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AMA Guide to Permanent Impairment, 6th edition
#11
((he did talk of doing a fusion, but we decided to try to avoid that.))

If there is nothing or very little there, what would be left to avoid is beyond me. Your only choice was to increase the space by means of a fusion, and relief the pressure off the Nerve Roots, or much more damge can happen by waiting. If you wait to long, and chance it, you will have only one person to blame. There isn't no injections or medications then that would even be considered to help you. For the pain might become out of this world. I only can wish you luck then. But this isn't sounding to good right now for you. My opinion only...RolleyesShy

As per the MRI as you stated;

Epidural fibrosis (EF) is a major cause of failed back surgery syndrome (FBSS), which induces disabling radiculopathy for which no effective medical treatment exists. Our understanding of the fibrosis mechanisms and our clinical and experimental results for the treatment of radiation-induced fibrosis prompted us to postulate that EF might respond to treatment with combined pentoxifylline (PTX)–tocopherol (Vit.E). 6 weeks after lumbar spine surgery, a 28-year-old man presented with recurrent left L5 sciatica without disc herniation on MRI in December 1993. From 1993 to 1997, he had unrelieved back and leg pain, which became increasingly resistant to intensive medical treatment and to a spinal cord stimulator, and confined him to bed as from December 1997.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#12
I don't understand that at all. If there is no disc material and no fusion or insturmentation was done what is maintaining the disk space? Eventually they will start to collapse on each other.
 
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#13
Their bone on bone now....RolleyesShy

Quote; (((Definately nothing there. The entire disc, at first accident, went into the spinal canal. The surgery was to go into the canal and remove the debris and relieve the nerve that was severly compressed. When the surgeon went into the canal, there was no debris there to remove....and nothing of the disc left at all. So....he did talk of doing a fusion, but we decided to try to avoid that.)))
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#14
Yes, well, I've been looking into the epidural fibrosis as well, and that certainly seems to be what they symptoms I am having are pointing to. Having said that, most of the research seems to suggest that most surgeons see it as a "mind" thing....i.e. all in your head. So I am not sure at all what to expect.

When I first went to the surgeon just after the accident, he told me that the disk in the L5-S1 had almost completely buldged out into the spinal canal and was pressing onto the nerve. He talked of several options. Epidural injections in order to relieve pain....failed. Surgical removal of disk.....had that, but I am thinking that he was looking to take the disk out of the canal and not the L5-S1 area. I really have to confirm more of this. He said that the fragments were no longer in the canal and when he tried looking for them could not find them. He is a very good surgeon and is highly recommended by everyone I have spoken to about him. He did mention fusion on first consutation, but said we probably wouldn't have to go there.

AFter surgery he starting talking of fusion again, but I seemed to be improving in strength and mobility so that option was dropped off the table. That is when he started to move for MMI. When I last saw him he told me that if I got any pain that was too much to bear that I should contact immediately. I have done this now.

It is only since the second week of July that I started to have more pain and disability which I dealt with by using physiotherpist massage and tens treatment. The pain subsided for about a week or two. Then the surgeon authorised a purchase of a tens unit for my personal use to deal with pain. I do use it pretty often. Having said that the pain started coming on stronger over the last two weeks...last week being bed ridden completely. This week the lower back pain has subsided but is replaced with severe shooting burning pains all over the bloody left leg. I couldn't tell anyone where exactly it was since it seems to be everywhere. Same for the right leg to some extent, though not down the entire leg. I am now not free of any pain. Ever. So whatever is happening is happy doing its thing. I have MRI tomorrow.....and see the surgeon on the 22nd. After reading all of the stuff I have on the internet, I suspect I will be removed from MMI. Which is kinda sad since I got a fat cheque in the bank today!!!! That was fast. I don't dare use it.
 
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#15
You mean your case has been settled all this time????RolleyesShy

(((AFter surgery he starting talking of fusion again, but I seemed to be improving in strength and mobility so that option was dropped off the table.)))

Who declined the surgery for the Fusion????
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#16
The MMI doctor told me that I would be ready, in her opinion, for MMI at the end of physio therapy sessions....which finished two weeks ago. She said it would be finalised when the sessons were finished and that I would probably need to see her again before it was settled. However, it didn't go that way. The WC considered me at MMI on the day that I saw the MMI doctor...and they have back dated my settlement to that date. I was expecting to see the MMI doctor again, so I was entirely surprised when I got the letter from WC.

No one made the decision for no fusion. It just stopped coming into the conversation since I seemed to be improving in strength and mobility the last I saw my surgeon. And I was. When I saw him last he asked if I was having any pain, and I said some, but I tend to work with it and go on with my life. That is when he said that if at any time it becomes unbearable to contact him. And I did contact him, but by then the WC had already declared the case settled.

If I had a fusion, would that stablize me better? I know I would lose some mobility, but how much? I have always had the feeling like the back was going to go at any time, my physio said it was because I had an instability there...but who pays attention to a physio when it comes to conclusions. I do, but honesty, the WC don't. And besides, if what I am experiencing now is because of scar tissue, I would risk more with a fusion. I don't know. All I know is that I feel like I've been pushed into a conclusion without consultation. With regards to settlement that is.
 
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#17
Well, I think it would have been better, when you started this thread to have told the whole story, and settlement issues. It might have change the way people would have made comments here to your questions and all.

That has to be the fastest settlement I have ever heard of.

Now that it is settled, and I would think you somewhere in the past had signed the agreement papers for a settlement. Has your medical been left opened? Can you re-open your case now? Who pays your medical bills now if you need a surgery or Fusion now? Surely your Health Insurance isn't going to pay for it. Since it was work related. See this is where we should of been at the begining of this thread.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#18
as i stated in the other thread, states have different ways of handling comp.
many treat PD payment as a simple switch between one account (TTD) and another, while states like Illinois see it as a case closure and buyout "settlement". The pattern seems to be how active the legal community and attys are. I suspect the Montana litigation rate is lower and there is probably less subjectivity in their comp laws.
they pay automatically what the system calculates and will pay the difference if it increases. They probably use "Illinois-like" settlements for situations where all liability is in dispute.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#19
I have not signed anything with regards to the MMI. The meeting with the doctor was to assess if I was ready for MMI, and what rating would be forthcoming from that. She didn't tell me at the time exactly what the rating would be, and my surgeon was contacting her to explain to her what his feelings were with regards to a rating. She did tell me at the time that any flare - ups would still be covered by w/c and under the umbrella of the office that she works in. They also have a fund there for what w/c won't cover just in case something big comes up. My medications still are paid by wc. I was also told that if anyting my surgeon wanted to re-open this, as a work place injury....he could. It does look like w/c just does a transfer from one type of payment over to the next.

When I was posting this thread, I was trying to ascertain if the guide was a fixed thing and if one could have points added onto the fixed. IE...for my surgery the rating is 12% disablity with some restrictions and a proviso that I would have continued flare-ups. But with what the surgeon was saying my disability is greater because of the dural opening that was found and the extent of the nerve damage. Since that doesn't seem to be covered in the guide, I was wondering how the surgeon could have even tried for a higher rating. I know for a fact that he would rate me well above a 15%. So I am sorry if I got the wrong thread here. I wasn't entirely sure what I should even be looking for....am still not.

Having said that, I will wait for the MRI results, I had that today, and talk to the surgeon again. His first opinion way back when I first saw him was that if w/c didn't go for vocational rehab, then I should fight it. The attorney that I spoke to yesterday advised that this would cost me approx $1500, but said that if I felt the outcome was worth that much then I should certainly go for it. Especially if my surgeon signs a letter stating what his feelings are regarding this whole thing. I am just trying to work out what is what. If the ratings are rigidly fixed, then what possible reason would I have for contesting it, since it would not change a thing. And I think that 1171 is right, Montana is not a state where people go out to pay for an attorney....who could afford that here. Not many. If any. Montana is a state of the very very rich, and the pretty poor, there really isn't an in between. And I have no health insurance. Coudn't afford it when I had a job. And the job didn't cover that at all. Most jobs in Montana don't.

The site that you sent me, Bad Boy, the one of advocate, I read through their site and their aim is to get a comprimise before it gets to the stage of going to court, so maybe I would have a chance there. I can talk to that person on Monday.

Overall, I feel pretty stupid over this whole thing. Like I should have seen it coming, but just didn't.
 
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#20
Most surgeons have never seen a copy of the AMA Guides so have no basis for an opinion of impairment based on those criteria. Only Drs who do the impairment exams would have spent the almost $300 dollars for the text.
 
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