Tuesday, April 23, 2013

A GOOD QUALITY MRI: FACT OR FICTION?

 

 



This photo demonstrates on 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 wish to share with the readers who have visited my orthopedic blog regarding the outcome of my decompression and fusion.  A L4-L5 posterolateral spinal fusion and hemi-laminectomy, my own autograft bone with pedicle screws and rod instrumentation, a L5-S1 decompression was performed by an orthopedic surgeon at St. Jude Hospital, in December of  2010.  Immediately after this spine surgery, I began experiencing the worse sciatica pain  and muscle spasms you could ever imagine.  

I had become suspicious that my surgeon failed in his attempts to perform a successful spine surgery to alleviate my pain.  As months went by, I felt that I didn't get honest answers or real help from the orthopedic surgeon.  I sought the medical advice from several other orthopedic surgeons, neurologists, rheumatologists, and an internal medicine specialist in Orange County. I had no options left except to return to pain management.

My pain level had increased from a five to a nine on a pain scale.  I experienced 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 a well known 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 unique 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, then the 3 Tesla MRI is an encyclopedia.  This 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 at their specific testing site. What is sets them apart from other centers 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 a gold standard in the field of radiological imaging showing better quality in scanning for abnormalities and providing concise 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 both orthopedic and neurosurgery spinal imaging.

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

 I am revealing the recent results of my Tesla  3T MRI report which unfortunately shows adjacent lumbar segment disease.

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

*Multilevel foraminal stenosis moderately 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 any major spine surgery, there are several factors that you must consider before you visit any doctor's office. The first thing you must do is to do a background  check and review the credentials of the treating surgeon. You can go look up the surgeon's 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 numerous spinal implants which have been recalled which come with a warning label listed on the Food And Drug Administrations website at  www.fda.gov


Metal hardware is classified as Type 1 or Type 2 pedicle screw implants. Make sure that the surgeon explains to you all the risks and benefits of the surgical procedure proposed including the alternatives to any surgical procedure. It is imperative to read all preoperative materials, and to request any articles or journal abstracts were recently published by the surgeon.  There are published websites such as vitals.com or heathgrades.com which gives their specialization and the ratings of doctors, if they are board certified and the public opinion on the physician. Beware of surgeons who use high pressure sales tactics, does not accurately diagnose and comes up with a quick treatment plan or just uses a study models in their offices to induce patients into their marketing office schemes.  

You are allowed to request from the surgeon's office in writing: the name of the spinal manufacturer, the lot number, the identification, and the serial number of the implant. If your surgeon acts evasive and he or she does not fully give you his professional time and cooperation, I would leave and go find someone else.  Never rush into any elective spine surgery. You should try to get at least a second or third opinion when there is major differences of opinion. On the day of surgery, make sure the surgical staff has fully checked and marked the location specifically where your operation is to be performed. There have been cases where there has been foreign objects left into the patients, whereby spine operations have gone bad because they were performed on the wrong side level or postoperative complications have occurred such as infection, the breakage or dislodgement of pedicle screws.

Wednesday, October 10, 2012

SPINAL IMPLANT ALLERGIC REACTION OR REJECTION?


There is a valid explanation as to why the human body rejects itself and does not accept a metal implant. The body has its own way of making an adjustment and is building up its own defense barrier. Immune cells do 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 signs of infection, injury or abnormal cell growth. These immune system cells are located in the lymph nodes throughout the body, known as 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" which protects the body against foreign invaders such as pathogens, fungi, bacteria and other 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 do have specific proteins and cell surface molecules become tags that the immune system cells recognize and attack.  When a Y shape protein is released from the plasma cells into the blood, they are known as antibodies. It is the antibodies job is to help kill or destroy the foreign substances by signaling the body to activate these 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 nevertheless occur when the immune system overreacts to any suspect environmental allergen.  When there is recognition of an antigen, the 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 that are 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 which will then protect the person from future attack by the germ or substance which produces this particular disease.

In the case of a metal implant exposure in a human being,  he or she does not recognize the foreign body as part of oneself. During this time of exposure, these antibodies are building up their defense system, and continue to mount an attack on the human body with a systemic reaction like a vengeance that is serious enough to cause permanent illness, infection and chronic pain. Immune response to implants can include hypersensitivity not limited to pacemakers, dental implants, and other types hip and knee orthopedic hardware. 

You can see a below a documentated time frame of photographs that I had taken over a year of my dermatological flare-ups of my body and extremities occurring after my operation. Soon after my implantation and lumbar 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 throughout my entire body.









 
In May 2011, I consulted a rheumatologist for further evaluation and treatment of this unusual medical problem. What facts and information that I received stunned me altogether. Not only was
the doctor not aware on what was really going on inside of me, she was under the impression that all I had fibromyalgia. the underlying cause.  I had sought another opinion with a dermatologist who dismissed my medical concerns altogether.  Never thought of ordering additional tests such performing metal patch testing or a muscle biopsy to check for myositis. For nineteen months, I had to endure constant agony, bizzare and debilitating symptoms which I knew deep down inside was destroying my life and no physicians who I could turn to to provide me hope or a chance for recovery.  

My blood markers were analyzed for other immune diseases such as lupus, Sjogrens syndrome, and rheumatoid arthritis. My ANA titer had skyrocketed.  Deep down inside, I instinctively knew that something was terribly wrong with me. My medical symptoms had worsened over time which profoundly affected my functioning in every area of my daily living.  I was in excruciating pain and in emotional distress. I felt exhausted, fatigued and desperate to get answers from my orthopedic surgeon and other medical specialists whom I consulted for further diagnosis and treatment however, I met with lack of concern or their resignment.
 
Where do you begin if you have a similar dilemma to face in your medical problems. If you do suspect a pedicle screw allergy, you should document them in a log if you experience any of these symptoms such as the inability to sleep, having a strange metallic taste in your mouth, any signs of a 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), increased back or neck pain with tenderness, or worsening depression for no obvious reason. Look for various and obvious changes in skin color, pigmentation, and intermittent flare-ups.
 
I was told by numerous doctors that they couldn't find anything wrong with me. However, I felt there was correlation to the metal implant in my body and other chemical changes that were going on inside my body which were causing these types of these immunity and dermatological problems. The only way to know for sure to find out if the metal implant is the source of the irritant is to have the implant entirely removed to eliminate it as a possibility. I had spent hours researching the internet thoroughly for answers to my condition however, I came to conclusion  that there no concise agreement amongst medical professionals and more conflicting information. It is rare but at least ten to fifteen percent of the human population can react very badly to metal implants. 
 
Device implant failure has been reported in surgical orthopedic and neurological or cardiac cases stating that metal debris is released by the grinding of artificial metal hips, which causes local tissue death around the joint and may increase metal cobalt and chromium ions in the bloodstream. Studies have reported there were small metal particles were flaking off and getting into local surrounding tissues, causing pain and increased inflammation in other joints and spinous processes.
 
 A website known as the Melisa Medica Foundation, is a laboratory with testing procedures that specifically determines a patient's susceptibility to specific types of metal. Their testing panels methodically analyzes the body's chemistry lymphocyte hypersensitivity to titanium and other alloy metals. Their laboratory testing method can detect more accurately other allergy antibody blood markers looking at  metal panels better than any skin patch testing which is currently available.  Note: There can be false positive results in testing that will not show any signs of a metal reaction.
 
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, anyone under a doctor's care should insist on allergy testing prior to any proposed surgery. The most common metal compositions used in the manufacture of pedicle screws, hooks and rods are stainless steel, titanium, aluminum and vanadium.  However, other types of materials found in implants will vary from metal to metal implant in the industry. These alloys may react in at least 4% of the population as I stated which may cause havoc with the body's immune system and then cause it to eventually break down and destroy itself. 
 
A person with an unknown hypersensitivity will surely 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, loosening or a bone infection. 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 and bone tenderness.
 
Every individual is different.  Therefore, you should make an effort to make sure your doctor is aware of your own medical condition to eliminate or avoid future exposure to a metal implant prior a fusion.  You may refer to the above links which I have posted on this blog to find out specific testing procedures as well as further discussions on these specific causes.  

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 a spinal fusion, pedicle screws, a crosslink and rod instrumentation are inserted in the posterior cervical or lumbar spine for added stability, to maintain correction and balance. The x-ray images below show the placement of where my titanium pedicle screws were 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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