[Donald Corenman, MD, DC]

#32280

Your spinal canal has remaining stenosis post the XLIF procedures at L3-4 “There is moderate right and severe left neural foraminal narrowing. There is mild to moderate spinal stenosis eccentric to the right abutting the traversing nerve roots”… and at L4-5 “There is moderate bilateral neural foraminal narrowing”.

Stand alone XLIFs are used by some surgeons to try and decompress the canal indirectly by distracting the vertebra and hoping the stretched disc will pull the bones and ligaments in the back of the canal “back into place”. It works sometimes but not all the time and your surgery unfortunately left nerve compression remaining.

Generally, I would back up the XLIFs with not only a decompression but with an instrumented fusion if there is no evidence that a solid fusion at L3-5 has taken place. You would need a CT scan to determine if there is evidence of a solid fusion.

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.

[Calista]

#32282

Thank you.
I finally received approval for the CT myelogram yesterday for surgical planning purposes. I will have done hopefully next week.

On X-rays the fusion looks like it has fused, but the surgeon did allude to the CT being a better test to determine, plus confirm MRI findings, and now since MRI is not so recent (July 2019) new imaging will be helpful.

If fused, can a posterior decompression be done well without redoing fusion? I know my new surgeon will discuss options, but was curious, if there would be a need for posterior fixation, and since I have lateral screws/plates if it poses more issues. I realize scar tissue may too. Not an ideal situation now.

[Donald Corenman, MD, DC]

#32285

If there is no question of solid fusion on the CT scan, then a posterior decompression can be accomplished without the additional posterior fusion. If there is any question of fusion status, you can leave it up to the surgeon to make that decision intra-operatively. He or she can use a tool to try and distract the spinous processes. Any noted motion would indicate an incomplete union and the need for a posterior fusion.

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.

[Calista]

#32286

Thank you for your feedback. I am also out of curiousity interested in finding out if L5/S1 has issues. Apparently my slip at the old fusion level has progressed. It has left me confused because it makes sense regarding some of the pain I feel, not all..but the pain that started in 2014 that demonstrated much less severe ASD, but noted first change in slip. I had a grade 1 slip, and not sure how many milimeters my vertebrae are, but think I had progressed from 3mm, to 5mm antero slip 3 years post fusion via MRI, and now last MRI it is 8mm. But maybe the other levels are causing distortion since have both antero and retrololisthesis now? Will let you know what the findings show..wish I lived in Colorado. A girl can dream.

[Donald Corenman, MD, DC]

#32288

It is unlikely but possible that you have a pseudoarthrosis of L5-S1 but even with a non-union, you should not have advancing slip if it was stabilized but not fused. The CT should help to indicate fusion status of L5-S1.

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.

[Calista]

#32289

I was fused 360 (anterior/posterior) at L5/S1. Pedicle screws were removed 18 mos post op. I had one screw fractured, and all 4 screws had bursa formed over them. Being petite,the hardware was hitting into skin vs fat. So still have cage at L5/S1, just peducle screws were removed.

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