L5/S1 Lateral Recess Stenosis

///L5/S1 Lateral Recess Stenosis
L5/S1 Lateral Recess Stenosis
Viewing 6 posts - 19 through 24 (of 28 total)
  • Author
    Posts
  • Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    I understand your confusion with all these different and disparate conclusions.

    I am unclear why two levels would be necessary to include in an operation. It is possible that a decompression would not yield relief but that would be unusual if your selective nerve root blocks were diagnostic. This surgeon is correct that if the SNRB does not support the diagnosis of LRS, “it isn’t helpful”. That is the reason for the SNRB in the first place! A non-diagnostic block should point the diagnosis in another direction.

    It is clear that the MRI notes LRS but the connection needs to be made between LRS and your symptoms. That is the reason for the SNRB. I disagree with this other surgeon regarding the CT scan. It would be helpful to know how much facet can be removed and what the anatomy of the operated facet looks like.

    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.
    YNA
    Participant
    Post count: 15

    Hi Dr. Corenman,

    My pain specialist is willing to order a standing 1.5 T MRI, if that would be helpful in visualizing the dynamics of my spine as I stand?  She would also order the CT, but asked if I wanted a CT “spec” and whether I wanted with and without contrast?

    We also talked about the SNRB and that it may be difficult to do a lateral recess block, in particular.  She said if she tried to block S1, most likely L5 should be blocked as well.

    Thank you, again!

    Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    A standing MRI generally is a 0.7 tesla “Fonar” machine and is generally not helpful. Motion artifact makes the images less readable.

    You already know what the potential diagnosis is (LRS). We just have to prove it. Your injection doc is correct in that both L5 and S1 roots will be blocked with a small volume TFESI at the L5-S1 foramen. The results from L5 are not relevant here as your films note no L5 root compression. The compression is at S1 and that root needs to be blocked.

    You don’t need a spect scan CT with it’s attendant extra radiation. The STIR images off the MRI (which are negative in your case) have supplanted the spect scan in almost all cases.

    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.
    YNA
    Participant
    Post count: 15

    Dr. Corenman,

    Should the CT be without and without contrast, or without? Also, she suggested a SNRB, then if it works a TFESI to provide some relief.

    I have a feeling none of the regarded spine surgeons I see would study the CT to guide them when they perform a decompression (I am disappointed by that). Do surgeons typically use monopolar or bipolar for a single level? I would think the less tissue destruction the better for healing and for maintaining a good vascular supply to the nerve roots, especially for neurogenic claudication.

    Thank you again, without you I really would be lost!

    YNA
    Participant
    Post count: 15

    Dr. Corenman,

    Thank you again for your advice, but I am need of it again. As you know from our consultation, my left leg is far worse than my right leg, BUT I actually I have a considerable amount of aching pain (sometimes 9/10, despite large amounts of Gabapentin) in BOTH legs (calves and hamstrings).  My surgeon thinks my amount of pain laying in bed on Gabapentin doesn’t match with my MRI. 

    I have an important question– at this point I can bear weight on my right leg.  My left leg can bear weight, but is very weak. I’m very worried that after my bilateral decompression (God forbid), if I have a complication I will not be about to even walk to rehabilitate myself.  Just yesterday I developed left-sided significant weakness (couldn’t plantar and dorsiflexion), went to the ER, and had an unchanged MRI.  Some of the strength came back, enough to hobble to the bathroom.  That scared me because I now need a walker to walk around my house because of significant left leg fatigue and deconditioning over the past 6 months. 

    What are your thoughts about doing just a left sided L5/S1 decompression vs. a bilateral L5/S1 decompression.  If I cannot walk after surgery, I will be in trouble and I have not been lucky at all since my left L5/S1 microdiscectomy. 

    Thank you, again.  I need to get better because my whole family is depending on me.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    It is always possible to have a complication from any surgery as you know well but this bilateral lateral recess decompression is a simple surgery. In fellowship programs would be performed by the fellow as it should be simple and has minimal complications. Yes, you had prior surgery which does incite some scar but a skilled surgeon should have no problem with this.

    I would do bilateral as if you had only one side and had a great outcome, you would be highly disappointed that you did not do the other side under one anesthesia.

    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.
Viewing 6 posts - 19 through 24 (of 28 total)

You must be logged in to reply to this topic.