[rjt212]

#6739

Dear Doctor, After a fall in 2005 began to have calf pain in both legs, then tleft buttocks pain, and then burning sensations in feet. MRI & CT scans showed L5-S1 Pars defect and compression of nerves at that level. After Minimal Invasive Surgery in 2007 everything got worst for many months but eventually returned to the same pain levels as before surgery. L5-S1 never fused and over the past 7 years I’ve been to several other Spine Surgeons. One said the fusion failed because the original surgeon only put a pedicle on the left side causing movement and consequently failure of the fusion, therefore I need to have full fusion surgery to correct it. Others say the CT Scan doesn’t show pressure on the nerves therefore surgery probaby won’t help, so don’t have more surgery.
Over the past 3 year’s my feet have become more and more painful on the bottoms when walking or standing, still have burning sensations in feet, can’t sit without constant pain in left buttocks and occasional calf pain. Never have back pain before or since surgery
Finally the question is if you think more surgery would relieve any of my conditions or prevent them from getting worst or if its not worth the risk? Since I’ve had this nerve pain for so long is it too late? Can nerve pain go away or is it permanent damage?

[Donald Corenman, MD, DC]

#6743

If you have a failure of fusion (pseudoarthrosis), especially if the original surgeon only place one sided pedicle screws, there could be instability. Even if the MRI does not reveal severe compression, compression can be underestimated on the MRI. Remember that the MRI is performed with you lying down and not under the influence of gravity.

Flexion/extension X-rays and AP standing and supine X-rays can reveal instability that the MRI will not. If your pain is increased with standing or walking, this would help to confirm this instability. Symptoms that do not follow this pattern do not mean instability is not present.

Nerve pain can be eliminated or reduced if the compression is removed but there is a 10% chance of chronic nerve injury with chronic compression.

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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