rileyMemberSeptember 3, 2011 at 9:41 pmPost count: 3
hello..I had a “significant’ ruptured disk and after MRI on 5/25/11 had epidural. Siatic pain was gone but numbness in right leg & weakness in toes. Spine doc in Denver recommended microdiscectomy 7/11 but used MRI from 5/25/11 which was taken before epidural. After surgery doc said will probably have perm. nerve damage as he went in and disk was almost all gone. Is it the norm that a MRI 2 months old would be used and there isn’t one used that very same day of surgery? Could not a MRI before surgery have showed no disk material and therefore, no surgery needed? His post op did mention going in and cleaning up the area but it seems weird that xrays/new MRI was not used. I was in the back brace 6 weeks as if I’d had a fusion as he said there was little to work with in the L4/L5 area and I guess it’s pretty weak /degenerated in that area he said.
Question…start PT 9/13 and hope to get back to work Nov 1 but am a flight attendant..Lots of twisting, lifting, pushing. Works galleys a lot which is lots of bending/twisting so is 6 weeks /twice week reasonable about of time for PT for near 100% recovery? Also, this scar tissue build up is a huge lump in the back, will that soften because it’s very tender and painful sitting. Lastly, How likely now is re-rupture of L4/L5. Thank you for your time..Donald Corenman, MD, DCModeratorSeptember 3, 2011 at 11:16 pmPost count: 8408
A new MRI is only warranted if you have had a significant change of symptomatology and not just relief of symptoms. If you had more intense pain or different pain, a new MRI is necessary.
Some spine surgeons have different algorithms for treatment but most will perform surgery sooner than later if weakness is present.
An epidural in the presence of weakness I feel is not the best idea because it will reduce the symptoms of pain and paresthesias (tingling) but will do nothing to reduce the pressure on the nerve root. The patient (and ordering physician) will feel there is substantial improvement because the annoying symptoms have been reduced and will be lulled into thinking there is less compression on the nerve root which is not accurate.
There are times that an extruded disc herniation (a herniation that is fully ejected from the disc space and is an unattached free fragment in the canal) will migrate out of the canal in a short period of time. The operating surgeon will find the tear in the disc and some small fragments but the main offending herniation is not to be found.
I have seen on some occasions that the fragment is missed in surgery as it might be “tucked away” in a hidden corner and doesn’t reveal itself easily. These patients will have continued pain and weakness after surgery and have to be differentiated from chronic radiculopathy patients (see website for that condition).
The post-operative treatment varies from surgeon to surgeon. Your surgeon uses a back brace. I use a soft corset like those seen on Home Depot employees for six weeks. A recurrent disc herniation can occur in the immediate post-operative period and the position of BLT needs to be avoided (bending and lifting while twisting). The corset reminds the patient not to BLT.
I take care of many flight attendants and six weeks is not unreasonable to return to work if you have a strong core and good body mechanics. There is considerable overhead work with your job which magnifies bad body mechanics. The key here will be the physical therapist as this individual will be working closely with you for this period. I would depend upon the therapist to tell me if there are any remaining mechanical faults or weakness that would put your return to work in jeopardy. Of course, you need an experienced spine therapist to make that judgement.
The lump in your back is most likely from a seroma that developed or inflamed muscle and fascia and should soon recede. If it is painful to lie back with sitting, you can use a small wash cloth, fold it over and cut out a center hole slightly bigger than the protrusion. Tape this over the area. This will reduce the pressure while sitting. You could also tape this to your corset and wear the corset while you work for another 4 weeks.
Re-rupture of L4-5 is called a recurrent disc herniation and the chances are 10% in an active population.
Hope this helps.
Dr. CorenmanPLEASE 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.rileyMemberSeptember 4, 2011 at 10:23 pmPost count: 3
This is so amazing. I can’t tell you how much I appreciate the time you’ve taken to answer my concerns. One last thing (I promise)…what do you think of this “back2life” machine you see on the informercials? Before my epididural my therapist had me try it and for 12 minutes you feel as if could do nothing at all. The following day I was in so much pain I was physically ill and it took 3 days to get me back to just being in horrible pain instead of this killer pain! I’m hesitant to ever use that again but now that I’ve had the microdis. could this actually be helpful for people?
Again, so impressed with your in depth response, I can’t begin to tell you how I appreciate it.Donald Corenman, MD, DCModeratorSeptember 5, 2011 at 5:47 amPost count: 8408
Most machines are not worth the money paid for them. There are some good one (Med-X and Cybex strengthening machines both come to mind) but most are not worth much for treatment. These machines are generally traction type machines like the DMX 9000, are very expensive and generally not very helpful. The “back2life” machine is an inexpensive traction unit that “rounds” the lower back (reduces lordosis). It would give temporary relief to some patients but with vertebral instability, this maneuver would increase mobility which would increase pain.
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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