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  • Avatarzachgolfs
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    Post count: 2

    Hi Dr. Corenman, I had an L5-S1 ALIF done about half a year ago for my isthmic spondylolisthesis, and while it has resolved all my horrible nerve pain at that level of my spine, I still have two other issues that are not getting any better (and maybe they won’t from this surgery). Both issues on my left side, they may or may not be related to each other.

    One of those is what my PT thinks is Meralgia paresthetica since i have a sharp and poking pain on my left waistline/hip area and a burning sensation down the side of my thigh. It is not like other nerve pain, not as directly painful and doesn’t make your body give out on you. Just very uncomfortable. Some of the stretches help, but relief is brief. This started after surgery.

    The other issue is one I have had since before surgery and that is pain in my left waistline/hip/SI region. It is basically a deep ache, and a somewhat painful grinding feeling when I flex up my leg and return it to normal. It is like a grind and sometimes more of a clunk.

    Do you have any thoughts on if these two issues will get better as time goes on, since I’m of course (hopefully) not fully recovered from surgery just 6-7 months ago? Any treatment options or surgical options down the road?

    Thanks so much! I greatly value all you do, and if issues persist would appreciate the opportunity for a consult with you.

    Sincerely,
    Zach

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7629

    Meralgia paresthetica is uncommon but not rare after spine surgery. It is more uncommon with an ALIF (anterior lumbar interbody fusion) as you normally are lying on your back during the procedure. This position (as compared to lying on your stomach) does not pressure the front of the pelvis where this nerve (lateral femoral cutaneous nerve) lives. There are occasions where an injection of some steroid over the nerve can be helpful and rare occasions that a surgical decompression can be helpful although I have never had to refer a patient for that procedure.

    “The other issue is one I have had since before surgery and that is pain in my left waistline/hip/SI region. It is basically a deep ache, and a somewhat painful grinding feeling when I flex up my leg and return it to normal”. This could be from the hip on that side, a pseudoarthrosis (lack of fusion), especially if you did not have screws from the back of the spine to “back up” the ALIF, or more uncommonly, the sacroiliac joint.

    The hip is diagnosed by an examination and diagnostic injection, the pseudoarthrosis by X-eays and a CT scan and the SI joint by a diagnostic injection.

    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.
    Avatarzachgolfs
    Participant
    Post count: 2

    I had the grinding before surgery and it feels like it is the SI Joint. If I were to get it diagnosed with an injection like you describe, would I need to strengthen that area around it or increase flexibility in that area? I haven’t received very good guidance from my PT, and this question I think would be really in a chiropractors wheelhouse.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7629

    As long as you have a solid fusion, manipulation of the SI joint by a chiropractor can be helpful. You can even try it before an SI injection.

    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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