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  • Dangerous Donna
    Participant
    Post count: 19

    I am a professional, ACSM fitness trainer for athletes, physicians and the corporate athlete for many years. Over the past 4 years, I have been searching for the answer to why no spine specialist seems to be able to put me back together again so my body may heal. I truly believe due to my advanced fitness level that I am not taken seriously. I have been working on repairing for 4 years now. I am performing with a L3-4 mild broad-based disc protrusion & small annular tear, a L4-5 moderate broad-based disc protrusion prominent on the right, grade 1 spondylolistheses & small annular tear & moderately severe central canal stenosis AND L5-S1 was ruptured but it took over a year to find a neuro that performed a laminotomy 2 years ago on the right of disc. However, my right leg continues with muscle atrophy and daily nerve pain and over last couple months the left leg is showing similar symptoms in same areas. So I am frustratingly perplexed on why I am walking around with all 3 discs still injured and no one has a clue what to do. I have seen 4 docs in Memphis. In addition, it was my research and suggestion to twice get a “upright MRI” in birmingham, AL because I was feeling more pain in spine over last 2 years. This past Oct upright MRI proved to show the L3-4 bulge which the physicians could not see on the lying MRI. My spine injury is due to extreme sports and being thrown off the back of a golf cart did not help the healing process. I greatly appreciate your time. Big thank you. I will travel for repair. ;)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    So-to sum up your symptoms and history, you have had a disc hernation at L5-S1 years ago and then a microdisectomy at that level. I am unclear if the residual weakness and atrophy stems from your previous nerve compression or from your current situation.

    You have a slip at L4-5. I assume it is a degenerative spondylolisthesis but an isthmic spondylolisthesis is also possible. You have “moderately severe central canal stenosis” so this is associated with a degenerative spondylolisthesis. You have developed left leg pain in the last couple of months which is what I assume to be continued compression in the canal at L4-5.

    An upright MRI is unnecessary and probably a waste of time as long as you have a good standard MRI. You will need flexion/extension standing lumbar X-rays.

    Your problem is not mysterious nor is it a diagnostic dilemma. You simply need a good spine surgeon to diagnose you and plan the appropriate treatment.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Dangerous Donna
    Participant
    Post count: 19

    Wow, I am appreciative of your quick response, moreover, while on vacation. In 2011, L5S1 extruded, L4L5 herniated. L3L4 could have been herniated at that time but Neuros did not see until this year. On initial injury, I could barely stand or walk on right leg. Did PT. Upon right calve muscle showing 1/2 inch of atrophy over 6 months and right leg pain never letting up went to second Neuro. This physician performed the surgery on L5S1. L5L4 was herniated then but not touched. Several weeks after this surgery the pain returned in back and right leg. Right Calve continued to atrophy and pain is a constant with standing and sitting with slight forward flexsion. No pain when exercising. I have flexsion and extension x rays taken again just this Oct. Thank you!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    If you had significant leg pain over six months and associated atrophy, you might have developed a permanent nerve root injury prior to surgery. If you had pain relief after surgery but the pain had returned two weeks later, I am suspicious of a recurrent herniation at that level. If the leg continued to atrophy further, there was probably continued compression of that root.

    Does the L4-5 level move (change in slip amount) with flexion/extension X-rays? How significant is the nerve root compression at this level?

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Dangerous Donna
    Participant
    Post count: 19

    The L4L5 level xray comparison of Oct 2013 vs Oct 2014 shows no slip, no movement. I am happy about that. Both past Neuros looked at x rays and were in agreement of no movement.

    Oct 2013 report L4-5: is severe bilateral facet joint arthropathy with grade 1 anterolisthesis. There is moderately severe central canal and bilateral foraminal stenosis.
    Oct 2014 L4-5 report: grade 1 spondylolisthesis, severe facet arthrosis, moderate broad-based disc protrusion, more prominent paracentrally on the right, small annualar tear, moderately severe central canal stenosis and moderately severe bilateral foraminal encroachment.

    Oct 2013 report L5-S1: there is disc desicaation an dmild reactive signal changes at the surrounding endplates. There is suggestio of prior right-sided surgery. There is a small, focal right paracentral disc protusion with questionable encroachment on the right S1 nerve root. There is mild to moderate bilateral foraminal narrowing.
    Oct 2014 L5-S1 report: Prior laminotomy on the right. Mild braod-based disc protrusion, slightly more promiment on the right, bilateral facet arthrosis, mild right lateral recess encroachment, mild bilateral foraminal encroachment.

    Oct 2013 L3-4 report: is disc desiccation and a circumferential disc bulge with a small annular tear posteriorly. There is mild to moderate central canal and mild bilateral foraminal stenosis.
    Oct 2014 L3-L4 report: mild broad-based disc protrusion, small annular tear, facet arthrosis, mild bilateral lateral recess and mild bilateral foraminal encroachment.

    Unfortunately, I also believe that nerve root injury is discouragingly permanent at this time. I went from partial plantar flexion of right foot to none. Moreover, I believe that continued damage is happening due to pain and healing is not able to take place. About 2 months after the 2012 L5-S1 surgery, I showed Neuro a place just above the surgery area where it felt like a knife was stabbing in the back. No advice was given.
    I have followed every protocol that has been suggested: 3 properly spaced out epidurals, nerve stim unit, chiropractic decompression (25 sessions), acupuncture. This month of Dec I planned to have laser surgery on soft tissue by North American Spine using the Accurascope method. After reviewing my new x-ray and mri reports, N. American Spine turned me down. Back to the square one.
    Thank you very much,

    Dangerous Donna
    Participant
    Post count: 19

    Oh! I also continue to get nerve conduction assessment. Have had 3 now I believe. Last one showed “slightly” more nerve conduction. I look at it as the body is trying to heal but there are other problems in the way.

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