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  • Lollipop
    Participant
    Post count: 31

    Hi Dr. Corenman,.

    I am wondering whether to contact my orthopedic surgeon regarding my recent MRI results. Here’s my spine history in a nutshell. I had a successful cervical laminoplasty with plate fixation C4,5,6 in 2009 for congenital cervical stenosis and spondylosis with myelopathy C3-4, C4-5, C5-6, C6-7. The doc told me I would always be hyper reflexive, have a positive babinski and clonus. I found that really interesting as I’m an R.N. After six weeks I was back to everything, no restrictions. :-)

    I have lived with low back pain/spasm for about twenty years…rarely was it incapacitating. Usually, I just had a moderate burning sensation and used ice, heat Motrin to treat. Last September, I developed sciatica down the back of my leg and eventually a horrendous back pain that limited my walking for two days. I ended up getting an MRI via my internist which showed:
    1. A posterior central to left paramedian disc herniation measuring 5 mm in AP and 9mm in transverse dimension at L4-L5 causing, ventral thecal impingement and also probable impingement on the intrathecal portion of left L5 nerve root accompanied by a severe central spinal stenosis due to combination of this and hypertrophy of the facets and ligamenta flava.
    2. Mild central stenosis at L3-L4 and diffuse bulging of discs associated with degenerative disc disease without spinal stenosis or focal disc herniation at L2-L3 and L5-S1.
    I had a lumbar decompression with partial discectomy last November. Follow up x-rays showed stable spine. I was released without restriction. :-)

    On a side note, I was diagnosed with osteoporosis in June and had a Reclast infusion due to hx gastric ulcers.

    I was peachy for a bit, but began to have intermittent mild pain on lateral side of left thigh from low back to hip and down. It continued off and on. Within about a month I had two consecutive nights where I could not lay on my left side due to severe pain. I was fine during the day….lateral leg pain continued and mildly worse. I saw my surgeon; X-rays of lumbar spine were fine. My leg strength good. I think he said it could be ligaments and if worse I could get a steroid injection. Ok…

    I kept on chugging along. I walk (aiming for 10,000+ steps daily) or use ARC trainer and/or elyptical at the Y for an hour. I do weight training 2x/wk….I limit training with any back strain. The pain continued from back to lateral thigh with intermittent tingling in toes. I saw my internist when the toes started. He x-rayed left hip and put me on Medrol dose pack. I was to call him if pain returned a week after I finished dose pack. I had no discomfort on the pack, but it did return along with toe tingling. just had an MRI with/without contrast. It showed:
    1. Laminectomy decompressing thecal sac L3 and L5 vertebral body levels with enhancement of postoperative bed and epidural enhancement extending to a portion of the right lateral recess and to a lesser extent left lateral recess L4/5 with component fibrosis. This is nonspecific, but may contribute to patient’s symptoms. No abnormal nerve root enhancement.
    2. Interval development of left L4 pars defect.

    Can you please interpret my most recent MRI. I have never been told of a pars defect and don’t know if I should let my surgeon know. My internist said he can send me to pain clinic but I’m just going to wait and see how I do. I am 55, 5’1″ and weigh 135. I do not smoke. I feel like I’m becoming a whiner and don’t want that. At the same time, given my 4 year history I want to be proactive. Thank you so very much!!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You have had great results from your two surgeries for nerve and cord compression. I am surprised that you were able to go back to full activity after six weeks from a posterior neck fusion. Time to fusion for a posterior neck takes at least three months. Well, obviously you did well so no need to focus on that surgery.

    A pars fracture in the lumbar spine after a decompression surgery is not highly unusual. The initial surgical decompression thins out the pars and if too thin, a fracture occurs. This fracture can cause all the symptoms you describe. Do you have most symptoms with standing and walking or with lying down? I assume your pain is mainly left leg oriented.

    The pars connects to the inferior facet at the level of the fracture. Without a pars to support the weight of the vertebra, the foramen collapses and the nerve root is compressed. Also, the fracture causes inflammation and the nerve is right in the path of the inflammatory process.

    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.
    Lollipop
    Participant
    Post count: 31

    Dear Dr. Corenman,

    Thank you so much for your response!
    I actually had a cervical laminoplasty in 2009, I think that was why I had no restrictions after 6 weeks. ( Dr. Henry Bohlman did it and has since passed.)

    The discomfort has been all left buttocks, hip, thigh, toes with the usual burning sensation I always have in lumbar region. I forgot to mention that in the recent MRI general report( not summary) pars defect at left L4 has reactive bone marrow edema which is minimal. I assume this is a recent fracture and the boney region is doing its job to heal on its own.

    The general report also states there is severe loss of disc space height demonstrated L5/S1. Also, I have multilevel end plate degenerative changes particularly L5/S1 as seen on prior exam in 2012.. From my understanding, my lumbar decompression/ discectomy would not have improved the L5/S1 disc degeneration. It sounds like L5/S1 is pretty ugly. Is it possible that it will not cause issues or should I not be surprised if I need intervention there sometime in the future? I have been told that my osteoporosis has nothing to do with my spine issues…. It just seems to me that it is a factor in the dejeneration.

    Thank you so very much! You are a gift to us, helping us understand our issues better. I know you are a busy man and the fact that you do this in addition is phenomenal!!! :-)

    Sarah

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    The burning sensation in your lower back is probably from the multilevel degenerative changes your MRI notes. I will assume that you could live with this long standing pain and the new left buttocks and leg pain is the most concerning issue,

    The L5-S1 disc is probably responsible for your lower back pain. This disorder is called isolated disc resorption (IDR) and you can read about it under “causes of lower back pain” on the website.

    The pars fracture of L4 is most likely new and the reactive bone changes are the results of attempt to repair (which will not occur unfortunately) as well as reaction to the abnormal motion of this level.

    A selective nerve root block with a pain diary (see website) will yield the diagnostic information necessary to determine if that is the correct diagnosis.

    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.
    Lollipop
    Participant
    Post count: 31

    So…. Take a copy of the MRI to my surgeon to follow up for possible nerve block is what I’m understanding?? I just don’t want to cry wolf. Thanks so much!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You have real and significant pain that is affecting your life. You want to have pain relief. How is this crying wolf?

    The purpose of your doctor is to determine what your pain origins are and try to solve the problem. Once he discovers that you have a pars fracture and now has a potential pain generator, he can order a selective nerve root block to temporary anesthetize the nerve in the L4-5 foramen. If you gain good temporary pain relief, he can potentially plan a surgery that relieves your 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.
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