[rypz79]

#33600

Dr. Corenman

AFAIU I’m dealing with several indirectly connected issues that are stemming from the same source – DDD:
1. Discogenic pain
2. Facet joint syndrome
3. Spine instability
4. Nerve pressure/damage

Again according to date medical knowledge  there is no guarantee that even If I go for a TLIF surgery there will be an additional improvement with problem #4 but it will solve probelm #1 and prevent problems #2 & 3. am I right?

Total disc replacements (TDR) or “arthroplasty-ADR” works well in the neck but are not very good in the lower back

In general, why? because it doesn’t solve “posterior issues“ such as spine stability and facet joint syndrome?
Common sense says tells me that if you restore the disc space to it’s previous state it also decompress the foraminal space reliving the stenosis and the exiting pinched nerve on this level.

According to this brochure
There is a surgery called Total Lumbar Facet Replacement which uses a newly TOPS or NEXUX artificial joint systems that stables the facet joints function while preserving motion.

Now the question I’m asking is if you add TLFR does it (at least it theoretically) solve the problems you presented with having a TDR: 

….redo decompression to free the nerve. This procedure might require removing significant facet bony mass which could make the facet incompetent. An intact and functioning facet is necessary to allow a TDR to function properly.

Thank You very much Dr. Corenman

[Donald Corenman, MD, DC]

#33602

“TLIF surgery there will be an additional improvement with problem #4 but it will solve probelm #1 and prevent problems #2 & 3. am I right?” 1. Discogenic pain 2. Facet joint syndrome 3. Spine instability
4. Nerve pressure/damage. TLIFs are the best surgery for nerve root compression as you can deal with compression directly. The surgery solves discogenic and facet pain by stopping motion and motion is required to cause pain.

The problem with Total Lumbar Facet Replacement is that the strain (pressure) on the facets are greater than on the disc and the bony area to hold this replacement is quite small (therefore greater implant pressure on a much smaller surface area) leading to potential implant failure.

The reason I don’t like total disc replacements (TDRs) is that they are not designed for shock absorption (which is one of the main purposes of the disc) and implant failure requires a repeat belly surgery that can be life-threatening. This is not the case for cervical disc replacements which I endorse and implant

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.

[rypz79]

#33718

Dr. Corenman

10 days ago I went for a one year post-op checkup. As you suggested the surgeon said that a re-herniation could’ve occurred but the fact that I said that I feel less pain and numbness made the impression that the re-herniation fragment probably have been absorbed.

The real truth is that my leg pain is in volatile condition it seems to me that the pain/numbness is worse in the morning while I take my first steps and gradually becomes less symptomatic during the day & night after I take my 2×150mg Pregabalin straight in the morning together with 3×0.5mg Klonopin spreaded through the day.

I try to maintain a daily routine of twice a day 10min 90° inversion stretches and core crunches along with twice a day 10min side bridge manipulation on a very wide yoga bolster. Unfortunately though I feel my back is much more stronger then 4 months ago there are still “bad” postures that never existed prior to the injury which aggravates my pain/burning sensation significantly.
I cannot live normal life while babying my back that’s impossible.

So my question is in practice if I’ll undergo a successful TLIF surgery to the stable and reconstruct the normal disc space thus open the foraminal stenosis completely will I’ll be able to sit/lye in those “bad” postures without having my symptoms aggravated or I will need to “baby” my back  and avoid those “bad” postures with ones that don’t aggravate my symptoms in any case (w/ or w/o a TLIF)?

Thank You Dr. Corenman

[Donald Corenman, MD, DC]

#33721

“the pain/numbness is worse in the morning while I take my first steps and gradually becomes less symptomatic during the day”. This is a typical condition with inflammation in the spine. Lying down makes your back the lowest part of your body and it acts like a sump. allowing fluid to gather at this point. When you stand up, this fluid accumulation congests the area causing increased symptoms. It takes about 20-30 minutes for this fluid to resorb in the standing position.

I can’t tell you a TLIF is your answer without further information but if it is indicated, you should be able to do what you want within reason once you heal.

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.

[rypz79]

#34025

Dr. Corenman

I still have problem with sitting.
Even for a few minutes even on a stable chair or on a comfortable couch. Almost immediately I feel pressure on my L5 nerve root which escalates the numbness to burning sensation on my right foot bed.

I’m currently overweight ~225lbs on 6’1 frame trying to maintain a healthy diet but not living a “healthy lifestyle” which includes daily aerobic exercises some of it has a mental issue with pain/paraesthesia tolerance which I’m trying to solve with a specialist.

A few days ago I went to see the surgeon.
He said that the “next stop” for me as you projected is TLIF he said that it’s not a necessary surgery but can be useful.

Now the question I want to ask is if theoreticaly I’ll loose ~30lbs and/or strengthen my core muscles (i.e the more weight I have the more strong those muscles must be) I will not have any problem with normal sitting or my DDD w/ forminal stenosis is such a biomechanical failure that no matter what I do with your core muscles and weight loss you will get nerve pressure wherever you sit or sit for prolonged time?

I can ask this from another direction will TLIF solve this pinched nerve problem without me having to loose weight or strengthen my core muscles or anyway I’ll have to loose weight/strengthen my core even after TLIF because of  potential ASD (Adjacent Segment Disease)?

Thank you Dr. Corenman

[rypz79]

#34329

Dr. Corenman

~18.5 months post op there is a significant improvement in the paraesthesia. 70-80% roughly most of the numbness is gone. heat/cold thresholds are almost the same in both feet, but there is still pain when walking with flipflops or non-cusioned shoe/clog and where I live ATM I use those a lot.

I’m considering the pros and cons of a fusion surgery. I met the surgeon couple of months ago he “pushed me” towards strengthening my core saying something like fusing one level could lead pretty quickly to ADD in the level above and strengthening my core is the “real cure”

although I think I’ve strengthen my core muscles significantly using a roman-chair an inversion-table at 90° and deadlifts there is always a position and time that will cause stress to the nerve (e.g driving an hour+ , sitting on the couch in a certain posture) or cause a vicious cycle of discogenic pain (mainly from bending forwards) even with a very good lumbar support strap in which I feel very stable and less prone to any sort of pain.

If I do a MIS TLIF to L5-S1:
1) The discogenic pain should be gone?
2) The L5 nerve root (which I believe is pretty much “alive”) will get maximal and permanent decompression no matter what’s my core strength/body weight+physical pressue ratio?
3) Will I loose significant Range Of Motion comprared to the ROM I have now with my current degenerate disc?

Though fully recovering from this kind of surgery takes about a year (bone to fuse) we are talking about a long term solution to my L5-S1 DDD while keeping L4-L5 healthy will be in my hands i.e ADD is very much avoidable ?

Thank You

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