[Germanic27]

#26674

Dear Dr. Corenman, my name is Nick and I live here in Los Angeles. I have serious lower back problems and, after many attempts to get this taken care for via non-surgical means, am now ready for a minimal invasive procedure if that will take care of the underlying problem. I went to several spine doctors here in LA, as well as visiting a chiropractor, which helps for a couple of days, but then I’m back to stage zero = when a tremendous pain all of a SUDDEN brings me literally down on my knees. I signed up at your forum and found a diagnosis of yours that pretty much describes what so far NO DOCTOR here has even come close to consider!! That’s why this message. Attached please find what I found – you say in the high-lit passages to one of your patient that he has “a degenerative spyndylolisthesis of L5-S1 which means a global breakdown of the stabilizing structures at this level.” A bit further down you said EXACTLY what experience!!! “The second symptom is instability. This is the apprehensive feeling that if you pit your back in a certain position that back will GIVE WAY. An unexpected force on the back (….) will cause a severe pain in the back that will almost drop you to your knees.” After reading this I’m pretty convinced that this is my problem – and I’m looking for someone whom I can talk to. I have an MRI and X-rays from May 2017, which so far only my chiropractor analyzed thoroughly and found “something” on the X-rays. He says that there is a “structural problem” between L5 and S1 – and his attempt is to realign me via 30+ sessions. Maybe this works, maybe it doesn’t – and that’s why I reach out to you. I tried to contact you via your homepage, but for some odd reason that site loads very slow and then stops entirely. Is there an email that I can write you – or any other means of communication? As said, I’m at the end of my rope since my live pretty much is on a standstill. I’m 52 years old and rather “skinny” (thus I had no overweight issues ever in my life) and was very active until a few months ago, when this pain more and more took over my daily life. The incident that might have triggered that way probably (but not for sure) when I lifted a 60 pound concrete bag in the fall of 2015, which snapped one of my discs and I fell on the ground. I recovered from that over a few weeks, but then these “episodes” started – out of the blue! All of a sudden my back “gave way” under hellish pain, when I moved a wrong way. This got worse over the last 20 months and now I’m at the stage where I’m permanently icing my back in order to be able to move at least for a while without any pain. But I’m afraid that the underlying problem won’t be solved that way. And that’s why this email to you. Maybe you can give me some feedback – and maybe we can communicate via Email or via phone. Seeing how active you are on your forum, I really APPRECIATE all you do – especially since you are the first person who put in words what I’m going through! Looking forward to hearing from you. Thank you and kind regards, Nick

[Donald Corenman, MD, DC]

#26675

You probably don’t have an isthmic spondylolisthesis as that condition is present in only 5% of the population although it is possible. The lifting of 60 pounds repeatedly with a “pop” or “giveaway” feeling can be from annular tears, herniations or even the tear of a preexisting pars fracture. Lets start with having you type up here the radiological report from your X-rays and MRI. We can then move forward.

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.

[Germanic27]

#26695

Dear Dr. Corenman,

Thank you for your quick response – and below please find the MRI report and then X-ray report.

Kind regards,
Nick

MRI REPORT

REASON FOR EXAMN
Low Back Pain

REPORT
History: 51 year old male with low back pain

Technique: Sagittal T1, sagittal T2, sagittal stir, axial T2, and axial proton density images are obtained through the lumbar spine without intravenous gadolinium administration.

FINDINGS:
Lumbar spinal alignement is normal. Mild congenitally shortened pedals are seen diffusely. Diffuse hyperlastic vertebrate bone mare changes are seen with relative hypointense T1 signal. Patient has history of myelofibrosis. T1 and T2 hyper intense lesions are seen at L1, L2 and L4 vertebral bodies compatible with osseous hemangiomas. The largest osseous meningioma 1,9cm in size at L2. Vertebral body heights are intact. No acute fracture or sublimation. Disc desiccation is seen at L3-L4 and L5-S1. Mild disc space narrowing at L5-S1. Posterior annular disc tear is seen at the L5-S1. Conus medullaris terminates at T12. Distal spinal cord signal intensity is normal. Degenerative lumbar spondylosis is seen.

At L1-L2, minimal posterior disc bulge is associated with mild facet joint hypertrophy. No central canal stenosis or neuroforaminal narrowing.

At L2-L3, mild broad-based posterior disc bulge flattens the ventral thecal sac. No central canal stenosis. Mild ligamentum flavor and facet joint hypertrophy. No neuroforminal narrowing bilaterally.

At L3-L4, mild posterior disc bulge is associated with ligamentum flavum and facet joint hypertrophy. No central cana stenosis. Mild leftward neuroforaminal narrowing. No right ward neural foramina narrowing.

At L4-L5, mild posterior disc bulge is associated with bilateral moderate facet joint hypertrophy. No central canal stenosis. No rightward neural foraminal narrowing. Mild leftward neuroforaminal narrowing.

At L5-S1, 3mm broad based posterior disc bulge is associated with moderate facet joint hypertrophy. No central canal stenosis. Bilateral mild lateral recess narrowing.

Abnorma hypointense bone marrow signal consistent with underlying history of myelofibrosis.

Multilevel degenerative disc and joints disease with spondylosis. Posterior annular disc tear at L5-S1. No central canal stenosis or significant neuroforaminal compromise.

Signed by: Kaveh S., MD on 5/23/2017

AND HERE THE X-RAY REPORT FROM 5/12/2017

Cerner Imaging Exam Report
Facility: GA-ASIOC

REPORT: Lumbar spine 3 views

Clinical Indication: Lower back pain, Spondylosis versus fracture.

Comparison: None

Finding: No fracture or significant subluxation. No increase or decreased translocation during flexion or extension. There is no suspicious bony mass. Intervertebral disc spaces are within normal limits. Bilateral sacroiliac joints are normal. No central canal or foramina compromise.

Impression: Unremarkable lumbar spine evaluation.

Signed by: James W., MD on 5/12/2017

[Donald Corenman, MD, DC]

#26705

So, according to your radiologist, you have degenerative changes of your L5-S1 level (“At L5-S1, 3mm broad based posterior disc bulge is associated with moderate facet joint hypertrophy. No central canal stenosis. Bilateral mild lateral recess narrowing”). See the section https://neckandback.com/conditions/causes-of-lower-back-pain/ to understand what is causing your pain.

IF you have truly failed all physical therapy and interventional injections, you need a workup to see if you could be a fusion candidate. If you are a surgical candidate, the success rate for fusion is about 90%.

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.

[Germanic27]

#26710

Dear Dr. Corenman,

Again thank you very much for your rapid response!

You write: “…IF you have truly failed all physical therapy and interventional injections, you need a workup to see if you could be a fusion candidate.”

I’m still at the stage to figure out what ELSE can be done prior any fusion. I was in physical therapy for a while, which didn’t seem to make any difference. Then I went to see my (current) chiropractor, who was able – by “realigning me” – to get the vertebrates/spine “stacked up” in a “correct way”. This treatment was a BIG relief to my situation prior – which was mainly triggered by standing more than 10-15 minutes and which I only can describe as “pressure built in my lower lumbar prior to the “snapping episode” = me losing control of my legs under a hellish pain that I had all summer long. Unfortunately, I had a hernia surgery last week which doesn’t allow my chiropractor to do any new alignment for the next 4-6 weeks. My chiropractor says that he can help me quite a bit if I come on for appr. 30 alignment-visits (first 3x week for 3 months, then 2x week for 2 months and then 1x week). Also, he advised my NOT to do any a excessive core or other workout in order not any other aggravate my spine – but max. do some walking, riding a bike upright at the gym or swimming.

Besides the interventional injections – what other treatment options do I have in your POV prior any fusion? Is there any specific therapy that neither my spine doctor here in LA who ordered the MRI & x-rays (and who btw. didn’t see anything “wrong” on the MRI!), nor my chiropractor so far have recommended? I’m more than willing to do ANYTHING in order to get all options checked prior to any surgery.

Thank you and best,
Nick

[Donald Corenman, MD, DC]

#26712

You do not need 30 visits to “realign” your spine. If you gain relief from manipulation, you can use the chiropractor on an as-needed basis for your flair-ups. You can consider Pilates, yoga and other types of therapy to help your back. I would advise trying an epidural steroid injection (ESI) to help reduce the inflammation which leads to pain. You can try a brace for the most painful flair-ups but not used continuously after the flair passes. See the section https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/.

Don’t misunderstand me, surgery is considered when there are no other options left and you cannot tolerate the pain. You might also not be a surgical candidate. See https://neckandback.com/treatments/when-to-have-surgery/.

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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