[Donald Corenman, MD, DC]

#35781

There is so much to unfold here. First, what are your current specific symptoms? Second, why did you have ADRs placed at L3-5 and when placed, what changed in symptoms did you have? Why did you have your SI joint fused and how did the symptoms change after the fusion? What does the radiological report state about L5-S1 (cut and paste the report)? See:
https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-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.

[Brian McC]

#35785

My pain is a persistent, continuous dull low back pain that increases after any activity. Periodic/frequent ‘flare-ups’. Sporadic pain in my left leg, intermittent very sharp pain in my low back, pain going into my foot and toes.
Here is a history of my symptoms and treatments over the years since my first experiences with back pain and first of several surgical interventions:
A history of SIJ problems since late teens requiring Chiropractic each time my back ‘locked up’.
• Microdiscectomy 25/11/97 L4/L5
• Chiropractic Care 2002-September 2007
• Massage Therapy 2002-to date
Continued pain leading to:
• MRI Scan
• Facet Injections L4/5 four times
• Epidural injection 26/06/07
• Diagnostic Facet injections 5 right side 07/08/07
• Diagnostic Facet injections 5 left side 19/09/07
• MRI Scan 03/10/07
• De-nervation 5 one side 16/10/07
• De-nervation 5 other side 13/11/07
• Nerve Root Block Right side L4/5 S1 18/12/07
• Nerve Root Block Left L4/5 S1 15/01/08
Increased pain
• Positive Discogram/Discography. Feb 2008. Diagnosed with Spina Bifida Occult and Sacralised Transverse Process (AKA Bertolotti Syndrome).
• Hybrid Charité ADR L3/L4, L4/L5, ALIF L5/S1 surgery 22/04/08
• Pain Management Hospital Stay Oct 2008
• FJ Injections
• SI Joint Injections
• Bi-lateral five level denervation
• De-nervation 3 one side Nov 2008
• De-nervation 3 other side Dec 2008
• Positive Discogram/Discography. March 2009
• Surgery April 25th 2009 – revision fusion L5/S1 with instrumentation and complete bi-lateral SIJ fusion
• February/March 2010. Pain Management and diagnostic/pain relief procedures and bi-lateral three level denervation plus Sacroiliac Joints.
• Surgery May 25th 2010 – revision bi-lateral SIJ fusion with instrumentation
• Pain Management Hospital Stay 16th January – 12th February 2010
• Repeat discogram, SPECT Scan, Infusion, drugs changes, hydrotherapy
• Referral to Pain Consultant, 1st March 2011 for SCS or Morphine Intrathecal Pump
• Referral to Spinal and Orthopedic Surgeon 4th July 2011. Diagnostic facet injections and MRI scans.
• Discogram 7th November 2011. Proved positive and confirmed two loose screws and mal-union at L5/S1.
• Surgery 8th November 2011. Revision fusion at L5/S1, instrumentation removed and replaced with larger sets both sides. Excise of Bertolotti Syndrome anomaly.
• Discharged 20th November 2011.
• Six weeks daily care from district nurse to monitor and dress infected wound.
• Hydro-therapy June 2012, on-going weekly. Stopped
• Referred to Pelvic Surgeon for assessment.
• Surgery 28th January 2013. Removal of bi-lateral SIJ instrumentation
• Referral to Pain Management Doctor 1. 23rd April 2013
• Referral to Pain Management Doctor 2. 1st May 2013 – Assessment for Spinal Cord Stimulator/Pain Management
• Referral to Pain Management Doctor 3. 8th May 2013 Assessment for Spinal Cord Stimulator/Pain Management
• Referral to Physiotherapy and acupuncture
• Pain Management. September 2013
• Three week residential in Coventry, Real Health
• Orsett Hospital Pain Management October 2013
• Various appointments with physiotherapist, Medication Nurse and psychotherapist.
• Aqua therapy April 2014 ongoing (stopped now)
Three times (min) weekly. 20 minutes walking with float in the water
• Orsett Hospital Pain Management November/December 2014
• January 7th 2015 Consultation Neuro Surgeon
• CT Scans 5th March 2015.
• July 14th 2015 Consultation Neurosurgeon, Pelvis Specialist, Pain Management Consultant
• Admitted to London Clinic July 27th 2015
• SPECT Scan 28th July 2015 – shows inflammation of bone around both SIJ cages possible reaction to metalwork.
• Local anesthetic and steroid bi-lateral SIJ injections 30th July – no pain relief beyond that gained from the local anesthetic.
• Admitted to London Clinic September 24th 2015
• Attempted bi-lateral denervation of SIJ’s, unsuccessful because of presence of scar tissue from previous surgeries as suspected.
• Repeated bi-lateral SIJ injections – no relief
• December 23rd 2015 The Roding Hospital Consultation Neurosurgeon
Discussed and agreed go ahead for trial of Spinal Cord Stimulator
• March 15th 2016 The Roding Hospital
• Trial 2 SCS, Medtronic and Nevro, one week each
• March 22nd 2016 The Roding Hospital Permanent Nevro HF10 fitted
• (December 2017 ORIF – fix broken right clavicle following fall on ice patch. Nuffield Hospital Brentwood)
• June 4th 2019 Spire Hospital Brentwood Consultation Neurosurgeon
Following six to seven months of muscle spasm flare ups and then a seven-week period of severe sharp acute pain to right side prior to: Bi-lateral Denervation Lumbar Facet injections L3/L4, L4/L5, L5/S1 plus injection in SIJ Bursa. Acute pain subsided within hours leaving ‘normal’ low back pain.
• April 8th 2022 Spire Hospital Brentwood
Consultation with Orthopedic surgeon – examination
• May 19th 2022 The Wellington Hospital London SPECT CT Scan Nuclear
• June 17th 2022 Blood tests
• June 20th 2022 DEXA Scan for checking bone density
• July 8th 2022 Follow up appointment
• September 7th 2022 SCS Adjustments made (NEVRO) new program provided.
• Same day. Zoom Call with Neurosurgeon 2.30-3.30. Discussed increased ‘new’ pain and diagnosis. BS evident on the printed image of my latest scan shown on Zoom. Suggested this or the fracture in the fusion mass in SIJ as the possible cause of the pain.
• November 3rd 2022. Agreed to go ahead with revision fusion right side sacroiliac joint for 9th January 2023 . This was to fix the fracture seen in the fusion mass and help reduce pain.
• January 9th 2023 admitted to hospital for SIJ revision fusion surgery si-bone right side.
• June 19th 2023 Follow up at Clinic
‘New pain’ to right SIJ had eased but all other existing pain still the same. (Discussed Bertolotti with consultant and is of the opinion that Bertolotti has regrown and is the likely cause of the pain. He would discuss with MDT meeting the following day)
Then met and discussed surgery outcome with surgeon who believes no further surgery will help with the pain and discounted the BS as the pain generator. Pain continues ….
• August 8th 2023 Discogram – positive. I had the discogram/diagnostic intervertebral disc injection L2/3, L3/4 and L4/5 and injection to my left SIJ on Tuesday. It has revealed: L2/3 a ‘globally torn, severe concordant pain at low pressure, L3/4 severe concordant pain at opening pressure, L4/5 severe concordant pain at opening pressure.
• L3/4 and L4/5 have Charite ADR but the exposed surfaces towards the back of each of the vertebra were tested resulting in the pain. I have been told that the Bertolotti at L5/S1 interbody is fused solid to my sacrum and is therefore not generating pain. I am confused by this because I was under the impression it was very likely the cause of all of my back problems originally and the reason why a resection was carried out some years ago and has since regrown. I can’t understand why it is now no longer a problem if it is back to the situation that it was before. Will it not place undue stresses on other joints even though L5/S1 is fused and my right SIJ now fused?
• The treatment being considered and discussed is to fuse all levels from L4/L5 up to T10.
My concern is in relation to the significance of the re-grown BS. I am told it is re-fused and rock solid but if it is now the same as it was before the resection, will it not cause the same sort of damage to the new fusions? My understanding was that BS creates asymmetry in the spine causing altered bio-mechanics leading to undue wear and tear on the various discs and joints.
Sorry for the amount of detail here but thought it best to let you know the complete history of my back problems and hope you don’t mind.

[Donald Corenman, MD, DC]

#35787

I wouldn’t focus too much on Bertolotti Syndrome as even when present, it rarely is a pain generator. When it is painful, both resection and/or fusion of L5-S1 resolves the pain generation, both of which you have had (fusion multiple times-hopefully it is solid). If L5-S1 is not solidly fused, that needs to be addressed surgically. Bertolotti Syndrome, once resected does not regrow but maybe the resection was incomplete. Nonetheless, you have had fusion of L5-S1 which is the definitive treatment. The ADRs at L3-5 could be pain generators but the only way to really know is to fuse these levels and there is no guarantees of success. L2-3 sounds like it has broken down (ASD) but you have had so much unsuccessful lumbar surgery that I would be very careful to engage surgeon’s services again for that.

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.

[Brian McC]

#35789

Thank you very much for your reassurance regarding the Bertolotti and your comments Doctor Corenman, and for your speedy response. It is very much appreciated. I am assured I have a solid fusion at L5/S1 despite it being very tender to touch. It also ‘lit up’ considerably on the last SPECT CT scan, along with both SIJ’s taken prior to the most recent si-bone fusion in my right SIJ in January.
I am aware of the possibilities of ASD and have feared this happening for a long time. Since the discogram provoked such a painful response (as did both ADR levels) I am told I can understand. I am alarmed about the prospect of fusing right up to T10 – what happens to T9 in the future.
The constant back pain is very hard to live with and the regular flare ups even harder. More surgery is frightening because I know what the recovery process is like. It’s a very big decision.
Thank you so much for your comments over recent weeks, all very much appreciated.
Regards and best wishes

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