[texasspondy]

#5557

Also he did concur to my (actually yours Dr. Corenman) input, a TLIF would be what they would do in my situation for a surgery. I find I manage, but sitting is what really does it in for me, and I’m really in a quandry, because my job is a mechanic, heavy and laborous, so I’m actually looking to make a career transition/promotion, no heavy/laborous lifting, but an office job, and I don’t know if I’ll make it ‘sitting’. Feel like a Danged if I do, Danged if I don’t approach here.

[Donald Corenman, MD, DC]

#5558

I think your surgeon was reluctant to give you a rosy surgical picture as success rate should be about 90% for 2/3 relief of pain. I agree with him that surgery should be done in your case for degradation of quality of life to the point that you cannot participate in activities enjoyable to you. I also agree that the next step is an epidural injection. It sounds like you have a good treatment program and are in the right hands.

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.

[texasspondy]

#5626

I had my first ESI one week ago today, Wednesday, and my follow up appointment today.

I don’t have the report but pain management doc showed me the pictures of the needle under xray. If I understand right he did a shot of anesthetic (numbing) and steroid to both sides of the L5 area, I believe to the pars area, and also he said he put some in the canal.

What I experienced was this….. I woke up from procedure, groggy, but got home and took a nap, and I would say that day, no real pain/aggrivation to the L5 area.
Next few days were very sore, but like I was bruised and it was tender just to walk, don’t know if that might of overshadowed the original pain but original pain was not on my focus. After about 5 days, the shot tenderness/bruise feeling wore off and the cycle of aggrivated type pain returned then muscle tightness/spasm tight pain returned on right low back, then today on left low back.
So it’s kind of back where it was before I went to have injection.

PMS doctor, said he would recommend another injection due to the fact the first roughly 24 hours the original pain had subsided. He said, at least some of the medication hit the area aggrivating me. He would this time injection the pars again but also put some in the central canal as opposed to the side to see if that hit the area better.

Anyrate, I had put for a promotion to an supervisory type of position with my current skill set and unfortunately found out that I was turned down due partially to my sick occurances last year, which was because of my back. One of the reasons I was looking for this promotion is to get away from the physical aspect my job can entail sometimes as a mechanic. Although honestly right now sitting aggrivates the area so not sure which is worse.

The question I am facing Dr. Corenman, if these shots don’t work, and I have to have surgery, is the pars repair, due to my age of 40, pretty much out of the question? If I do indeed have to have a TLIF, L5-S1, in your experience, have some of your patients been able to return to some physical labor work? And if so, my surgeon had said minimum 3 weeks for an office job, and I would guess 6 months for a physica type job if at all?

[Donald Corenman, MD, DC]

#5632

In regards to your injection, the information gained was good even though the procedure probably used IV sedation which had you back home taking a nap while the anesthetic was active. Normally, I encourage the patient to be active for the first three hours after an injection to determine if the anesthetic “takes the pain away”. None the less, 24 hours of pain relief identifies the spondylolisthesis as the pain generator.

In regards to the potential surgery that could help you, pars repair is only for patients with normal discs and facets. Your MRI report notes:”At l5-S1, there is bilateral L5 spondylolysis without spondylolisthesis of l5-S1. There is minimal 1-2mm posterior broad based disk bulge slightly indenting ventral thecal sac without mass effect on s1 roots or sleeves. There is facet arthrosis. No central can stenosis. Mild inferior foraminal disk bulge and spondylolysis seen with mild bilateral foraminal narrowing”.

This report indicates that you have degenerative disc disease of the L5-S1 disc as well as facet arthrosis. A patient with that report in my practice would not be a candidate for pars repair but would need a TLIF. See the section under surgery- recovery for a complete explanation of what a TLIF recovery is all about. In my opinion, a one level TLIF is compatible with olympic level activity so going back to being an auto mechanic falls within that category.

I am sorry to hear that you lost the potential supervisory position as that would have helped you. With a one level TLIF however, I think you should be able to return to your position as a mechanic.

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.

[texasspondy]

#5939

Dr Corenman, I am in the process of moving and was going through some files of my deceased parents and came across something I wanted to ask you about.
Now I knew my dad had back surgery’s in the 70’s. I don’t really know as to what triggered them, such as trauma early on or what. I do believe there was an vehicle accident that might of triggered or complicated surgery’s.
I was looking over a report from what looks to be a lawyer working with my dad on social security disability. What I found interesting was a comment that said in 1982, he was granted disability due to Lumbo-Sacral disk disease.
I figure the 70’s would of put my dad at roughly the same age as me, in his 40’s, he had some back surgery’s, that included fusions. Now I also know there were multiple surgeries, maybe a fusion failed, not sure. I do know his diet was rather poor, meaning, he smoked and drank more alcohol than he really should of for good health, not to mention from what I have read, those things can impair good healing for a fusion to be successful.
What I’m interested in knowing, since this mentions Lumbo-Sacral, I would assume my pars L5-S1, could be referred to the same thing or area. Is poor spine health congenitive or genetic make up something that could be passed on? I just wonder if I was dealt a bad hand of cards when it comes to back issues. It doesn’t change things now, but I’m continuously trying to learn about my medical situation. Thanks for taking the time for my questions.

[Donald Corenman, MD, DC]

#5942

The 70s were the “bad old days” of spine surgery. Many patients received a diagnosis of “lumbago” which simply meant low back pain. Surgeons had inferior tools for diagnosis including the pantopaque myelogram, a particularly miserable test. Implants were poor and the biomechanics of the spine was misunderstood. Surgery had about a 50% success rate and complications were common.

Comparing today to that period would be to compare a skateboard to an automobile. There are still unsolved problems that we as spine surgeons face but at least we know now the potential problems that can occur.

Multiple surgeries back then most likely meant that a fusion was performed that failed and multiple attempts were undertaken to repair the pseudoarthrosis.

Genetics plays a greater role in spondylolisthesis than most surgeons give credit to. It is possible that your father had an unrecognized isthmic spondylolisthesis and a fusion surgery was unsuccessful but we will probably never know.

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.

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