[Donald Corenman, MD, DC]

#6347

Paresthesias in the lateral boarder of the foot could be from nerve entrapment of the foot (somewhat like carpel tunnel syndrome) or from the lower back. The fact the tingling becomes worse with each step tends to increase my suspicion of the former.

Good luck with the operation. Take some time to pick the right surgeon.

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.

[Abbeygirl]

#6351

Thanks Doctor for your kind thoughts i hope i have got the best surgion i wished you were in australia i dont think i would be as nervious as i am now

[Abbeygirl]

#6414

Hi DOCTOR Iwas wondering if you could explain my discogram results to me please L3-L4 The discogram was significantly positive at this level There is a significant defect in the anterior aspect of the annulus which results in contrast tracking into the circumference of the annulus through this defect immediately reproducing the patients low back pain A broad- based posterior disc bulge is noted L4-L5 Level The discogram is negative at this level a normal disc is demonstrated on CT. L5-S1 Level The discogram was strongly positive at this level with symptoms immediately reproduced The CT scan demonstrates that the disc space is significantly narrowed with a posterior disc extrusion demonstrated which contacts the descending nerve roots at this level Vacuum phenomenon and annular disc degeneration is noted Conclusion discograms at L3-4 and L5-S1 with a normal disc demonstrated at the L4-5 level doctor i also have a disc with the results but not sure how to attach it and Thank you so so much for the service you provide i am in so much pain that i am going insane but your answers help me a lot

[Donald Corenman, MD, DC]

#6416

The discogram is a subjective test that needs to be performed under just the right circumstances. Factors such as the opening pressure and maximum pressure to pain are important. You as the patient have to be awake and aware enough to answer questions appropriately to identify concordant and non-concordant pain. The discographer has to have the needle in the center of the nucleus and not in the annulus to provoke an appropriate response. A post-discogram CT scan is typically performed to look at the morphology of the disc.

Assuming all these circumstances are met, I have some questions for you. Defects in the anterior annulus are typically either not painful or painful but non-concordant (pain that you would not typically recognize). Do you remember the examination and especially the testing of L3-4? I suspect that level was not as painful or was non-concordant but if it was as you mention, that brings up some skills in surgical decision making.

The L4-5 disc had a “broad- based posterior disc bulge” noted on discography but was noted to be normal on the post-discography CT scan. Those two findings are at odds with each other. Nonetheless, if this disc tested negatively (no pain reproduction), this is good news as a non-painful disc is important to make sure there is no pain processing issues in the brain.

The L5-S1 disc is very degenerative and “strongly positive”. By inference, this disc had severe degenerative changes.

Your discogram is helpful. I am unclear if the L4-5 disc is degenerative but non-painful or anatomically normal and non-painful. This will not affect surgical decision making but has some inference for prognosis. If the disc already has degenerative changes, you will have to be somewhat more careful not to tear it further (no pole vaulting, brick laying etc…)

Assuming you have significant lower back pain and your disc at L5-S1 is highly degenerative, you would probably be a good candidate for a fusion of this one level. I do not think that you should address L3-4 surgically as generally, you do not want to fuse non-adjacent discs. It also may be that the L3-4 level is not causing as much pain as the discogram test indicates.

If indeed the L3-4 level is causing pain, the percentage of total pain caused by this disc is probably less than 50% (probably 20-30% of global pain). If that is the case, the expectations for a high percentage of pain relief with only a fusion of L5-S1 is still quite 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.

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