[jericho163]

#21844

May I add on to the above post.

My MRI shows a full annular tear at l5s1. All other discs are ok , mild hypertrophy at l4l5 facet joint(had a block but didnt feel anything).Scaro joint is fine. Mri 15 years ago ahowed the main issue at L5S1 too.
MRI did show atrophy of the lower back muscles with fat infiltration.

So my surgeon did thqe tlif on l5S1. I was hoping sitting/standing will become better after 5 months but it hasnt and there is always a constant tension in the lower back even when lying down flat(slowly becoming better). Muscle tension builds up upon loading the spine and the muscles seem overworked and easily fatigued. Motion like walking is ok. Static positions are bad.

The surgery did relieve some discomfort down the leg to the outside of my thigh to the big toe on my left legs. L5 nerve root? Surgery also helped in the mid spinal stiffness. Preop I cannot bend because of a bony stiffness, postop still cannot bend well but it feels like muscle shortening.(I had a discogram and L5s1 and it replicate the disc pain I had and before surgery i did had transdiscal biacuplasty which eliminated the disc pain but not the constant muscular spasm.)

What do you think is the main cause of this? Hardware? Muscle? Chronicity?What advice will you give to such a patient like me?

Thanks once again DR Corenman for your time.

[Donald Corenman, MD, DC]

#21850

It looks like you had the correct workup for your disorder. You had years of conservative treatment, then the discogram confirming your diagnosis and finally the TLIF surgery. I worry a little about the transdiscal biacuplasty as this occasionally can injure the nerve roots but I will assume your pain is more back pain and not leg pain.

If there was no BMP used, you are still in the healing fusion phase. For patients without BMP use, it does take as long as a year to determine fusion status. With BMP, 90% are fused at 5 months and 99% at one year.

An X-ray series with flexion/extension views would be helpful to know “where you stand” in the fusion cycle.

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.

[Donald Corenman, MD, DC]

#21852

At his point in your fusion cycle without BMP, you are still healing. Stiffness and ache would be expected but these symptoms should be slowing improving. Patience is the key with small incremental increases in stretching and exercise. Hopefully, you are with a physical therapist and if not, I recommend this.

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.

[Renee123]

#21858

jericho – Did your surgeon use BMP ? If so, was it used in the disc space and the posterolateral fusion ? Did you have CT scan to see if you are fusing ? May I ask where you had this surgery ?

Hope you are well !

[jericho163]

#21861

Thanks Dr,

My surgeon used my own bone and some dimineralized bone matrix, no bmp. He is having me take the standard frontal and side xray again at 6 months, not the flex-ext. I am not sure whether he can see fusions w standard xray? No CT scan yet.

He mentions actual fusion takes quite long and it has nothing to do w muscular tension. Do you agree?

[Donald Corenman, MD, DC]

#21864

The motion of a segment that is not fused is micro motion but will affect the muscles. Muscles might get “tight and achy” with a non-solid surgical segment.

I would recommend motion X-rays and when the surgeon feels it is solid (but with continued symptoms), a CT scan.

Please do not identify the surgeon as this is an anonymous site.

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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