[Donald Corenman, MD, DC]

#10472

If you have a stable pseudoarthrosis (no pain or neruological problems), then you do not need surgery. If you have symptoms of back pain without neurological findings, you only need surgery when you cannot tolerate the symptoms. If there is neurological findings, surgery needs to be contemplated sooner. If weakness is present due to the pseudoarthrosis, you need surgery much sooner.

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.

[cdebrun2002]

#10475

I’m sorry for being dense, but what are neurological findings? By weakness do you mean an observed deficit in the legs etc., or just general weakness in the back? If I could tolerate the symptoms of back pain and tried to live a halfway normal life, ie work, swimming, etc, will that level of activity risk further damage to the spine since it has not fused.

Thank You

[Donald Corenman, MD, DC]

#10482

Neurological findings generally mean a documentable weakness in the leg (or legs) due to compression of a nerve root(s). This could also include bowel and bladder involvement if the canal is compressed and cauda equina syndrome could be a possibility. Weakness of the back is normally generated from pain inhibition and not a neurological problem.

If you have a stable pseudoarthrosis, this means that you do not have bone to bone connection of the two vertebrae but do have heavy fibrous tissue (scar tissue) that acts as a binding agent between the two bony surfaces. This will allow slight motion which can create some discomfort but the bony surfaces are tethered together and will not move enough to cause instability or significant 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.

[cdebrun2002]

#10491

If my fusion is shown to be unstable, (I assume the stability is determined by flexion/extension X-ray), combined with my current pain, will I cause any further damage if I put off surgery? Alternatively if it is shown to be stable will the slight motion cause problems over time?

Could you point me to a resource that I can check to learn about how to read/use the flexion/extension X-ray to determine whether the fusion is stable/unstable.

Thank You

[Donald Corenman, MD, DC]

#10492

Unless the instability is significant (greater than 3mm of translation or lateral shift which would be unlikely), this instability can cause increased pain but generally is not dangerous.

Motion of the pseudoarthrosis can cause bone spur formation and nerve root compression over time but nerve pain generally would come on slowly and normally not cause weakness.

There are some parameters to look at flexion/extension x-rays to determine instability but many intangible factors also come into play. This is where the art and science of medicine roll into one.

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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