AnimalLoverMemberJanuary 17, 2012 at 10:58 amPost count: 3
I was told by an Ortho Spine doc that a fusion is what i need. My PM doc said i need a mDisc. Another neurosurgeon suggested an ALIF because he said I have spine instability, but warned me of retrograde ejac. MY QUESTION: How do i know if I have “spine instability”. Obviously, if i can get relief from a mD..thats the route i’d like to try first. I just don’t know if i’d be making a mistake by not doing a fusion.
Please explain how will i know if i have “spine instability”.
Left L5-S1 bulge/hern w/DDD at same level only.
Symptoms: Intermitent left foot numbness, terrible lft leg sciatica, both hamstrings ache, burning pain in left lumbar back. Now (after transforaminal steroid inj.) I’ve got pain in the rt. lumbar back. I can’t lay down on my back because the pressure on inj. site nerves burn, I can’t sit at my desk for any long periods. Have random back pain with leg issues. Help pleaseDonald Corenman, MD, DCModeratorJanuary 17, 2012 at 9:46 pmPost count: 8468
Spinal instability originates from wear of the disc and facets and then “looseness” of the connecting tissues (capsule, annulus, ligaments). Instability is best recognized by abnormal motion or alignment on standing X-rays including flexion and extension X-rays. Some surgeons would also consider potential instability after surgical intervention like the case of an angular collapse causing nerve compression in the foramen (what I call foraminal collapse). In that case, the surgical decompression of the nerve would lead to instability.
By your description, it sounds like most of the pain you have is in your left leg. If that is the case and there is a compression of the left nerve root (without confounding factors like the foraminal collapse noted above), then the most likely effective surgery would be a micro-decompression (probably microdiscectomy). However, without a thorough evaluation (history, physical examination, evaluation of all images and tests), this is just theoretical.
The reason for the need for the fusion should be explained to you. Revisit with the surgeon and ask why he or she feels the fusion is necessary. If the explanation doesn’t make sense to you, get a second opinion.
Dr. CorenmanAnimalLoverMemberJanuary 18, 2012 at 6:15 amPost count: 3
Thanks for the prompt answer. BTW, I truly feel this is the most complete “Spine” website I have ever visited. It is truly thorough. I’ve lurked and seen many forums etc….this is clearly the best place. Your professionalism and team responsible for this site is greatly appreciated. Thank you for doing what you do!!
A.AnimalLoverMemberJanuary 18, 2012 at 6:28 amPost count: 3
If I have random nuero pains in the lumbar back (shooting type) that are equal in amplitude to my leg pains (ie: both back pain and leg pain are severe, which are now in both legs), would that influence you as a doctor toward the fusion being the appropriate intervention?Donald Corenman, MD, DCModeratorJanuary 19, 2012 at 12:01 amPost count: 8468
That question can only be answered with a thorough evaluation of your history, physical examination and specialty studies (special X-rays, possible MRI, CT scan and possibly others).
The indications for fusion are instability, back pain from degenerative disc disease, deformity, decompression that will produce instability and fracture. By the amount of information, I cannot tell what your diagnosis is.
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