[Jellyhall]

#32840

Dr Corenman, I want to thank you for giving your time and answering our questions about our spines.
I have problems throughout my spine and have already had a cervical ACDF of C3/4/5 eight and a half years ago, and a lumbar fusion of L4/5 which was ten and a half years ago.

I am now suffering with adjacent levels causing pain, but today I want to ask you aboout my lumbar spine.
I now have herniated discs at L2/3, L3/4 and L5/S1 which are causing me pain.
Surgery was mentioned about three and a half years ago, on L2/3 and L3/4, which he said would need to be fused and the L4/5 fusion would have to be extended into them. He said it would be very invasive.
The last neurosurgeon I spoke to a week ago said that to do surgery on those levels, it would be very difficult to remove the hardware. I assume she meant the rods to put in longer rods. She referred to how long ago my surgery was and I think she was saying that it would now be difficult to get them out because of bone grown over them.

I do hear of people having fusion surgery on adjacent levels to an existing fusion, so it must be possible. Does the fact that my surgery was over ten years ago make this more difficult.
I am also wondering about fusing L2/3/4 and L5/S1 and joining them into the already fused level of L4/5.

I am also concerned that L1/T12 has a herniated disc and has developed a degenerative spondylolissthesis (retrolisthesis) which is beginning to change the curve of my spine. There are herniated discs at L7/8, L8/9, L9/10 and L10/11. There is also a retrolisthesis developing at L2/3 and another at C2/3. Is there anything I can do to stop or slow down the progression of these slips?

[Donald Corenman, MD, DC]

#34517

It is distinctly not a problem to get old hardware out. When I found it necessary to remove hardware, I had about a 99% success rate and if one or two screws cannot come out, you can easily bypass them. If you have multiple levels and most need TLIF fusion (which you cannot do at cord level (L1-2 generally), you can do anterior-lateral OLIF and posterior fusion. You do have to be careful in that you have degenerative levels already above your T12-L1 level and these can wear out more quickly if already degenerative. You also cannot stop a fusion at the apex of a curve (T7-8).

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.

[Jellyhall]

#34571

Thank you for your reply Dr Corenman.
I have now had a telephone appointment with another of the registrars of the consultant that I am under. I deal with a different one at each appointment, so neveer know how much of my file they have read and there isn’t time to go through everything during the appointment, which is 15 minutes long, because we are talking about the whole of my spine.

This latest neurosurgeon said again, several times, that doing surgery on my spine would be “extensively complicated and invasive”. He also said that “any surgical intervention on my spine would be associated with significant morbidity and would not guarantee reversal of symptoms and could make them worse. In fact, there is no surgical target for the back pain.” He said it would be a last resort and is sending me to Pain Management to try spinal injections. I was referred for this in August 2019, but by the time my name got to the top of the list, I had one appointment but the Covid shutdown happened, so I never moved on to have the Medial Branch Block injections he wanted to do to check which levels were pain generators before doing Radiofrequency Ablation there. I am still waiting to receive a reply to a letter I have sent asking to move forward with my treatment.

I now have numbness in the little finger and half the ring finger on my left hand, that doesn’t go away. Sometimes it is worse than others, but it never completely goes away. The neurosurgeon said he wasn’t worried about this because the EMG/nerve tests I had done a year ago didn’t show any evidence of left ulnar neuropathy. I hope he is right. My Mri report done in November 2019 states there is right exit foraminal narrowing at C4/5 and C5/6 and minimal left exit foraminal narrowing at C6/7.Flexion and extension cervical x-rays done in November 2019 showed a grade 1 anterolisthesis of C2 on C3 which reduces slightly on extension.

The MRI report from November 2019 mentions there are small disc osteophytes (?) in the mid and lower thoracic spine as noted previously in 2018. These are at T12/L1, T8/9, T9/10 and at T2/3.
It also says there is straightening of the lumbar spine and minimal retrolisthesis at L2/3. It also says there are disc-osteophytes noted at L2/3, L3/4 and L5/S1 levels.
I asked him if the straightening of my lumbar spine was going to be a problem because I suppose the spine isn’t loaded correctly now. He said yes it would and that it would be part of the reason I was in pain.

He also mentions that my MRI scan done in November 2019 showed acute effusion in both cervical and lumbar previously operated sigments. Also that there is extensive degenerative spine disease along the whole spine.
They will have another telephone appointment with me in 12 months time.

Dr Corenman, I would be extremely grateful if you could comment on this, especially the points that I have put in bold. I know that there is a lot here, sorry.

[Donald Corenman, MD, DC]

#34572

Adjacent segment disease is a real pain generator but doesn’t necessarily mean that your pain generators are the adjacent levels. A work-up would need to be completed to determine that. Nonetheless, your consult surgeon sounds like he would not be interested in pursuing surgery. If you have not yet gone thru MBB and RFA, that should be the next step before surgery is considered.

For your neck, your complaint of “I now have numbness in the little finger and half the ring finger on my left hand, that doesn’t go away” could be the ulnar nerve at the Cubital tunnel, the C8 nerve root, Tunnel of Guyon compression or even thoracic outlet syndrome. The EMG/NCV and a thorough physical examination can determine that.

See:
https://neckandback.com/conditions/cubital-tunnel-syndrome/
https://neckandback.com/conditions/thoracic-outlet-syndrome/
https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

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.

[Donald Corenman, MD, DC]

#34573

Adjacent segment disease is a real pain generator but doesn’t necessarily mean that your pain generators are the adjacent levels. A work-up would need to be completed to determine that. Nonetheless, your consult surgeon sounds like he would not be interested in pursuing surgery. If you have not yet gone thru MBB and RFA, that should be the next step before surgery is considered.

For your neck, your complaint of “I now have numbness in the little finger and half the ring finger on my left hand, that doesn’t go away” could be the ulnar nerve at the Cubital tunnel, the C8 nerve root, Tunnel of Guyon compression or even thoracic outlet syndrome. The EMG/NCV and a thorough physical examination can determine that.

See:
https://neckandback.com/conditions/cubital-tunnel-syndrome/
https://neckandback.com/conditions/thoracic-outlet-syndrome/
https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

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.

[Jellyhall]

#34577

Thank you for your reply Dr Corenamn.

I am waiting to see the Pain Management Consultant, but here in the UK the wait is generally long.

My MRI scan done in November 2019 showed acute effusion in both cervical and lumbar previously operated segments. Also that there is extensive degenerative spine disease along the whole spine.

Could you pleases explain what ‘acute effusion in both cervical and lumbar previously operated segments’ means?

My next appointment is in September 2022 and will be another telephone appointment, so it won’t be possible to have a thorough physical examination.
I suspect that the neurosurgeons will leave me until I need to have surgery urgently, as there is such a long list and backlog due to Covid stopping elective surgeries.

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