Aftermath of an Elevator Accident, Looking for Help!

[FreeFallin]

Hello Everyone,

This is the first blog posting I have ever done and my story is not an easy one to tell, but judging by what I have read on this site, most of you can understand and relate to some of the things I have been through and suffer through everyday; better than anyone else ever could. I want to introduce myself and tell my short version of a long story that explains how someone so young, active and healthy; having no history of any back pain could come to be in constant pain and have damage throughout their spine. My questions and recent MRI results are below if you would like to skip to that section, I could really use all the help I can get.

Elevator Accident
Several years ago I was working on the third floor of an office building at my first job out of college. It was evening and most people had gone home when I took the elevator from the third floor down to the lobby. I had my back against the side wall and I remember feeling wedged between that and the large Rubbermaid cart I had in front of me. Seconds after the doors closed and the elevator started to descend, I felt my stomach drop, like the elevator was in a free fall. I remember looking over at the buttons and thinking that if this didn’t stop soon, I would be facing serious injury or maybe even death. Then I remember the feeling of a tremendous force through my body as if the elevator slammed into the ground or maybe some kind of gear brake kicked in and stopped me on a dime. The next thing I remember is pounding on the elevator door, yelling for help; focused only on getting out and not knowing if I was suspended in air or at the bottom of the elevator shaft. I was soon able to pry the doors open from the inside and get up onto the first floor level all while the elevator doors were trying to force themselves closed on me. It appeared that the elevator had come to rest 2-3 feet below the first floor and I’m pretty sure I was in a state of shock.

Minutes later I felt pain in my spine for the first time in my life at age 26. Before this accident I thought about my spine about as much as I think about my elbow or maybe my ribs or spleen. The pain was in my upper and lower spine but it was nothing I couldn’t handle so I drove home and went to the Work Comp doctor in the morning (my small company was forced to drop our health insurance 2 months prior). Days later my neck started hurting very badly. I remember that at first it felt like I was being stung by a bee and soon nerve pain was raging through both legs and most of my neck and back. I could feel the pain spreading and growing stronger, it felt like my spine and legs were being crushed and stabbed and it has every day and every minute ever since. For well over a year the Work Comp doctors downplayed my injuries and tried to get rid of me, it was awful to say the least.

After putting Work Comp behind me I went to the Cleveland Clinic and saw some other surgeons who said I needed a multi-level fusion in my neck and a single fusion in my lower spine. Each one of them remarked on my age and the fact that more surgeries would likely follow every 10 years or so. Before this, I had only heard the word surgery and really didn’t know what that entailed; but I was very disappointed upon finding this out and I could picture myself almost completely fused by age 50.

The Laser Spine Institute
My desire for better technology brought me to the Laser Spine Institute in 2009 and though only partially successful as a whole, they reduced the pain in my neck and increased my range of motion. This made it safer to drive and bought me time because without it I most likely would have had my neck fused by now.

Radio Frequency Ablations
Soon my research brought me to Radio Frequency Ablations and I wondered to myself, out of the 20 or so doctors I had seen; why had I not been introduced to this procedure before? Considering every MRI has shown my facet joints are clearly damaged. The RFA’s have been very effective in controlling the facet joint pain which stabbed with an unimaginable intensity and made it difficult to walk or stand for long without wanting to curl into a ball. They last an average of 3-6 months and must be repeated in 4 areas throughout my thoracic and lumbar spine; but the severe, raw, crushing nerve pain remains. It constantly rages deep in my back, neck and legs. Moving too quickly or even a mis step could send my pain off the charts. Coughing, sneezing or yelling without bracing myself will intensify my neck pain and shoot down my arms like a bolt of lightning into my fingers.

ADR Surgery Denied by BCBS
Recently I went to a surgeon who I liked but he said he could only do a single level disc replacement and that one disc in my neck was worse than the rest so we scheduled surgery to replace c6-c7 I think it was. A week before the surgery the doc’s office called and told me Blue Cross Blue Shield denied the surgery and I could not appeal because “There is nothing to appeal”. The doctor’s office has been unresponsive and I am still working to get answers as to why this happen.

Discogram Debacle
This same doctor sent me for a Discogram and though he knew L5-S1 had responded well to steroid injections and most likely the cause of my leg pain, he only prescribed L1-L4 and weeks later when I asked him why he said there is no ADR for L5-S1. I was angry that this disc was not tested along with the others during that long, painful procedure but at the same time this was the first surgeon to actually listen to me and cared enough to dig deeper into the cause of my severe and constant pain.

The doctor performing the Discogram saw I was angry they excluded L5-S1 so he assured me he could reproduce my leg pain from the L4-L5 disc as they were wheeling me into the procedure room. During this torturous procedure one disc hurt far worse and I yelled “that’s my normal pain!” just as he had instructed me to do. He seemed frustrated when he shouted back over my cries of pain “You have to tell me if that is your normal leg pain!” I said “it’s normal but not into my legs.” Apparently he misunderstood me or just didn’t hear me over the cries of pain because months later, when I saw the Discogram report, it acknowledges I felt severe pain in L1-L2 and that disc is probably torn but he goes on to say that I did not identify that as my “normal” pain. That explained to me why the surgeon dismissed the report and could do nothing to help my low spine. The pain in that area is severe and feels like my spine is being ripped apart over and over and the pain feels like it extends into both kidneys. I am done dealing with these guys, I need outside help!


I have watched helplessly over the years, as I struggled to hold my life together and it slowly fell apart. First, my dreams and ambitions; then my wife and girlfriend of 13 years after scabs formed all over her body. She knew she could do nothing to make it better and could no longer handle the stress. Finally, my job, and they had put up with me far longer than most companies would. I owe whatever life I have left to the support of my family and the powerful pain medications that enable me to exist and slowly move around while my body is screaming in pain and agony.

I am ready to go to California or overseas to England or Germany, wherever I need to go to get the most experienced care and best technology. I know some of you have made the journey overseas and others may have had the ADR procedure here in the states; I understand that most of you are not medical professionals but I value your suggestions and feedback based on your past experiences and familiarity with some of the injuries and issues I have had to face.

My sincere thanks, to any and all of you who take the time to read and respond to my story. My hope is that I too can help people after I get better and maybe even along the way. I know many answers can be found by reading through the pages of this blog so please respond to which ever question(s) you like.

1. Overseas vs. USA for multi level disc replacement?

2. Most recommended facilities or doctors here in the states or overseas?

3. Different financing options you may have discovered?

4. Will damaged facet joints prevent me from having ADR surgery?

5. Other options I can look into?

6. Advice/Guidance?

I have pasted last 2 MRIs, Discogram, CT Scan, EMG below.
Freefallin

C 3-4
MRI 2010 Disc bulge flattens the thecal sac. There is bilateral Uncovertable joint hypertrophy. Bilateral uncovertebral joint hypertrophy causing moderate neural foramen stenosis, greater on left than rt.
CT 2010 DDD most severely affected. Uncal Vertebral Degenerative Joint Disease

C 4-5
MRI 2010 Disc bulge and slightly paracentral right disc protrusion impinging on the ventral spinal cord. Bilateral uncovertable joint and mild facet hypertrophy contributes to mild neural foraminal stenosis, greater on right.
MRI 2011 Protrusion has calcified and still indents thecal sac but a little less prominent and does not indent the cord centrally the way it did on the prior examination. It now appears to be calcified or spondylitic overtime. Minimal nerve root foraminal narrowing.
CT 2010 DDD most severely affected. Right Sided Apophyseal Degenerative Joint Disease. Uncal Vertebral Degenerative Joint Disease

C 5-6
MRI 2010 Degenerative Endplate Changes greater than would be expected for the patient age. Disc bulge asymmetric to the rt. Vs. bulge and broad-based paracentral to lateral rt. Protrusion. Flattening of the ventral spinal cord asymmetric to the rt. Facet and uncovertebral joint hypertrophy greater on the rt.
MRI 2011 Disc bulge is now calcified and the amount of compression on the ventral surface of the spinal cord on the right is stable. Severe narrowing of the right nerve root foramen by a Luschka joint component is stable.
EMG 2007 Bilateral C5-C6 chronic radiculopathy, show by Electro diagnostic studies
CT 2010 DDD most severely affected. Right Sided Apophyseal Degenerative Joint Disease. uncal Vertebral Degenerative Joint Disease.Moderate-Severe, Rt. Sided neural frontal narrowing from hypertrophic bony change. Mild disc bulge and bony spurring

C 6-7
MRI 2010 Disc bulge and ligamentum flavum hypertrophy contributing to Moderate/Severe bilateral neural foraminal stenosis in the distribution of the C7 nerve roots.
MRI 2011 This is the most severe stenosis in the spinal canal, more severe than it was on the prior examination. Sagittal diameter of the spinal canal in the midline was 8.6mm and is now no more than 7.0mm The diffuse spondylitic bulge compressing the cord diffusely is more calcified than it was previously an now has a greater degree of narrowing of both nerve root foramina.
CT 2010 Relatively advanced degenerative changes present in multiple joints, especially for the patient's young age. DDD

T 9-10
MRI 2010 Disc desiccation, minimal bulge and small paracentral right protrusion indenting the thecal sac, may touch ventral spinal cord w/o deformity.
MRI 2011 Disc extrusion indenting the thecal sac is larger than before. Bright focal high intensity zone in the posterior margin of the disc represents subligamentous annular fissure or tear.

T 10-11
MRI 2010 Facet hypertrophy

T 11-12
MRI 2010 Degenerative endplate changes. Bulging disc and desiccation. Facet hypertrophy causing mild canal and left foraminal stenosis. Schmorl’s node on superior articular surface is stable.
Loss of vertebral body height anteriorly at T-12 which may represent a remote, benign compression fracture or degenerative type compression deformity.

L1-L2
MRI 2010 Small paracentral right disc protrusion resulting in right lateral recess stenosis. Possible right L2 nerve root impingement. Mild canal stenosis
MRI 2011 Small disc bulge. No stenosis
Discogram 2011 Annular Tear along the posterior aspect of the disc annulus. Degenerative Disease.

L4-L5
MRI 2011 Bilateral facet hypertrophy.

L5-S1
MRI 2010 Bulging Disc and rt. Greater than left facet hypertrophy contributing to moderate right and moderate to severe left neural foraminal stenosis, possible L5 nerve root impingement.
MRI 2011 Persistent disc bulge touching the thecal sac and narrowing the neural foramina. L5 nerve root impingement cannot be excluded.
Right greater than left facet hypertrophy contributes to moderate to severe right and moderate left neural foramen stenosis, stable on the left and increased on the right compared to previous exam.

[Harrison]

Hey FreeFalling, welcome, sorry you are here. After reading your story, I understand your screen name! Wow, what an unfortunate event. Regarding one of your questions: damaged facets are a contraindication for artificial disc replacement. When you get a chance, search our community with related terms, like "facet hypertrophy." You'll find many past discussions related to this. Also see this topic:

http://www.adrsupport.org/forums/f51...ications-9620/

[JEVE19]

Best money ever spent...talking with Dr Boeree!
He was my 7th doctor and my last!
The most honest man and doctor I have ever met.
He is about fixing you, not milking you.
If he can help, he will.
If he can't, he'll tell you.
Send your info, xrays, mri's, using google docs or Dropbox.
Best thing I ever did!

[jss]

Freefallin, what a terrible story! I'm sorry that you've had to endure all of that; especially starting it at such an early age. Welcome.

Originally Posted by FreeFallin

1. Overseas vs. USA for multi level disc replacement?

2. Most recommended facilities or doctors here in the states or overseas?

3. Different financing options you may have discovered?

4. Will damaged facet joints prevent me from having ADR surgery?

5. Other options I can look into?

6. Advice/Guidance?

1. This depends on what you can afford. There are many multi-level experienced surgeons in the US. But it looks like you'll be paying out of pocket. The cost is typically, though not necessarily, much lower overseas. The Europeans tend to be more experienced with multi-level.

2. From my experience and research, my favorite doctors are (no particular order)

• Jack Zigler of the Texas Back Institute in Plano, TX
• Pablo Clavel of the Barcelona Spine Center, Barcelona, Spain
• Nick Boeree, Hampshire, England
• Luiz Pimenta, Sao Paulo, Brazil

3. Dr Boeree is the only surgeon I've seen talk of providing a financing option.

4. Damaged facet joints is a very strong contraindication for ADR surgery. However, some surgeons will implant some devices with moderate facet degeneration. On this note... Some of the German surgeons have a reputation of being willing to operate on anyone. I would encourage you to do a lot of research and to be very sure before going ahead with an ADR surgery against a contraindication. A failed ADR surgery often leaves the patient in far worse condition that no treatment at all; and said surgery usually cannot be undone.

5. Other options... It looks like you've already covered more options than I knew existed. I don't know if it would be applicable to you, and I don't believe that its effectiveness is very consistent, but there is a stem cell therapy available in Europe that has helped some people. (with that I've exhausted everything I know about that treatment)

6. It sounds like there is some question as to exactly what level is generating your pain. I would encourage you to have that conclusively proven before undergoing any ADR or fusion surgery. In your shoes I would probably start with an examination and evaluation by Dr Zigler in Plano, TX. Aside from being only a few miles from my house, he is thorough, conservative, caring, a world class spine research surgeon, and given his huge volume of experience, there is precious little negative said about him on any forum.

Good luck, Jeff

[brackie]

Freefallin - sorry to hear about your situation. Dr. Zigler at the Texas Back Institute is actually having a seminar on artificial disc replacement on April 5th. Texas Back Institute : Community Seminar on New Treatment Options for Neck Pain and Back Pain Dallas, TX use this link to find out more details. Hope this helps!