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  • texasspondy
    Member
    Post count: 25

    Dr. Corenman, appreciate your visual of the 70’s and back surgery’s, that’s puts a little bit of ease in my mind.

    I just got a couple of days ago my bone scan report back, that my pain management doctor had requested for further treatment options.

    The PMS said that the report shows negative hot spots, so to speak, so it would appear that my facets, or pars area are old issues, I guess. He also said this made sense as to why the two ESI pars injections that I had did not help, because there was no inflammation for the cortizone to reduce. His thought process was that the nerves exiting the L5 canal are some bigger ones going to the legs but also some very small ones that he called “sensory” nerves and he is thinking one of these is getting aggrivated on the left side and that is what is causing my muscle spasm/tightness/pain in the low left back. He also suggested a nerve block in the facet area to try and hit that nerve for pain relief, if it worked, he wanted to do a RF procedure in that area to put that nerve to sleep, cook it, whatever. Your thoughts??

    Here is the report from the bone scan, I also was glad to see the hemangioma is not active….

    CLINICAL INDICATIONS: lumbar radiculitis

    SE (LOCATION)
    CLINICAL COMMENTS:
    Pregnancy Information:

    EXAM: Whole-body bone scan and nuclear medicine SPECT imaging.

    CLINICAL INFORMATION: Lumbar radiculitis.

    COMPARISON: MRI lumbar spine of 10/04/2011.

    TECHNIQUE: Approximately 25 mCi technetium 99m MDP given IV. Delayed anterior and posterior whole-body images obtained. Additional SPECT imaging of the lumbar spine were performed for further evaluation.

    FINDINGS: No abnormal focal radiotracer uptake is present, specifically of the lumbar spine. No focal intense radiotracer uptake is present within the L5 vertebral body related to benign lesion of vertebral hemangioma.

    IMPRESSION: Negative bone scan and SPECT imaging.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    A bone scan would probably not have indicated significant changes as this is not a new fracture of the pars but a very old one (probably occurred when you were 12-18 years of age). Bone scans tend to light up if the fracture or bone injury is less than six months old.

    Normally, the facets are not pain generators in an isthmic spondylolisthesis as they are unloaded. That is, the fracture of the pars disconnects the facets from the body of the vertebra and the stress is shifted to the disc. The facets, being unloaded typically do not cause any pain.

    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
    Member
    Post count: 25

    Dr. Corenman,

    First, I’d like to say (while it’s fresh in my mind), it was an absolute pleasure to meet you during my appointment 10/16/2012. Your knowledge and personality were just as I figured, second to none. Your staff was, very nice and quite helpful. Your PA, (sorry don’t remember his name), was also very knowledgeable and I enjoyed meeting with him, and of course the surrounding view is a narcotic itself.

    I knew there would be other questions after I left your office. With my Mri and xrays, do you think it is of any value to persue what my PMS had wanted to do next, a nerve block, or RF? I gathered from our meeting that my discomfort is coming from the pars fracture themselves, possibly a hair from the slight l4-l5 bulge. So I’m guessing nerve endings in the pannus are what’s actually behind the discomfort and nerve block won’t do anything to alleviate that?

    Just thought I’d see if you thought that would be of any use or if I should just maintain for now (in my new office job), until I have the procedure done by you.

    Thanks again, (The aircraft Mechanic)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Nerve blocks can be valuable to reduce symptoms until a surgical procedure can be performed. I do not think that RF (radio-frequency ablations of the facet nerves) would be valuable.

    By the way, I have two PAs, both named Eric (one spells his name Ehrich).

    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.
Viewing 4 posts - 13 through 16 (of 16 total)
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