Why can’t I be having back issues 5 years from now!

First up – ISTO – they will be competing with Mesoblast.

NuQu, a cell-based therapy derived from ISTO’s platform technology for cartilage regeneration, is intended as an early intervention treatment for patients suffering from low back pain by potentially repairing, regenerating and restoring function to the disc. In preclinical studies, the juvenile chondrocytes used in the NuQu program have shown to have far greater regenerative potential than adult cartilage cells in both in vitro and in vivo environments.

Next up is Cornell Univeristy engineering new invertebral discs.  Dr. Hartl is about 5 years away from a clinical application and this sounds VERY promising.  I’m guessing they will also have to sever the ALL in the installation mind you.  An ounce of prevention…

I’m going to inquire about the NUQU clinical trial.

-Brett

http://www.orl-inc.net/spine_publications/2007/State%20of%20Spinal%20Arthroplasty%202007.pdf

As of 2007, anyway! 🙂

All anterior approach ADR surgeries seem to sever the Anterior Longitudinal Ligament.  This will contribute to further spinal instability from what I have read.  More research is needed and I will definitely have to speak with my surgeon about it. 🙁

This fellow plays rugby union with an artificial cervical disk and this guy rides bmx for redbull with a lumbar ADR (l4-5 issues like me).

A follow up on Mike Day can be found here.

I’m still no closer to make a decision.

-Brett

I had a very informative and engaging appointment with Dr. McMorland (D.C.) at National Spine Care here in Calgary.  I was finally able to sit down with someone well versed in spine care and go through my MRI mm by mm to get some insight into my condition.  Besides Mr. Boeree/Dr. Clavel, Dr. McMorland has been the only person to offer me a glimmer of hope in returning to an active lifestyle.  We’re going to try some traction/manipulation to get some blood and nutrients flowing for the next 4-6 weeks.  He also asked to submit my assessment to some spinal neurosurgeons to get their take on my plight.  Again, surgery is my last resort, but he voiced concern over my leg weakness and numbness. 

Also, Mr. Boeree was bang on about my facets – very little hypertrophic changes.  My biggest issue back there are my short pedicles and the infamous bulge.  I have “chunky” facets, short pedicles and a big bulge… WTF!

If I notice no improvement over the next few weeks, I believe surgery in Europe will be my only recourse.  Even if the local guys agree to take a look at me, it will be a 12-18 month wait for surgery as it is not critical.  I can’t go another year like this, especially while its getting worse.

-Brett

It’s back to feeling funny/tingly/numb again.  Son of a…

Since dropping the NSAID’s my pain has hit a pretty constant 4 (while sitting and really spikes when I bend/twist/move.  Sitting is becoming increasingly a chore and I find I’m best in the morning when I lay on the couch all night after work.  I’ve gotten the feeling back in my right big toe, but I’ve got some new pains across my left ankle and my skin is getting kind of tender on the front/outside of my shins – VERY weird. The tingles/numbness are still in my left buttock and thigh off and on.  It is also very hard to lift anything without sharp pains in my lower back.

I’m not sure if this is related to the injury itself, or the lack of exercise, but I’m noticing my legs giving out at the knee a little more while I’m walking or standing.   It’s like when someone pushes on the back of your knee when you’re standing with weight on it.  My legs are feeling a little weaker, shaky and “off”.  I don’t know how to explain it.

It’s getting pretty tiring and depressing with the pain always being there.  I’m trying not to think about it, but it’s like that annoying little dog from the old kibbles n’ bits commercials.  I’m also finding it hard to concentrate at work.

I swam solid at least once a day for the past week… no change for me yet.

After a week in sunny So-Cal (tough life, I know), I went to my follow up physio appointment at Caleo.  We went through some new stretching and exercises… and I was informed that I’m a “neutral  patient”.  This means that I no longer do well with any bending and need to maintain a straight spine.  An ideal diagnosis for a goalie!! 🙁

The physio has given me 2-3 weeks to see if we notice any improvement – so I’ll plug through and see where I end up.

I also called the director of the facility and voiced my concerns over my diagnosis.  He said it was important for me to follow up with the triage doctor in a few months and to continue with physio.  When I indicated that I had already spoken with 3 European experts, he offered up the information that we have a fully private, state of the art facility in Vancouver.  I’m not sure if he was hinting that I should contact them sooner than later, but I decided to email them today.

http://www.csc-surgery.com/ (MRI’s in 1-2 days and surgeries can be booked from 2 weeks out – CRAZY)

http://www.specialistclinic.ca/ (their triage system)

It can’t hurt to get another opinion while I wait and do my physio.  I’ve also forwarded all of my scans off to Dr. Liuz Pimenta in Brazil.  Given the cacophony of opinions on my spine so far, I want to have at least a consensus of opinions from the most respected spine surgeons worldwide before I proceed with Mr. Boeree.

I’ve also began the process of getting some advice from the Texas Back Institute – they come very highly recommended online.  My health spending account is going to be DRAINED!

-Brett

It would have been nice to have been offered a glimmer of hope, a shot of cortisone or maybe a nice scotch and an engaging chat.  Instead, they gave me the “suck it up” talk.

The physio assessment by Marco was very thorough and he was very nice and listened well.  We re-established my issues with flexion and extension, twists, numbness, tingles and pain.  My leg raise tests increased back pain exponentially as expected (more right than left) and he remarked about my limited range of motion.  Marco then took a quick look at my MRI, noted the bulge and brought in Dr. Meerholz to go over my history and scans.  The doctor also noted the bulge, my symptoms and the hypertrophic(arhtritic) changes of my joints, the disc degeneration and all the the nerve root compression as a result.  Obviously a fan of conservative treatment, he told me to continue my limited exercise repertoire and that a fusion now would result in ~3 more surgeries over my lifetime to relieve the degeneration on adjacent levels.  According to him, you only operate when the leg pain/numbness/tingles exceeds the back pain.  Seems simple enough.   He said I’m destined to live with my current (and worsening) level of pain for the next 20 years, when they will likely pursue a 3 level fusion to turn my lower spine into a 2×4.   Suck it up, you wimp.  As such, I am not a candidate for any surgeries yet, but if the leg symptoms stay or progress, I will need something.   He didn’t indicate what kind of a procedure that would be.  When I asked him specifically about laminectomies and ADR, he replied:

1) Laminectomies will just create more tissue growth than before and make everything worse

2) ADR will not help any of the pain I’m feeling

Needless to say, I was hoping for something a little more helpful.  🙁

The exercise therapist John, was a very nice fellow and we went through my current treatment regimen.  He laughed out loud when I showed him everything I was doing, where I limit due to pain and my current core strengthening exercises.   He told me that I know my body very well and that I’m my own doctor already.  A very telling statement… I thought doctors were supposed to heal?  I’m just trying to maintain what little range of motion I still have.  I know if I told my boss to suck up and that he’d never get email again, I’d be fired.  We’ve cracked the atom, gave birth to the internet and landed on the moon – and we can’t fix one shitty little degenerated disc?!

I booked in for some physio with them anyway to see if they might help.  I’m not expecting much, but it can’t hurt if they can teach me something new.  For anyone interested in McKenzie back exercises, they are all really just yoga poses.  I guess that is the best I can hope for.

My net result:  Confused as hell.  I’ve got 3 surgeons in Europe telling me my only hope is ADR, one in the US telling me I need a laminectomy, and my Canadian triage spine specialist telling me I need to suck it up for 20 years until they 2×4 my spine.  Seriously, WTF.  I’m very comfortable with Mr. Boeree’s assessment, but is it only because I don’t want to give up hope on leading a semi-normal life again?  I’ll gladly fork out $30k for an operation if it will actually help me… but am I acting foolishly?  Is the arthritis REALLY causing all of my pain?   I thought I’d have a clearer outlook after Caleo, but I now have conflicting prognoses and no sense of direction.

I’m no closer to anything.

-Brett

Is a bust… I missed out because my stenosis is slightly greater than the 3mm cut off.  Ah well, it was a long shot from the start.  There will be a pivotal trial (phase III) later this year or next that I would probably meet the requirements for – but that means another year of pain for sure and maybe more if I’m stuck as a control.  It just might not be in the cards for me and I’m feeling pretty discouraged at the prospect of surgery.

I’m hoping there is something similar happening at Caleo with stem cells, but I’m guessing not.  I’ll know what they think this Friday.  It feels like its been an eternity waiting for this appointment!

ADR might be closer to reality than I previously thought.