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  • Avatarmaxsuarez
    Participant
    Post count: 3

    Hi,
    Thanks for considering my question.
    My doctor is recommending a Left L1-4 XLIF and L4-S1 ALIF surgery for my scoliosis. I am 63 years old in pretty good physical condition. I am not in too much pain, I have had no need to take any pain medications, so the surgery is more to prevent getting worse, since my Dad is 88 years old and has very severe scoliosis and his scoliosis progressed very rapidly in less than 10 years.
    Below is the MRI report of my lumbar area.
    FINDINGS:
    Approximately 19 degrees left convex lumbar curvature centered at L3-L4.
    Mild acute degenerative endplate changes at L1-L2 and L4-L5. Otherwise, the marrow signal throughout the lumbar spine is mildly heterogenous without significant focal abnormality on the STIR images.
    The conus medullaris is normal in caliber, signal intensity and location, located at the L1 vertebral level.
    T12-L1:
    Mild loss in the signal. No significant disc bulge or protrusion is identified. The neural foramina and spinal canal are normal in caliber.
    L1-L2:
    A 1 to 2 mm retrolisthesis with 3 mm central bulge. No central spinal canal stenosis with AP diameter measuring 1.2 cm. Patent neural foramen.
    L2-L3:
    A 1 to 2 mm retrolisthesis with 2 mm bulge towards the right side. No central spinal canal stenosis. Disc extends into the right inferior foramen with no indentation of the exiting right L2 nerve within the foramen. The disc does extend far right lateral measuring 9 mm with abutment of the adjacent psoas muscle. Disc extends into the left neural foramen with abutment of the exiting left L2 nerve without visualized compression.
    L3-L4:
    A 1 to 2 mm retrolisthesis with 3 mm rightward bulge abutting and possibly mildly indenting the descending right L4 nerve. Disc abuts the exiting right L3 nerve with no visualized compression. No central spinal canal stenosis.
    L4-L5:
    A Central bulge measures 4 mm with asymmetric right-sided facet hypertrophy with moderate changes also on the left facet. Both lateral recesses are narrowed with abutment of both descending L5 nerves with questionable mild indentation. Moderate to marked right neural foraminal narrowing with mild indentation of the exiting right L4 nerve.
    L5-S1:
    A 2 mm central protrusion results in no spinal canal stenosis. Moderate left neural foraminal narrowing.
    IMPRESSION:
    Allowing for significant differences in technique, no interval change.
    Approximately 19 degrees left convex curvature centered at L3-L4.
    No central spinal canal stenosis.
    At L4-L5, mild indentation of the exiting right L4 nerve and abutment of both descending L5 nerves with questionable mild indentation.
    At L3-L4, questionable mild indentation of the descending right L4 nerve.
    I would like to know if this type of surgery is a good idea at this time. And if it is what will my life be after such a big fusion. Will I be able to stay active after my back heals. Will I be able to hike, bicycle ride, swim and workout. I do not know anyone that had this type of surgery so I don’t know what to expect.
    Thanks in advance,
    Max

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7569

    When you state “I am not in too much pain”, you must define that statement for me. Do you have only mild pain that is not impairing (won’t stop you from activity) or are you becoming more sedentary with pain onset?

    Do you have earlier X-rays to compare with the current 19 degree curve. That is, has this curve advanced in the last 5-10 years or is it stable without need of corrective surgery?

    If we assume that you need the surgery, I would be somewhat wary of the planned procedure for a scoliosis. All of this planned procedure is performed from the front (anterior) and I see no posterior pedicle screw planning. These anterior procedures do not have the stability of a posterior procedure and this is probably “too much surgery” for the planned results. I would get a second opinion with a spine surgeon who has experience in these procedures.

    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.
    Avatarmaxsuarez
    Participant
    Post count: 3

    Hi Dr. Corenman,

    Thanks for the reply.

    I am not is much pain now. I do not take any pain medicines. The pain is more frequent when I am sitting, I am a computer programmer so I am sitting a good part of the day. I just move around and it ussually takes care care of the pain which is more of a burning sensation. I have various discomfort’s here and there but they are manageable.

    I have X-rays that have shown that the curvature has progressed in the last 5 years. Since it is not too bad now what do you recommend at this time, should I wait a few more years and see how the curvature progesses in the next few years.

    Let’s said that the surgery is the only way to go, which surgery would you recommend so I can have an idea when I go for a second opinion. I wish I could be in Colorado to come over to see you, but financially I can’t.

    Thanks again,
    Max

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7569

    Pain is generated by discs, nerves and facets. Your pain might be generated from only one or two segments. You might need a full lumbar spine fusion but my bet would be you only need a portion of the spine addressed. Of course, without reviewing the X-rays, I’m just using my experience for a general estimate of your disorder and what needs to be done. Find a spine surgeon (spine orthopedist) for a second opinion.

    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.
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