Viewing 6 posts - 7 through 12 (of 17 total)
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  • RenCurtis
    Participant
    Post count: 8

    Hello, Dr. Corenman. I was checking my medical records to see if there may have been more to my pre- surgery MRI concerning my L5-S1 fusion. I came across something I was not aware of and I’m wondering if it could have/did contribute to what is going on with my back now and what you think in regards to my MRI results. Granted, this test took place before my fusion surgery in April 2017. I will send this part of my record to you if I may.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Very good.

    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.
    RenCurtis
    Participant
    Post count: 8

    Hello Doc, I am finally getting in for an MRI on January 2. That appointment I had was with one of the office PA-Cs. They did a 3 view X-ray and he said it looks as if the L4 had been working harder and picking up the slack from of the L5-S1 area not being able to work as hard. He suggested the spinal injections again and if I have no relief then surgery again but in the L4-L5 section. He said he doesn’t have a lot of hope with the injections working because they were not successful prior to my previous fusion but says we will still give it a try.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Injection results are inconsistent but if they work, the injection can be quite beneficial.

    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.
    RenCurtis
    Participant
    Post count: 8

    Hello Dr.Corenman,
    I reviewed my MRI from January 2 with my surgeon’s PA. He said he has never seen deterioration as bad as in my spine at the L4-5 level. He said the fusion from 2 years ago looks wonderful but that the other vertebrae have deteriorated greatly. He said for the upcoming appointment for the injection, I will be receiving 2 instead of just 1. He then proceeded to tell me that I cannot go 4-6 longer without another fusion. We will be scheduling that second surgery at the end of this month.
    I have my medical chart and found notes from a previous CT (dated April 2017 and my fusion was in Sept 2017) that states….. Intervertebral discs are mildly narrowed and desiccated throughout the lumbar spine. The conus ends normally at the L2 level. The conus medullaris is of normal morphology and signal intensity. Cauda equina are also of normal signal intensity and morphology with the exception of crowding due to canal stenosis as described in further detail below. T12-L1: Mild facet arthropathy, without significant narrowing. L1-L2: Mild facet arthropathy, without significant narrowing. L2-L3: Moderate facet arthropathy, without significant narrowing. L3-L4: Moderate facet arthropathy, without significant narrowing. L4-L5: Bulging annulus eccentric towards the left with moderate facet arthropathy/ligamentum flava thickening, which creates mild canal stenosis, mild right foraminal narrowing, and moderate left foraminal narrowing. L5-S1: Bulging annulus with superimposed central extrusion which migrates 1 cm below the level of the disc, and moderate facet arthropathy/ligamentum flava thickening. Constellation of findings together with above described retrolisthesis creates severe canal stenosis with pronounced crowding of the cauda equina, posterior displacement of both descending S1 nerve roots, and moderate foraminal narrowing. So now, my question…. Reading this regarding the L4-L5 and hearing how badly my back has deteriorated regarding L4-L5, would there be a significant reason why that area would not have been taken care of at the same time as the fusion of my L5-S1? I’m quite confused. It sounds to me as if that whole section needed to be fused.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Unfortunately, you have the genetic version of CBS (crappy back syndrome). By the remarks of this radiologist, the L5-S1 level was very degenerative and compressive of the nerve roots (“Constellation of findings together with above described retrolisthesis creates severe canal stenosis with pronounced crowding of the cauda equina, posterior displacement of both descending S1 nerve roots, and moderate foraminal narrowing”).

    Your L4-5 level was degenerative as well (“L4-L5: Bulging annulus eccentric towards the left with moderate facet arthropathy/ligamentum flava thickening, which creates mild canal stenosis, mild right foraminal narrowing, and moderate left foraminal narrowing”) but not half as bad as L5-S1.

    The argument that L4-5 should have been included could have been somewhat valid but then you have to account for the degenerative changes of L2-3 and L3-4 (both “Moderate facet arthropathy, without significant narrowing”) which are already degenerative.

    I don’t think it was a mistake to only initially do L5-S1 but your lower back has degenerative changes throughout the lumbar spine and you might have need to reduce stress activities to your lumbar spine due to your genetic predisposition. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/

    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.
Viewing 6 posts - 7 through 12 (of 17 total)
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