializes in spine, but really, that's an unnecessary suggestion. No surgeon will touch a spine (nor will most hospitals let them) unless they are fellowship trained in it.
[Update]: So, it's been 4 months since I first saw the neurosurgeon and went through several weeks of physical therapy plus two medial branch block procedures and, finally a radiofrequency ablation (RFA) of the nerves in my neck. If successful, the RFA was supposed to remove or reduce the pain and perhaps become a method of managing the pain.
Well, the RFA didn't really do what was hoped - there is a small amount of relief and the area where I was experiencing pain in my neck and upper right shoulder seems to have been reduced to mostly in the neck area only but, every day the pain will build as I turn my head and use my neck. Eventually, I have to lay down for an hour or two and remove the weight off the neck.
So, I went back to the neurosurgeon and expected that he would give some guidance or offer his best advice as to what the next steps might be (surgery? additional injection/ablation procedures? more or different PT?). But when we met he was indecisive and really didn't offer any recommendations - when I pressed him about possible surgical remedies he said that my situation would probably mean a multi-level Anterior cervical discectomy and fusion (ACDF) but that the odds of a successful outcome for this procedure was about 50/50.
He didn't offer any other options and wasn't very encouraging; I tried to get him to comment on other possible types of procedures (e.g. foraminotomy, posterior or endoscopic procedures, etc.) but he wouldn't expand on anything. When he wrapped up the meeting he said that I had to make the decision on whether I want to have the surgery done; if so, then let him know. And that was it - end of appointment.
He was certainly a different person from the pro that I met in the initial meeting; then he seemed to have a well defined list of options that might be tried and it was encouraging to know that there a variety of procedures that could improve things. Now, he was a real wash out with nothing much to offer.
I'm really disappointed - I think I'll go back to my GP and see if there's someone I can see for a 2nd opinion.
Has anybody else had a doctor "go cold" on them ?
Have you considered wearing a neck brace? It does help some people as long as you get a decent brace. Insurance should cover it. I wish I had advice on which brace to get, I know that some are way better than others. My daughter has about 4 of them, she uses them when she needs to.
See if you can find a spine forum or a private Facebook group. The groups can be a gold mine for health information because people like you will be sharing their journey. It was how I figured out that my daughter has a deformity in her brain and cervical spine called Chiari Malformation (CM) that is supposedly rare but these days with better imaging, more people are being diagnosed. It is a specific pain associated with it.
We've had a lot of doctors "go cold" on us, back when I was trying to figure out what my daughters mystery illness was. Even now that she knows exactly what her health issues are, she still has doctors go cold on her. She also has some doctors telling her she doesn't have CM or any of the associated disorders because it's "rare". I would find a new doctor since he did go cold on you.
Since it sounds like you have extensive issues, the best advice I could give you is to find the best doctor that you can, preferably at a university hospital because they usually see the most cases and have had patients similar to you. You want someone that does a lot of cervical surgeries whether you choose to fuse it or look into the flexible disks I posted about.
I'm not sure which type of doctor you should consider seeing between an orthopedic spine surgeon and a neurosurgeon that also does spines. It would be a great question to ask at a spine forum or Facebook group to ask who used which type of doctor and what outcome did they have, good or bad? I can't stress it enough how much it helped in my daughters case. If it weren't for finding the groups, I'm not even sure if they would have diagnosed her yet. My 8 year old grandson had CM in the womb, they never even told her! The way she found out was by looking at her ultrasound scan CD's. My daughter is now very good at reading MRI's which she learned in a groups called beyond the measurement.
Are you still traveling, living out of the camper?
I have to go see my GP for my annual meeting and will discuss 2nd opinion sources with him then. But, for now, I'm going to go back and get a conference with the doctor at the pain clinic where the medial block procedures and ablation were performed.
Even though the ablation didn't provide the desired results, it did have some effect and this doctor did take time to show me what was going on and provide some insight as to how the procedures were designed and what might be expected. I'd like to talk with him and see if a 2nd try of the ablation procedure might be worthwhile. If not, I'd like to get his opinion as to why it might not have worked - when he was doing these procedures he was viewing my neck vertebrae and facets on a fluoroscope; perhaps he can describe the pathology specific to my neck.
I think going back is a great idea because he may be able to do a second one that could work. I've had that happen with various injections I've had. Sometimes it took three before it gave me relief.
Quote:
Originally Posted by Texas Ag 93
Yes, do that. Good luck. Try and get one opinion each from an orthopedic spine surgeon and a neurosurgical spine person. They both do spine fellowships, but their residency training and board certification is different, and they sometimes have slightly different opinions about how to do things. I would say see only a surgeon who specializes in spine, but really, that's an unnecessary suggestion. No surgeon will touch a spine (nor will most hospitals let them) unless they are fellowship trained in it.
I agree that the OP should get multiple opinions even though he knows his cervical spine is trashed. I'd want to see at least two ortho and neuro doctors to see if he gets doctors who agree with each other or how different their advice will be. I agree that the various doctors may have different opinions on what to do and what not to do.
Once he has surgery, he is committed to that for the rest of his life unless spine technology greatly changes in the next few years. I had one anesthesiologist who thought that stem cell treatment would have been available at least ten years ago to help people like me who had a failed lumbar fusion. I wish I knew what I do now back in 2001 but the net was very new. We didn't have all of the sites to connect with similar people like we do now. I surely would not jump into fusing my spine now like I did back then. My good friend is also upset she didn't do more research like I advised her to do. She's three years out of a lumbar fusion that also failed but she's 64. If I could redo my lumbar surgery, I would have spent approximately $10,000 to go to Germany to get the flexible fusion that they do there. They've been doing the flexible ADR for twenty years already. Wonder why the US is not as advanced with spines as Germany is.
Personally, I would want someone that does specialize in doing spine surgery, and even better if they do a lot of cervical spines because they will know the latest technology and have a better idea if the surgery will be successful for the OP.
Yes, do that. Good luck. Try and get one opinion each from an orthopedic spine surgeon and a neurosurgical spine person. They both do spine fellowships, but their residency training and board certification is different, and they sometimes have slightly different opinions about how to do things. I would say see only a surgeon who specializes in spine, but really, that's an unnecessary suggestion. No surgeon will touch a spine (nor will most hospitals let them) unless they are fellowship trained in it.
I've gone back to searching the internet for information about cervical spine spondylosis and treatments but from an orthopedic perspective as opposed to that of a neurologist. From what I'm reading, it sounds like an orthopedic doctor is the focus and control of a patient's treatment, therapies, and possible surgical intervention whereas the neurologist is a specialist who will diagnose a patient's spinal nerve problems, prescribe treatments or therapies and refer the patient onto other specialists.
In other words, the orthopedist follows the patient's treatments from beginning through to recovery while the neurologist is one specialist within a series of specialists who handle different aspects of the patient's care. I am guessing that patient-doctor communications with an orthopedist are perhaps more comprehensive than the compartmentalized considerations of a neurologist.
Any way, in re-reading the overviews and conditions of cervical spondylosis I come across descriptions of various levels of impairment that may be present. Just about all overviews say the a majority of people over 60 years of age will develop some form of the condition, one article says "The condition most often causes pain and stiffness in the neck—although many people with cervical spondylosis experience no noticeable symptoms". The more severe and debilitating forms of the disease result in mylopathy with symptoms such as gait instability, bladder dysfunction, fine finger motor difficulties, and worse.
So, within this range of affliction, I'm not experiencing anything like mylopathy but I do have neck and upper shoulder pain on the right side, probably due to some type of nerve compression between C4 thru C6. An MRI shows bone spurs (osteophytes) growing along the joint edges of the vertebrae but the spinal canal is open and not impinging on the spinal cord.
During my typical day, everything starts off well in the morning but as I become active, moving my head and turning my neck, my neck becomes sore, sometimes radiating to the upper shoulder and by mid day I usually have to lay down for an hour or so to take the weight off my neck. It appears that there are a lot of people who handle this level of pain with some program of periodic injections or nerve ablations and, perhaps the use of muscle relaxants and over-the-counter anti-inflammatory medications.
Do you know if orthopedic doctors administer injections or perform ablation procedures?
I've gone back to searching the internet for information about cervical spine spondylosis and treatments but from an orthopedic perspective as opposed to that of a neurologist. From what I'm reading, it sounds like an orthopedic doctor is the focus and control of a patient's treatment, therapies, and possible surgical intervention whereas the neurologist is a specialist who will diagnose a patient's spinal nerve problems, prescribe treatments or therapies and refer the patient onto other specialists.
Do you know if orthopedic doctors administer injections or perform ablation procedures?
I mean a neurosurgeon who does spine versus an orthopedic surgeon who does spine. They overlap quite a bit, but there are some generalizations, namely that an orthopedic surgeon has more and better experience with bony structures and hardware, implants etc and a neurosurgeon has more and better experience with microsurgical work and nerves. But again, maybe I'm painting with too broad a brush; a spine fellowship will adequately train either of them. Don't discount either one.
Neurology is it's own nonsurgical specialty as you know, but they do have their own take on things, so maybe not a bad idea to talk to one. Why not?
Everyone I've known who's had an epidural injection or RFA or anything of the sort has had it done by either an Interventional Radiologist or an Anesthesiologist who specializes in pain management. Those procedures are done under fluoroscopic guidance and have requirements about where they should be done and by whom. But other posters might have had those procedures done directly by surgeons.
I mean a neurosurgeon who does spine versus an orthopedic surgeon who does spine. They overlap quite a bit, but there are some generalizations, namely that an orthopedic surgeon has more and better experience with bony structures and hardware, implants etc and a neurosurgeon has more and better experience with microsurgical work and nerves. But again, maybe I'm painting with too broad a brush; a spine fellowship will adequately train either of them. Don't discount either one.
Neurology is it's own nonsurgical specialty as you know, but they do have their own take on things, so maybe not a bad idea to talk to one. Why not?
Everyone I've known who's had an epidural injection or RFA or anything of the sort has had it done by either an Interventional Radiologist or an Anesthesiologist who specializes in pain management. Those procedures are done under fluoroscopic guidance and have requirements about where they should be done and by whom. But other posters might have had those procedures done directly by surgeons.
Whoops - I was too quick in using the titles "orthopedic' and "neurologist" as opposed the the specific type of surgeon - I'll need to go back an re-read my sources. But it did seem that the spine neurosurgeons' involvement was more that of a specialist among several while the orthopedic spine surgeon seemed to head up a team of professionals. Perhaps I was reading too much into the difference.
Yes, the doctor who did the medial block injections and the RFA was also credited as a licensed anesthesiologist however, there was no specific title associated with his name. He practiced through a pain management clinic at a local hospital and was simply listed as an M.D. He did all the procedures while using a fluoroscope; even though the resolution of a fluoroscope is not as crisp and clear as other imagery, he is the one person who has seen the arrangement and condition of my neck vertebrae more than anyone else - that's kind of why I wanted to have a conference with him, get his impressions of the situation, and see if a repeat of the RFA was warranted.
Thanks for your insight on these things Texas Ag - I'm still stumbling through the online info and trying to get handle on things. Before I saw my GP in February I just thought I had a sprained neck but after some XRays and an MRI it's turned into all of this ...
Thanks for your insight on these things Texas Ag - I'm still stumbling through the online info and trying to get handle on things. Before I saw my GP in February I just thought I had a sprained neck but after some XRays and an MRI it's turned into all of this ...
Roselvr has good suggestions about finding spine specific health forums. In addition to the links provided, one I used when I was having issues is spine-health.com. They have forums on there. And I'm sure there's Reddit boards as well. Good luck.
Roselvr has good suggestions about finding spine specific health forums. In addition to the links provided, one I used when I was having issues is spine-health.com. They have forums on there. And I'm sure there's Reddit boards as well. Good luck.
Thanks. OP hasn't said a word about either replies, maybe he has me on ignore. I'm done.
I guess the OP missed where I said consult one of each doctor. They both fuse spines. Pretty sure that for my 1st surgery I had both an orthopedic and a neurosurgeon but for my 2nd it was only an orthopedic spine doctor because the field had done some changing.
Thanks. OP hasn't said a word about either replies, maybe he has me on ignore. I'm done.
I guess the OP missed where I said consult one of each doctor. They both fuse spines. Pretty sure that for my 1st surgery I had both an orthopedic and a neurosurgeon but for my 2nd it was only an orthopedic spine doctor because the field had done some changing.
Right ... 'sorry I didn't reply directly to you.
What I've decided for the moment is to go back and have a conference with the doctor who did the injections and ablation procedure. He did all this while using a fluoroscope; he is the one person who has seen the arrangement and condition of my neck vertebrae more than anyone else. I'd like to get his impressions of the situation, and see if a repeat of the RFA was warranted.
What I've decided for the moment is to go back and have a conference with the doctor who did the injections and ablation procedure. He did all this while using a fluoroscope; he is the one person who has seen the arrangement and condition of my neck vertebrae more than anyone else. I'd like to get his impressions of the situation, and see if a repeat of the RFA was warranted.
This could be potentially helpful. You're right, he sees a lot of people in your situation. When I went in for my first injection, the IR doc who did it walked into the room and said "you have a spine that looks a lot like mine" and then proceeded to tell me how he also had DDD in his lumbar spine, what his symptoms had been and why he had (at that point) decided to hold off on surgery. He was also the guy who read my spine MRI a few weeks earlier. Funny thing was the first person who actually saw my MRI was my husband. I had it done, the Tech burned it on to a CD and I took it home and immediately showed my husband, who despite having not looked at a spine MRI in probably like 10 years, flew threw all that B&W stuff on screen and found where my herniation was in under 30 seconds. When you look at MRI's all day, you know what to look for. He called my herniation "impressive", which I quickly realized meant "bad", LOL.
Hi y'all - in my last episode I mentioned that I decided to go back to the Pain Management clinic and see what the doc there might suggest. So, rather than a repeat radio frequency ablation (RFA) he recommended that we try cervical epidural steroid injections (CES).
I had the first CES back in mid-October and I have to say, the results were longer lasting than the ablation - about 10 days of noticeable pain relief (the ablation only worked for about 5 days) and the upper back pain pretty well diminished to where it is now only noticeable along the top of the right shoulder. I reported the results to the pain doctor and he had me come in for a second CES last week and generally, the pain seems to be pretty well controlled for now. My neck still gets pretty sore if I've slept with my head in the wrong position or if I do a lot of repetitive bending my neck and turning my head.
My question to anybody who has had these Cervical Epidural Steroid injections - is this a reliable way to manage the pain? Are there limits to how many - or how often - you can do these injections?
Thanx for any insight ...
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