[Donald Corenman, MD, DC]

#6920

I think you are on the right track. Flexion/extension X-rays are important to determine the weight bearing component of your disorder. A CT myelogram is a great test to determine both fusion quality and nerve compression. If you were my patient, that would be a test I would endorse.

In addition, as I mentioned before, a SNRB of the L2-3 level bilaterally would be considered if there was a solid fusion of L3-S1. A good temporary result would indicate those nerve roots as the pain generator (see pain diary on the website). This does not necessarily mean that the nerves are mechanically compressed but the likelihood of that is very high.

If the L2-3 level turned out to be the problem, surgery would depend upon the angulation of the deformity. If the endplates of the two vertebra were parallel on standing films but there was instability (spondylolisthesis) present, a simple one level TLIF fusion would be the likely surgery needed. If there was significant angulation (called a kyphosis), adding another level might be necessary to correct the deformity.

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.

[SpinelessWench]

#6932

Given the band of severe bilateral pain approximately 2″ above the gluteal cleft (seriously, I just really like “butt crack” better, but…..), the intense and sudden “bee sting” sensations in the upper buttocks and hips, and the bilateral throbbing in the anterior thighs and lateral calves, could spondylolithesis at L2/3 be a possibility? Or, could hypertrophy of the facets, in and of themselves, be a pain generator? I have several that appear thickened and markedly inconsistent with others. Unfortunately, clarity of the areas below L4 is severely compromised due to titanium artifact, however those around L4 and below seem to jut out to the left (if you look at the sagittal view), then encroach upon the area where you can see the cauda equina. Is it typical for these bony structures/facets to significantly jut out like this? Or, are they supposed to be somewhat aligned with the far right edge/border of the spinal canal?

My PM anesthesiologist ordered plain films of my lumbar spine today, making sure to include both flexion and extension views. The dynamic stabilization instrumentation, because of that small hydraulic “hinge”, makes flexion much easier than extension…bending backward is almost impossible. Which is more important in assessing instability and spondylolithesis?

As always, thank you again.

S.W., NC

[Author]

Posts