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  • Stephen Manchester
    Post count: 2

    Hi Dr Corenman,
    I am new to this forum but have read many of your comments and items within the site which have been very informative – thank you.
    I hope you can offer me some guidance/opinion on my current conditions.I do understand this is all you can offer without the full history/examination but I am rather desperate and would appreciate any help you can give me.
    Back problems history/treatment:
    1985 L5/S1 surgery to remove bulging disc – no improvement and facet joint degeneration followed.
    2012 developed severe bilateral sciatic pain. MRI scan revealed severe spinal stenosis of the lateral recess at L4/5 and narrowing of L4 foramina plus severe facet joint degeneration at L5/S1 with moderate stenosis of lateral recess.It also showed disc at L2/L3 was normal and slightly bulging disc and mild stenosis at L3/L4. No spondylolysis.
    2013 decompression surgery and fitting of coflex device at L4/5 this gave good and continued relief of bilateral sciatica. However within 4 weeks I developed itching on the lateral thighs which developed into severe bilateral nerve pain along both outer thighs (burning and stabbing) later diagnosed as meralgia paresthetica. This condition has worsened over 2 years I have bad pain around both inguinal areas from entrapment of the lfcn together with significant pain/muscle weakness around the groin/thigh areas. I also have constant bilateral fasciculation in calf muscles and an increase in back pain around L5/S1 and sacroiliac joints.
    I have had steroid injections with no change and a nerve conduction test which confirmed active denervation over a number of lumbosacral root distributions.
    I apologise for the length of the above but wanted to give you as much information as possible.
    My questions are:
    Is it possible the Coflex device at L4/5 is the cause of the lfcn compression as it closes the gaps (particularly L2/3) and the cause of the calf fasciculations plus the cause of increased back pain as it does the same at L5/S1?
    What are the disadvantages of having the device removed specifically if the supraspinous and interspinous ligaments have been removed (as you explain)?
    What other procedure may be considered after removal of the device to reduce the chances of the stenosis at L4/5 causing recurrence of bilateral sciatica?
    I am seeing a chiropractor who specialises in spinal nerve compression, she suspects the Coflex is causing a lot of the symptoms and is hampered in her efforts because of the existence of the device, is there anything you might suggest she could do to alleviate the problems without surgery?
    Finally what about Pilates as a short term measure?
    Thank you for taking the time to read this and I look forward to any help you may offer
    Kind regards,

    Donald Corenman, MD, DC
    Post count: 8660

    The Coflex device is designed to distract the back of the two vertebra it is sandwiched in-between. This indirectly opened the canal as flexion (which is what this device forces the vertebra to do) opens the canal.

    The problem is that the forced flexion of these two vertebra affects the ones above and below forcing these adjacent levels into more extension to compensate. WIth any compression above or below the Coflex device, the adjacent levels will cause further compression and new symptoms. This is why I don’t like the Coflex device for many disorders.

    You probably do not have LFCN or meralgia paresthetica. This disorder rarely is bilateral and is typically caused by compression of the nerve at the inguinal ligament. The nerve is strictly sensory so “muscle weakness” is not part of this syndrome. I assume you have compressive radiculopathy but has yet to be diagnosed.

    Your “severe facet joint degeneration at L5/S1 with moderate stenosis of lateral recess” makes me think you have a significant degenerative spondylolisthesis of L5-S1. You need a very good spine surgeon to go over your symptoms and determine what your disorders really are.

    Dr. Corenman

    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.
    Stephen Manchester
    Post count: 2

    Hi Dr Corenman,
    Thank you for your detailed and informative reply. I am due to see a highly respected consultant neurosurgeon who can review my symptoms as you suggest. However I am very concerned about the cause of these symptoms as they appear to indicate multiple nerve entrapments – sensory – burning/stinging anterior thigh and motor – iliopsoas muscle weakness and bilateral calf fasciculations. I also have severe lumbar back pain. Immediately after my Coflex surgery I had a significant cerebrospinal fluid leak through the unhealed scar over a period of 2/3 days ( confirmed by the hospital ). Because of this and my multiple symptoms I am extremely concerned that the cause may be Arachnoiditis. I appreciate you do not have access to all information – MRI scans etc but I would be grateful if you would give me your views on this possibility as it is understandably very worrying. I am very grateful for your advice and guidance as I am sure many readers of this Forum are.
    I will try not to trouble you with any more questions and am very grateful for your help to date.
    With best wishes

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