[Donald Corenman, MD, DC]

#32290

If you had a fractured screw before, one of the more common causes a screw fractures is a pseudoarthrosis. Removal of the L5-S1 hardware could increase instability and possibly increase slip. The CT should be interesting to review. Have them assess all levels and you have the surgeon look at the film with you present. You would need a posterior fusion at L5-S1 if you have a non-union. BMP will be quite useful in this case.

See:
https://neckandback.com/conditions/bone-morphogenic-protein-bmp-2-for-spinal-fusions-2/

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]

#32291

Thank you. I have had BMP used for all three levels. I am not sure if the old fused location could be impacted by osteoporosis. I have never been checked for it. I had anorexia nervosa, most severe between 15-20yrs old – BMI was about 15 and multiple stress fractures in my leg by 19yo.

My former surgeon knew this, but thank you for having me think about again. I should tell my new surgeon. It was so long ago, and my BMI has stayed in the 19.5-21 range. Given I cannot do much activity wise, I drink Boost Calorie Smart shakes to not gain weight. At my height, and increasing age, each calorie needs to be meaningful.

[Donald Corenman, MD, DC]

#32297

Make sure you have the radiologist and the surgeon review your CT scan and both comment on the fusion status.

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]

#32299

I definitely will and update you too. Now that you have been ironically the most engaging and informative surgeon, I am compelled to keep you in the loop. I know nothing is better than visualizing, as almost all imaging I have had in the past missed pathology or it was grossly underestimated.

I have mixed feelings about L5/S1..certainly do not want to revise from short-term outlook, however if it has issues it would offer some hope to a solution. And answer some questions that I have not received – 2 radiologists thought the level was causing issues/pain, but my surgeon said they were wrong. So coin toss?

Then L3-5, I feel less clueless about, the pain correlates definitely axial and some direct to L3-5, but the groin pain may be from higher levels unless my nerves are not quite aligned normally due to LSTV, or just for me manifests lower, who knows?

The definite unknowns are the XLIF fusion status, and I think I know what nerves are damaged vs impinged by the, lack of a better word, “different” sensations – think the quad/knee is not reversible, praying hip, lateral thigh, groin and feet issues are to some extent.

Not sure how an EMG/NCS confirms if salvageable? It will be the test after the CT Myelogram. But prior test, the results did not differentiate between damage/impingement. So not really understandinghow they work.

[Donald Corenman, MD, DC]

#32305

EMGs can indicate which nerves are affected by motor weakness but will not predict which nerves are generating pain. This test in your case could be somewhat helpful but further surgery should be directed more toward the nerves that are compressed as noted by imaging and which levels that are not fused noted either by imaging or by direct examination intra-operatively.

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.

[Donald Corenman, MD, DC]

#32306

EMGs can indicate which nerves are affected by motor weakness but will not predict which nerves are generating pain. This test in your case could be somewhat helpful but further surgery should be directed more toward the nerves that are compressed as noted by imaging and which levels that are not fused noted either by imaging or by direct examination intra-operatively.

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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