[Donald Corenman, MD, DC]

#8607

Electrical simulation can now be started. Work on strengthening the intact muscle cells with weights or theraband. You can also obtain a repeat MRI to make sure the root is fully decompressed.

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.

[catmadni]

#9141

Doc,

It’s been three months since my last update

Per my last post, #4333, I began electrical stimulation therapy. Basically twice a week. I feel that I have gained marginal strength in the left calf. My gait is still greatly compromised by the lack of push off.

The event that prompted this message is that last Thursday I felt that familiar slipping sensation in my lower spine that had occurred previously. It was immediately followed by left lower back pain and radiciopathy pain down my left thigh, outer lower leg, foot, and heel

This event is very similar to the 10/9/12 event that I described in my #3220 post. I had the first surgery, L4/5 discectomy on 10/19/12, then followup MRI indicated a large fragment (2cm in one dimension) of L4/5 disc material, had broken off, traveled down the canal, and settled on my S1 nerve root below. This ‘slippage’ sensation event of the migrated fragment, is what caused my S1 radiculopathty? Then I had the second discectomy (L5/S1) on 11/9 to remove the migrated fragment.

I am extremely discouraged that the already battered nerve is probably compressed again. It makes no sense to me that I should continue to get partial microdiscectomy where disc material is left to cause future damage to the same nerve root.

Should I go back to my same neurosurgeon? Is fusion surgery now indicated? Is it possible to live with this circumstance, without further intervention, and still hope for a complete nerve recovery within the next few months? Should I get new images and send them to you? Should I fly out there to have you examine me?

I am very unsure what to do next

[Donald Corenman, MD, DC]

#9150

You report the L4-5 disc has herniated twice. If it has herniated now a third time, it is time for a fusion of this level. What is somewhat confusing is that the second herniation surgery was performed at the L5-S1 level. Are you certain that the fragment taken out at the L5-S1 level originated from the L4-5 level? That would be unusual.

The neurosurgeon cannot be blamed for recurrent disc herniations. These recurrent hernations occur in about 10% of active patients.

Disc material is left within the disc space after surgery to provide cushion to the endplate bony surfaces with impact activity. In the “old days”, surgeons would try and remove as much disc material as they could. The result would be lower back pain in many patients.

If you would like, you can send your previous MRIs to the office for my review.

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.

[catmadni]

#9152

Doc,

Sorry for the confusion. I was being brief. I had already provided all the details in my previous posts several months ago, and did not want to bore you.

My first microdistectomy was of L4-5. This first procedure was set up following an MRI which indicated the most significant herniation at that level. However it was done emergently following muscle weakness.

My muscle weakness was assumed by the neurosurgeon to be from this same level, but I presented with inability to raise on my toes. The neurosurgeon proceeded anyway without a new MRI.

Without any releif from the first microdisectomy, I pushed for the second MRI. The MRI was done and it was discovered that my S1 nerve root was being compressed by a fragment that had migrated from the L4-5 disc material and settled down to compress the S1 nerve root.

The second surgery was scheduled to remove the fragment and decomress the S1 nerve root. During this surgery a microdiscectomy of L5-S1 was also completed, considering that this level was also diseased, although not enough necessarily to prompt surgery initially.

I was not inferring blame on the neurosurgeon, just inquiring about whether a neurosurgeon is the correct discipline for fusion or any other procdure moving forward.

Please consider my questions again, now that I hopefully cleared up the facts.

Should I go back to a neurosurgeon? Is fusion surgery now indicated? Is it possible to live with this circumstance, without further intervention, and still hope for a complete nerve recovery within the next few months? Should I get new images and send them to you? Should I fly out there to have you examine me?

Thanks again for all your valuble time

[Donald Corenman, MD, DC]

#9155

My understanding now is that you have had two microdiscectomies at L4-5 and one at L5-S1. You do not have a new MRI when these new symptoms have occurred but the new symptoms are very similar to the older ones when you had the previous two herniations-correct?

If the above is true, a new MRI is warranted. If there is a new herniation at L5-S1, you only need a microdiscectomy at that level since you have had only one prior microdisc surgery. If the new HNP is at L4-5, you would need a fusion.

Would the neurosurgeon be the one to perform the fusion? That I cannot answer. It depends upon his or her experience and how many fusions this individual has completed. Look under “Treatments” in the header of the website and scroll to “Questions to ask your spine surgeon”. You might gain insight as what to ask.

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.

[PFCRANGER]

#9156

Hey Doc, it’s been now 9 months since my L5 S1 fusion surgery. A quick recap I had 3 back surgeries total, laminectomy/ diskectomy on 6/26/12, another on 8/21/12, then fusion of that level 11/6/12. Problem occurred from a motor vehicle accident in 3/11/12. The fusion was preformed because of the third herniation and disk collapse/ instability. I have not been the same since the fusion lots of pain and issues with my back and leg. As the previous post will explain, since the fusion I have had 2 MRI’s one only a month after the fusion which show possible disk fragment impinging on the L5 nerve, but alot of scar tissue so the scan was deemed no good. I recently had another one done which stated a protruding disk at L5 S1 in the foramen at L5 impinging the L5 nerve. So the Dr decided to preform a Myelogram, the Myelogram shows a osteophyte in the L5 neural foramen impinging the L5 nerve. My question is how did this form and are the surgeries causing the body to respond to the stresses of these procedures in this manner?

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