Viewing 6 posts - 1 through 6 (of 12 total)
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  • Purduejaime
    Member
    Post count: 6

    Dear Doctor,

    I need help determining if a second surgery might be of any help to me or if I should remain a chronic pain patient my whole life! I’m only 31!!!

    I am a 31 year old former figure skater who had a pars defect that turned into Grade 2+ Spondylolisthesis. In 2002, at age 21 I had a posterior only fusion WITHOUT disc removal using 4 pedical screws and autograft from iliac crest. At the time of surgery, I got 90 percent of pain relief from radiating pain, and 75 percent low back pain relief.

    Since that time, after about 4 months to two years post surgery, the low back pain began increasing in frequency and quality. It was worst when sitting or standing for any length of time. Also, ive had chronic muscle spasm knots in low back since 2 years post-op. At 12 months and two years post-op, I had imaging done that showed normal post-fusion changes and successful fusion. At 2 years post-op, I went to visit a pain management doctor, after the surgeon determined it is possible remaining pain is from disc left in (disc was only bulging at time of fusion, was not standard protocol in 2002 to remove). I Was unwilling at that time to consider further surgery.

    Since that time I’ve had SI injections, epidural injections, and been on 9 years of short-acting narcotics. In 2011, I gave birth to my son, and since that time, I’ve had increasing SEVERE pain at all hours of day and cannot stand or sit for any length of time. The only semi-relief I get is while laying down, but the actual motion of laying down is EXCRUTIATING. It feels as if my whole back is shifting into different place and is painful for two minutes then let’s up.

    Imaging studies I’ve had since birth of my son show increased mild osteophytes and arthritis, increased kyphosis in thoracic spine, mild spondylolisthesis in l5 (is this normal, has never been recorded before?), post-fusion changes, and of course the disc between L5s1 is very very sick thin and black. In response to these imaging, I had RAF procedure on left side and have actually been in extreme pain since this as muscles responded with increased spasm. So, arthritis doesn’t seem to be cause of spasm? I’ve also had massage, chiropractor care, traction (felt best of anything) and PT since having him.

    I’m in line to speak with a spine surgeon, but I would very much appreciate another opinion!! Do you think it is possible my pain has been caused by dying disc that was potentially moved during delivery of son? Do you think additional surgery could have a potential beneficial outcome? I do not want to be disabled and become a lifetime chronic pain patient (although I am right now) and have to go on longer acting meds. However, I have always heard that 2nd surgeries are not very successful. Also, do you think upper back numbness from kyphosis is related at all to the fusion in my lower back?

    Anyhow, I apologize for the length, but I hope I’ve provided you with enough necessary information to tell me whether I may be a candidate for surgery or other procedures (Botox etc). One parting thought…. The ONLY time I’ve been pain FREE since 1996 was when I had the epidural to have my son. I am in so much pain I begged for constant epidural at the cost of using my legs, which of course has been declined.

    Thank you, Jaime

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    A grade II+ spondylolisthesis does not respond well to a posterior only fusion with instrumentation but at the time of your surgery, the posterior fusion was the procedure of choice for many surgeons. The first suspicion I have is that the surgery did not create a solid fusion. Most patients who had undergone fusion with good relief for only a short period of time (in your case four months to two years) have a potential for a non-fusion (pseudoarthrosis). I am suspicious of the imaging a year down the road that indicates solid fusion.

    You indicate “mild spondylolisthesis” of L5. I am unclear if you mean the L4-5 level or residual slip of the L5-S1 level. If the L4-5 level is slipped, this most likely is a degenerative spondylolisthesis (see website), a common problem for females and a common spinal pain generator.

    Has the disc at L5-S1, the prior fusion level changed in appearance since your initial fusion so many years ago? Normally, a posterior fusion at L5-S1 will “freeze in time” the appearance of this disc as the fusion “unloads” the disc. A change in the disc appearance leads to suspicion of motion and loading of this disc space regardless of the fusion status.

    You need a complete work-up including a CT scan and MRI (on good scanners) and a diagnostic work-up from a meticulous and experienced spine surgeon.

    Dr. Corenman

    Purduejaime
    Member
    Post count: 6

    Oh my goodness!!! I want to thank you Dr. Corenman!!! You’ve thoroughly answered the questions I have (given the constraints) and told me things no doctor has told me before! I cannot tell you how much I appreciate your advice and the time you took!

    In regards to your further questions, the recent films I’ve had (flex and extension X-rays and mri w/ and w/out) show mild Spondylolisthesis at L5/s1 and nothing wrong at the next level up. In regards to your disc question, YES a change has happened! Over the years I’ve had imaging, my disc has gone from bulging (at time of fusion) to nearly completely black and compressed! I had NO IDEA that the disc was supposed to stay the way it was, ie frozen in time!!

    So, even though the X-rays don’t show movement, could there still be movement?

    Thank you again for these answers. I’m optimistic that I could have helpful treatment for the first time in a decade!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The change in your disc appearance over time most likely indicates a non-solid fusion. Flexion/extension x-rays do not have to demonstrate gross motion for a non-union to be present but there are subtle signs that can indicate motion without measurable motion being present.

    See if you can ask your current doctor for a CT scan of the L5-S1 segment. The scan should be on a 64 slice or 128 slice scanner for the best accuracy.

    Dr. Corenman

    Purduejaime
    Member
    Post count: 6

    Dr, I just want to again thank you for your help! I saw a spine surgeon today and he told me immediately (with no examination and short history taken by the nurse) that he didn’t see anything he could help me with on my MRI. I was immediately in tears because that was the answer I feared the most.

    Because of your responses, I was able to ask him about the possibility of movement in my fusion and he ordered CT and Xrays. I had the xrays done today and because I’m not a doctor or radiologist I don’t know if the appearance of movement between the vertebrae is just a trick due to the change in angle from laying to standing.

    Could you please take a look at these xrays to see if it is apparent at all. Also, I really wish that you lived near the area where I live because you are doing a great service to people through this. (I sent the pictures by email).

    Jaime

    Purduejaime
    Member
    Post count: 6

    ALSO, in addition to above text, the spine doctor I saw said that the reason why my disc is degrading so much is because it is not being used. Is that possible?

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