[Donald Corenman, MD, DC]

#25717

Unfortunately, you did have a full facetectomy (“Status post left hemilaminectomy at L4-5 and facetectomy”) at left L4-5. This does destabilize this level and allows increased motion which puts the nerve root under stress. There is no comment about this on the X-rays (angular collapse or slip).

I generally endorse a fusion at a level with a full facetectomy so as to prevent collapse and nerve irritation. The straightening of the lumbar lordosis can be an antalgic lean (an adopted posture to prevent pain).

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.

[Mikec]

#25720

I guess I’m not surprised with the full removal of my facet. During my second office visit the surgeon had a intern with him and he was explaining that he had to be careful not to remove more than 50% of my facet as that could potentially leave me unstable. And I am certain this is what was said as I recorded the office visit and went back and reviewed the recording. During this same office visit his initial recommendation was a ALIF but that BCBS would not approve this procedure unless I had a prior failed back surgery. During my one month follow up he repeated this same thing but stated they would not approve an ALIF unless I had one, two or possibly even three failed back surgeries. Which I now know is not true.

Unfortunately this appears to be nothing short of an unethical money grab buy the surgeon. So why would the full removal of my facet be a surprise? And by the way I also have a recording of him stating I would need 1 to 3 failed surgeries before being approved by my insurance company for the surgery I truly needed.

At this point I am left with the feeling that this has turned out to be nothing short of a cash grab by the surgeon. And by the way who in their right mind would stay with the same surgeon after two failed surgeries??? Guess there is not enough money in office visits when you can do multiple surgeries on your patients.

Since the MRI and X-rays don’t address the percent or amount of facet removed would you recommend returning to the imaging center and asking them to ammend their report to specifically address the amount of facet removed. Also, I am going to contact the surgeon’s office and request an order for a CAT scan.

I have found a orthopedic spine Dr that is a specialist in revision surgeries and I’m in the process of gathering all the prior MRI’s, office and surgical notes to take to my first office visit.

The most recent MRI barely mentioned DDD and stenosis which have been on all my prior MRI’s. After one MRI my interventional pain Dr reviewed mt films on disc and was shocked at the report. The report listed minimal DDD, arthritis and stenosis and he stated my condition is far from minimal. He even had the anesthesia Dr to come in the exam room and review the films to confirm what he was seeing and they both can to the same conclusion that my condition to be moderate to severe.

I understand that some conditions are open to interpretation but it seems like they want to go with the less severe conditions or they just minimally read the films and have a predetermined conclusion prior to reviewing the films. It seems they are scared to list a condition as severe and want to leave that determination to the surgeon. But what about the people who have MRI’s ordered by their family physician who is only going to read the report and not review the films? These people continue to suffer and not forwarded to a spine specialist as the report alone does not warrant a referral. I find this behavior to be highly unethical as a lot of insurances now require a referral from the family Dr to a specialist???

Seems like the pain and suffering from my first surgery was all in vain.

Discussed in Alabama, I am;

Sincerely,

Mike Couch

[Mikec]

#25723

One other thing if interest while standing and I cough it get pain across me left buttock cheek and down the back of my left leg. What would bring on this symptom and could it be related to my back condition?

[Donald Corenman, MD, DC]

#25768

I would press the radiologist to identify that the facet has been removed so the insurance company is aware of this finding. A CT scan would also be very helpful to identify these findings. I cannot tell you why the facet was removed but maybe there was significant nerve compression in the foramen and the only way to decompress this exiting nerve root was to remove the back wall of the exit hole (the facet). Doing this in surgery without the plan of fusion (you can’t easily change surgery intra-operatively from decompression to fusion) is a real problem.

You now have some instability of this level and when you stand or cough, there probably is some translation of the foramen and nerve root compression.

By the way, it is not uncommon to go back to the radiologist and point out problems that were missed. They can’t be omniscient and most of the time, they appreciate the help.

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.

[Author]

Posts