Tuesday, April 23, 2013

A GOOD QUALITY MRI: FACT OR FICTION?

 

 



You can see how a patient is being positioned in a MRI Scanner.

 There is an alternative, an open MRI scanner for those patients who are claustrophobic.





I  do want to share with the readers who visit my orthopedic blog about the outcome of my L4-L5 posterolateral spinal fusion and hemi-laminectomy with autograft bone and pedicle rod instrumentation, L5-S1 decompression performed by an orthopedic surgeon at St. Jude Hospital in  December of  2010.  Soon after this spine surgery, I began experiencing  the worse sciatica pain  and muscle spasms you can ever imagine.  

I became suspicious that my surgeon failed in his attempts to perform a successful surgery and to alleviate my pain.  As months went by, I felt I didn't get honest answers or real help from the orthopedic surgeon.  In March 2013, I sought the medical advice form a noted neurologist in Orange County. I also had returned to pain management.

My pain level increased from a five to a nine on a pain scale.  I experience right numbness and tingling sensations every time I would ambulate a few blocks. During my office visit with the neurologist, she performed nerve function tests on me checking for both motor and sensory reflexes. She was concerned when there was absent reflexes found in my exam. I was told to go further and obtain a detailed imaging of my spinal cord, discs, ligaments and showing more in detail the soft tissue of my lumbar spine from T2 though the L5-S1 vertebral column. It was recommended that I undergo a T3

Tesla MRI to be done at specific radiology imaging center. Tesla (T) is the unit of measurement quantifying the strength of a magnetic field.  Prior to the 3 Tesla Machine, the high-field standard was 1.5 Tesla.  This scanner generates a magnetic field that is twice the strength of 1.5 Tesla machines and 10 to 15 times the strength of low field or open MRI scanners.  The magnetic field produced by the 3T Magnetom  MRI System  yields exceptional anatomic detail in both the lumbar and cervical regions of the spine.  

If a picture is worth a thousand words, the 3 Tesla MRI is an encyclopedia.  The increased image clarity revealed by 3T is particularly beneficial for such pathological conditions involving the brain, spine and musculoskeletal system.  This reconstructed scanner is advantageous over the other MRI machines. I believe it is worth researching which MRI diagnostic center who has the latest technology in its imaging machine to get a higher quality testing procedure performed.  Most insurance companies will allow for it and pay the same rate in its insurance reimbursement fees.  

Patients assume they are getting the same results from any MRI scanner but they are being mislead by their doctors. You need to insist on it.  On April 17, 2013, I was referred to the Newport Diagnostics Center in Newport Beach for their specific testing site. What is different is that they have a state of the art in magnetic imaging, known as the 3T Tesla Magnetic Resonance Imaging Machine. This scanner is considered to be the gold standard in the field of radiological imaging showing better quality and providing more diagnostic information in all areas of spine imaging.  The 3T Magnetom scanner machine has a more finer detail in 3D sagittal and coronal reconstructions in neurosurgery spinal imaging.

The physician ordering this test may not know about it or advise the patient and be sent somewhere else. Unfortunately, you may possibly obtain less satisfactory and quality in scanning results. It really makes a big difference in the quality of the radiological interpretation when it comes to preoperative surgical planning. 

 I am telling you  about the recent results of my Tesla  3T MRI report which unfortunately shows problems with my lumbar spine

*Multilevel spondylosis with degenerative central canal stenosis moderately pronounced at the L3-L4 lumbar level.

*Multilevel foraminal stenosis moederately marked at L5-S1 on the right.

*L4-L5 postsurgical changes

*L5-S1 anterolisthesis

*Mild scoliosis


Wednesday, October 17, 2012

MY ADVICE TO PATIENTS WHO ARE CONSIDERING SPINE SURGERY

If you are going to have major spine surgery, there are several factors you must consider before you visit any doctor's office. The first thing you should do is review the background and credentials of the treating surgeon. You can go look up the doctor licensing at the Medical State Licensing Board.  You should have a list of questions and be prepared to have the surgeon answer any and all questions regarding the exact details of the procedure. There are lots of spinal implants which have been recalled and they all come with a warning listed on the Food And Drug Administrations website.

They are classified as Type 1 or Type II pedicle screw implants. Make sure the surgeon explains to you all the risks and benefits of the surgical procedure including the alternatives to any surgical procedure. It would be helpful to receive a product  a product brochure, video or makes the information available to the public. Some surgeons will use  high pressure sales tactics or study models in their offices to induce patients into their marketing office schemes.  

You are allowed to ask for the name of the spinal manufacturer, the lot number, identification or the serial number of the implant. If your surgeon is evasive or does not fully give you his time and cooperation I would leave and go elsewhere.  Never rush into any elective surgery. You should get a second or third opinion if necessary when there is  major differences of opinion. On the day of surgery, make sure the surgical staff has fully checked and marked the location where your operation is to be performed. There have been many cases where there has been foreign objects left into the patients,  or spine operations performed on the wrong side or level or postoperative complications  have occurred such as infection or breakage of pedicle screws.

Wednesday, October 10, 2012

SPINAL IMPLANT ALLERGIC REACTION OR REJECTION?


There are is an explanation as to why the body rejects and does not accept a metal implant. The body has its own way of making an adjustment and building up its own defense barrier.  Immune cells have their own specialized circulatory system known as the lymphatic system.  Lymphatic fluid bathes the body as it transports white blood cells to areas of infection, injury or abnormal cell growth. These immune system cells are located in the lymph nodes throughout the body, as in the thymus, bone marrow and in the spleen which manufactures leukocytes or (white blood cells) in response to any foreign invaders when they are detected in the body.

The purpose of the immune system is a "force field" that protects the body against foreign invaders such as pathogens, fungi, bacteria and viruses.  The immune system fights on our behalf day in and day out.  Antigens are anything that is foreign or "non-self" which will turn or attack the body when a foreign substance is being detected in our immune system.  Antigens have specific proteins and cell surface molecules become tags that the immune system cells recognize and attack.  When a Y shape protein are released from plasma cells into the blood they are known as Antibodies.  Although there are many types of antibodies, their job is to help kill the foreign substances which signals the body to activate the natural killer cells both of which kill the antigenic invader. Natural killer cells destroy antigens by releasing cytokines proteins directly into these unhealthy cells such as cancer or other autoimmune diseases.

Allergies occur when the immune system overreacts to any environmental allergen.  When there is the recognition of an antigen, this allergic response can occur when the body's immune response goes into overdrive when it tries to rid itself of a foreign invader  These antibodies continue to exist in a person's body, so that if the same antigen is presented to the immune system again, these antibodies already present are ready to do their job. immunization thus introduces the body to an antigen in a way that doesn't make someone sick, but does allow the body to produce antibodies that will then protect the person from future attack by the germ or substance that produces that particular disease.

In the case of a metal implant exposure, the body does not recognize the foreign body and during the time these antibodies are building up their defense system, they mount an attack on the human body with a systemic reaction serious enough to cause permanent illness, infection and pain. Immune response to implants can include hypersensitivity not limited to pacemakers, dental implants, and other types orthopedic hardware. 

Below you can view the photographs I had taken of my dermatological flare-ups of my body and extremities occurring soon after my lumbar spinal implant.  Three months after my spinal fusion, I began to notice these annoying symptoms of unusual neurological symptoms such as dizzy spells, insomnia, burning sensations of  body pain, outbreak of skin irritations, discoloration, rashes, with increased bone tenderness and constant fatigue.







In May 2011, I sought the advice of a rheumatologist for evaluation and treatment of this unusual medical problem. The doctor's impression was that I had fibromyalgia yet she didn't know what was the underlying cause. For nineteen months, I had to live with bizarre, ongoing and daily symptoms with no relief of pain. 

My blood markers were analyzed  for other immune diseases such as lupus, rheumatoid arthritis, and myositis. My symptoms worsened over time which profoundly affected my functioning in every area of my activities of daily living.  I was desperate to get answers from my orthopedic surgeon and other medical specialists I consulted however, there were none.

If you suspect a pedicle screw allergy, you should document them in a log of physical symptoms  if you experience any of these symptoms such as the inability to sleep, neurological imbalance, sudden hearing loss, migraines or unexplained pain, weakness (feels like all of your energy is drained from your body), depth perception off (spilling drinks or dropping things), back or neck pain, or worsening depression for no obvious reason. I took months of photographs to document the timeline of the various changes in  my skin pigmentation, and flare-ups.

I was told by doctors there was correlation to the metal implant in my body which I thought was causing these types of these immunity and dermatological problems but that it could be removed to eliminate it as a possibility. I have spent hours researching the internet thoroughly for answers to my condition however, I came to conclusion there no agreement and more conflicting information. It is rare but people can react very badly to metal implants. 

Device failure was also reported  in surgical  cases stating metal debris is released by the grinding of artificial metal hips, and causes local tissue death around the joint and may increase metal cobalt and chromium ions in the bloodstream. Since small metal particles were flaking off and getting into local surrounding tissues, causing pain and increased inflammation

A website called the Melisa Medica Foundation is a laboratory which specifically analyzes the body's chemistry lymphocyte hypersensitivity to titanium and other alloy metals. Their laboratory testing method can detect more accurately allergy antibody blood markers looking at  metal panels better than any skin patch testing that is available.  

There are different grades of implant metal alloys commonly used in surgical procedures both in the medical and dental industry. To be safe, and not sorry later, one should insist on allergy testing prior to any proposed surgery. The most common materials used in pedicle screws and rods are stainless steel, titanium, aluminum and vanadium.  However, there are other types of metal materials found in implants which vary in the industry. These alloys may react in at least 4% of the population as I stated may cause havoc with the body's immune system and cause it to eventually break down. 

A person with unknown hypersensitivity will have an increased response to an implanted surgical device. If not removed, later on it could lead to more serious autoimmune disorders such as fibromyalgia, multiple chemical sensitivities, sinusitis, neuralgia , or infection.  I also have read instances where certain persons who have had orthopedic screws implanted  in their cervical or lumbar spine have experienced dizzy spells, brain fog, or unusual chemical metallic tastes.

Every case is different and you should make your doctor aware of your condition to eliminate or avoid exposure to a metal implant.  You may refer to the above links I have posted on this blog to find out specific testing procedures as well as further discussions on the causes regarding implant reactions.  

IMAGE OF A SPINE PEDICLE SCREW DEVICE

 Lumbar Spine Pedicle Screw Fixation Fusion 3D Animations:

Internal fixation is a surgical procedure in which to restore the structural integrity of the lumbar vertebrae. To help the patient in early mobilization and curvature correction in the lumbar spine. Implant metallic devices consists of hooks, screws, rods or plates to span the area between healthy bone. During a bone graft, fragments of bone are placed in the space between two bones. If the space is rigidly kept in place, these bone fragments will correctly fuse together and to the adjacent bone to form one solid, stable, pain-free piece of bone. If any excess movement occurs between the adjacent bones before these bone fragments have fused, the bone graft can become displaced. This can risk causing pain, injury to the adjacent tissues, mal-alignment (of bones) or non-fusion of the bone (pseudoarthrosis) and further weakening of the pedicle screws if left inside.  

The pedicle screw is used as a support to aide in the healing of the spine fusion and a means of gripping a spinal segment. The screws, themselves do not fixate the spinal segment rather they act as firm anchor points to be connected to a crosslink with one or more rods for insertion and adjustment in their placement. Pedicle screws can be inserted into three or more lumbar segments.  

Pedicle screws come in different diameters and lengths made from metal alloys such as titanium or stainless steel. Please see updated warnings or recalls from the FDA as many are fast tracked in their design and application.  In a posterior lumbar spine operation, the surgeon places the hardware in the back through the hole of a cylinder-shaped pedicle into the vertebral body. 

Medical manufacturers are now color coding in differentiation of their orthopedic devices. The surface of these titanium screws are coated for the visual identification of their components during the surgical process in installation of these pedicle screw systems.

Aluminum and titanium metals are anodized to increase corrosion resistance. Sensitivity to these color coated substances have not been addressed by the medical community. How these materials may react to the skin, organs and other tissues may pose inherent dangers to the human body's immune system thus leading to implant failure and chronic allergies.  You can see in the photograph below, the violet anodized color of a hip bone device. In the second illustration, blue and yellow titanium color coated screws are used in this latest technology.











MY ORTHOPEDIC MEDICAL CONDITION


At age 50, in my lumbar spine, I developed severe  L4-L5 facet degeneration and impingement which resulted from degenerative osteoarthritis of the joints and breakdown of cartilage along with spinal stenosis at the L5-S1 lumbar level. This condition is extremely disabling with difficulty in walking causing numbness, neurological deficits and weakness down the legs.

In December of 2010, I underwent a spine operation involving a L4-L5 posterolateral fusion, L5-S1 bilateral lateral recess and foraminal decompression,  a hemi-laminectomy to open up the inner shell of the lumbar spine. The surgeon used morcelized, local auto graft bone graft transplanted into the laminar defect. Bone graft material is usually taken from the hip or harvested from a cadaver bone bank and packed along the lateral gutters on both sides of the lumbar sacral areas.  In order to gain access to the spine, surgeons can use either an posterior or anterior approach during the operation.

To add stability and success in fusion, pedicle screws, a crosslink and rod instrumentation are inserted for added stability, correction and balance.  The x-ray images below indicate the placement of where my titanium pedicle screws as they were being implanted into my lower lumbar spine at the time of my operation on 12/22/10:








Tuesday, October 9, 2012

A Good You Tube Video

Here is an excellent illustration of how a pedicle screw fixation system is inserted into the lumbar spine as demonstrated on YouTube:

http://www.youtube.com/watch?v=VR8ggyfk1xk&feature=player_embedded#!












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