[Duckgirl]

#21894

Good afternoon, Dr:
Thank you so much for your input. My pain is most prevalent on the lower right side of my back and in my right leg. I called my doctor today with my concerns, particularly with this new report. He stated that the metallic marker was for the disc, and that I had nothing to worry about. He also stated that the “mild neuroformal narrowing” was an improvement than what I had pre-surgery. I am confused, as I was never diagnosed with neuroformal narrowing or stenosis (and don’t even really know what exactly that is) in my many diagnostic tests over the last five years prior to surgery. He read the report while I was on the phone, but I don’t believe he was simultaneously looking at the image. He was very rushed, which I understand during a weekday. My last post-op appointment was about 3 weeks ago. At that time, I expressed concern about the length of recovery. My dr stated it definitely wasn’t normal, and he didn’t know why. He ordered the CT to make sure all hardware was in place. After the image came in, he called and said everything looks OK. He also indicated that saw bone growth, although I didn’t see anything about the bone growth on the CT radiology report referenced herein. I genuinely feel like something might be wrong. I know 5 months is too early to tell if the fusion is “successful” or if I will fully fuse. Do you think a second opinion could be beneficial? Thank you again for your time!

[Donald Corenman, MD, DC]

#21898

It would not hurt to read the radiological report although many radiologists will not comment on fusion masses. The metallic marker generally is imbedded in the PEEK cage and indicates where the edges of the cage are located. I am unclear why your surgeon states the marker was for your disc but he might know something I am unaware of. The marker, if it does mean cage displacement, could explain your right leg pain.

Fusion at 5 months might be mature but without BMP, the fusion mass might be premature and “woven”, not solid.

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.

[jericho163]

#21899

Hi Dr Corenman,

If we dont use bmp, just autologous/demineralized protein, what do we expect to see at a 6 month static xray on plain film. Will there be a noticeable difference compared to the third month static xray?

I understand static xray cannot really judge progression of fusion unless it is already solidly fused. Am I right to say that?

And if there is good bone growth, what are the signs of a progressive bone growth?Some cloudy bones at the 6mth mark?

Can I assume if we dont use bmp, those woven premature bones are actually any strong?

[Donald Corenman, MD, DC]

#21902

If autograph bone is used-especially a good amount from the iliac crest, this can cause fusion at 6 months but more likely fusion will occur at a year.

Static X-rays can help to indicate solid fusion but more likely will be indeterminate on fusion status.

Good cortical stringers in the disc space and the posterolateral position indicate a solid fusion. This however can be deceiving especially if there are no flexion-extension films.

Woven bone is a stage before solid fusion but may also be the stage before fusion failure.

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.

[Duckgirl]

#21916

Thank you, Dr. Corenman. The quotes I gave regarding the metallic markers were on the radiology report. If the PEEK cage is displaced, is that corrected surgically? I am thinking it is time to take all of my images to get a second opinion.

[Donald Corenman, MD, DC]

#21917

If the PEEK cage is displaced and you have a solid fusion, it can be trimmed just like a disc herniation. If it is extruded and there is not a solid fusion, it can be removed or revised to gain a solid fusion.

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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