I begged him to order a Thoracic spine MRI 2018 - 09 - 14 as my midback pain was increasing. Dr. John Koch (Spine pain management) of Prevea Clinic Green Bay, WI did not even recognize an arachnoid web of the spine when the MRI was right in front of his face! He even sat with me after I asked to see the MRI on screen in his office. He never mentioned any arachnoid web as we sat there looking at the MRI pictures.
Below is my message to him to take another look at the Thoracic MRI as I was also concerned about some bridging of vertqabreas at T4. This gave him a second chance to see the scalpel sign of the thoracic arachnoid web! Do you think he would have went back to have a radiologist look at it? NO! I did not know what a arachnoid web was suppose to look like but I did know what bridging looked like!
Message
From: Terry
Sent: 9/13/2018 4:18 PM CDT
To: Dr. J Koch
Subject: Follow Up/Update
Dr. Koch,
Thanks for the response on the bridging syndesmophyte issue on T4-T5. I went back to look at another old 2008 CT of the abdomen. T4 -T5 were already bridged on the anterior side. It measured 1/2 cm wide 10 years ago. It is now 1cm wide on axial view.
I also looked at T8-T9 which has an anterior osteophyte trying to get to T8 from T9.
I also notice the MRI of my thoracic spine was oblique and not an adjustable scout line as is normal for spine MRIs. Do you know why that was not done?
I have not had a CT that shows anything above T4. As this is part of my DX from Mayo of Seronegative SA should I know whether there is more Bridging above T4?
Obviously when I get back compression from a hard mattress it is like a knife in my back. It is no wonder PT could not move those vertabrae.
Response from Dr. Koch:
RE: Follow Up/Update
To:
From:
Dr. J Koch
Received:
9/14/2018 10:33 AM CDT
Terry, Thanks for the update.
I took another look at your imaging. I looked at your thoracic MRI images from August 2018 and the thoracic x-ray images from July 2018. I do not see any significant additional upper thoracic bridging from these images. Even if there was a small amount of bridging present at the upper thoracic spine, it likely would not change the treatment plan. I would not recommend any surgery for this, and injections are ineffective for this condition.
Regarding the technical aspects of the thoracic MRI, I am satisfied with the way the thoracic MRI was performed. There was a good comprehensive scout image on the MRI extending all the way up the cervical spine and thoracic spine giving us good visualization. I was able to adjust the markers adequately when I reviewed the images.
Hope the back pain is being controlled. We can reevaluate again in the future as needed. Take care,
John Koch, MD
AUG 5, 2012
JOHN M KOCH, im 8/5/2012 5:34 PM Signed
Procedure: Left L5/Sl transforaminal epidural steroid injection under fluoroscopy.
Indications: Radiculopathy
The risks, alternatives, and complications including infection, bleeding, no pain relief, increase in pain, nerve injury, and allergic reaction were fully explained and the patient wished to proceed.
PROCEDURE: After consent was obtained, the patient was brought to the fluoroscopic suite. The patient was placed in the prone position and the back was prepped by sterile procedure with Hibiclens, friction, sterile draping, and alcohol prep pad x 2. An IV was placed and patient given 1 mg of Versed for light sedation. The patient was monitored during the procedure with cardiac, blood pressure, and oxygen saturation monitoring. Subcutaneous and muscle tissue was anesthetized with 1% Lidocaine. A 6—inch 20 gauge stimulating needle was then guided under fluoroscopy to the trans foraminal space at the inferior aspect of the L5 pedicle. Lidocaine 2%, less than 3 cc, was used as an intermittent local anesthetic after needle insertion and used as needed for reducing focal pain from needle repositioning. Contrast agent was injected showing very good medial epidural flow. After negative aspiration for blood, therapeutic injection was completed using Depo—Medrol 60mg. Hard copy films were saved. Vital signs remained stable. There were no complications and the patient was taken to the recovery area in stable condition. See also nursing flowsheet for detailed vital signs, notes, and pain scores pre—procedure and post procedure. Patient was observed in the recovery area after the injection. No signs of any progressive weakness. Patient medically stable after the injection and was released to supervised care. Written discharge instructions were given to the patient. Follow—up will be as scheduled with me.