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  • JimMiller
    Participant
    Post count: 40

    I had MIS TLIF 22 months ago. I have CT report that says that I fused, however I still feel pain. All hardware is in place. No movement on Flex/Extx rays.

    My local Neurosurgeon suggested having a bone scan which could show even the slightest non union.

    1.) What are your thoughts on having a bone scan in order to further evaluate fusion?

    2.) If you agree, what kind of bone scan would you suggest?

    3.) If bone scan shows non union, then what ?

    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You must first back up and ask if the correct diagnosis was made to determine if your lower back pain was initially caused from the level addressed surgically. What was the diagnosis, the work-up to determine what caused the pain and the reason for the surgery?

    If all that questioning is satisfied, how have the symptoms changed since the surgery? Are the symptoms the same or have they changed in location, intensity or causation (activity or position). What can or cannot you do that you did before surgery? Do you have leg pain where you did not previous to the surgery?

    Finally, does the CT scan definitely demonstrate fusion? The answer should be yes. Sometimes, the radiologist is unfamiliar with what a fused segment is suppose to look like or will not call whether a fusion is or is not present as not to offend the ordering surgeon. The CT scan trumps the bone scan as to whether fusion is present. I assume you have had an MRI since the surgery did not meet your expectations. The MRI is just as sensitive as the bone scan for inflammation using the STIR sequences. Most of the time, the bone scan is superfluous.

    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.
    JimMiller
    Participant
    Post count: 40

    bi-lateral pars fracture before surgery, grande one spondy

    Sounds unaminous that I fused from several different surgeons. still straight back pain and weakness.

    1.) If pain was coming from SI joints, would it be unilateral or bi lateral ? I have new pain going down TLIF (right side) hip, groin and thigh. I am wondering if there is a relationship between right sided TLIF and hip/SI joint pain or if just a coincidence.

    2.) What are STIR sequences? I am going for MRI, should I request a specific type of MRI ?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Typically the SI joints do not cause pain. Your right sided pain more likely than not is caused by nerve root irritation. Did you have the exact same pain prior to the surgery or is it new? TLIFs do require nerve root retraction so if you had a right sided approach, this might explain your leg symptoms.

    All MRIs come with STIR (inversion recovery) sequences. These are the equivalent of a bone scan when compared to the typical T1 and T2 sequences.

    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.
    JimMiller
    Participant
    Post count: 40

    This is new pain that showed up right after surgery, however it could be hip bursitis from walking

    I have sacrilized joint beneath fusion at L5,S1. Would that exacerbate SI joint pain ?

    So the next step would be to have an MRI instead of a bone scan ? Doesn’t bone scan show non union and MRI is more for soft tissue and nerves?

    Thank you

    JimMiller
    Participant
    Post count: 40

    Also, does the “quality” of bone matter with regard to symptoms after surgery?

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