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  • Lewiswatts
    Participant
    Post count: 5

    Hello Dr Corenman,

    I have asked a question here previously regarding a TLIF. I have consulted a surgeon back 5 months ago and he didn’t think it was the correct time for surgery as I didn’t seem in a lot of pain and symptoms were intermittent. Although he did express I will likely need it inevitably at some point.

    I have a grade 1-2 spondylo at L5/S1. With moderate/severe exit foramina stenosis. There is also Pffirmans grade 4 degeneration of the L5 disc. I am also 31 years old and fit and healthy. My symptoms have been very intermittent with low grade back ache mainly in the morning. More recently I am experiencing more frequent intermittent altered sensation bilaterally with strange muscle aches is the only way I can explain it. There is also a horrible hamstring tensions on the left side pretty constant which I believe is from nerve irritation I also feel as if I can feel the L5 moving sometimes when I sit up. Also if I wake up on my back after a night sleep it seems to be at it’s worse. My questions for you are:

    1) When do I know it is the right time for surgery, as I don’t want to leave it too late and have lasting nerve damage?

    2) I’m a new grad chiropractor, how long would I expect to be off work from treating patients roughly?

    3) Can I expect to have a long career still as a chiropractor after having a TLIF surgery in your experience?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The right time for surgery when you have an isthmic spondylolisthesis at L5-S1 is when symptoms prevent you from doing activities you desire to do or motor weakness is noted. Since the L5-S1 foramen is compressed and contains the L5 nerve root, you need to know what muscles could be affected that you can test.

    When the tibialis anterior (which brings the foot up) is weak, you can’t walk on your heel on that side. Simple “duck walking” (walking on the heels without your toes touching the ground) is a good test. If the toes eventually start to touch the ground, you have weakness. Also the gluteus medius muscle is an L5 muscle. In something called a “Trendelenberg gait”, with weakness, you cant stand a one legged stance on the opposite side of the weakness.

    Dr. Corenman

    Lewiswatts
    Participant
    Post count: 5

    Thank you Dr Corenman, I do the L5 Heel walk daily to make sure I’m not getting a drop foot.

    The Dermatomal numbness is intermittent through L4-S1 which I find wierd. There is no Myotomal weakness but there is diminished L5-S1 deep tendon reflex but has been for a long time.

    What would the recovery time be estimated at after TLIF until I could manually adjust and work with patients would you think?

    I can still exercise but not run which I used to love because of symptoms later in the day which is mainly compression in low back from impact.

    Thank you in advance for your speedy replies.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    DTR diminished reflex generally is the S1 nerve which should not be affected in your disorder. Slight to moderate intermittent compression of a root will cause dysesthesias of the dermatome without motor weakness.

    If you adjust in your daily practice, it will be at least 4 months before you can do grade 5 mobilizations.

    You should be able to run after solid fusion of L5-S1.

    Dr. Corenman

    Lewiswatts
    Participant
    Post count: 5

    Thank you Doc,

    You are a credit to your profession!

    Very much appreciated.

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