[Lollipop]

#21799

Hello,
I saw my doc 12/8/15 for my 3 month F/U and all was good. I meant to include in my previous email that I DID fall on my rear on an icy walkway 1/11/16 (just after my 3 month visit). I was able to break the fall just //enough that it was not a straight down hard fall on my bucket. It was about two weeks later that I noticed very minimal and very occasional changes. I did tell him about this at my recent F/U visit 3/22/16. I wonder if this was what could have caused the lucency/loosening? I did not have flexion/extension x-rays, just PA and lateral. He always does the x-ray before seeing me. I’m really in a quandary as to how to proceed… would you advise contacting his office to request a CT scan?
Thanks so much!

[Donald Corenman, MD, DC]

#21805

The fall at 3 months post-op should not have caused any significant impairment with your fusion but that is not an absolute. I am unclear as to why he does not take dynamic motion X-rays (flexion/extension) as these are the easiest and cheapest technique to look for motion in the fusion mass. It would be a good plan to call the office to note concern about your symptoms and the loose screw and ask for a CT scan. If they will not help you, you can always ask your primary care provider for a CT scan.

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]

#21823

Thanks Dr. Corenman! I will contact his office. I really appreciate your website forum and all you do!!!

[Donald Corenman, MD, DC]

#21853

Please keep us informed.

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]

#22711

Hi Dr. Corenman,
At my six month F/U I was told my fusion was solid and was released with no activity restrictions. I have been walking and have gotten back to weight training twice a week with a personal trainer and we modify as needed. I am fit and strong.
My back pain is back most days where I feel like I have been smacked in the lumbar region with a two by four…just like it felt prior to my fusion in September 2015. I also have pain radiating again down my left leg. The pain goes to my upper calf and sometimes is lateral, sometimes medial. A portion of my left buttock is numb to the touch and I continue to have the stinging sensation. These symptoms seem to be worse at night when first laying down and turning in bed. They also occur when I am sitting. The aching in my low back is not as bad some days. Today, I would say it’s an 8/10. I take Flexeril each night at bedtime and nothing else. No NSAIDS due to previous gastric ulcers.
I have been in contact with my orthopedic doctor’s office and a CT scan will be ordered. My questions to you are
!. Can he be sure the fusion is solid just by an x-ray? He did see lucency at one screw in March. My symptoms definitely are getting worse. 2. Can a fusion fail at 6-12 months post surgery, though looking solid at six months via A/P and lateral x-ray? 3. Can the pain and discomfort/numbness be due to nerve irritation from a loose screw? 4. Prior to my fusion, I had pain radiating down my left lateral thigh without calf involvement when walking only.
Why, now, would the issue be more when sitting/lying down?
Thank you so much!
I will let you know what the results of the CT scan are. My doc is on vacation now. I’m checking to see if CT order has been submitted.

[Donald Corenman, MD, DC]

#22712

Your back pain that has returned within about six months has a number of potential causes. One of the potential pain generators is a pseudoarthrosis (non-fusion). The next is another level that is causing pain. The third is some abnormality at the surgical level (bone spur or scar) and the last is a chronic radiculopathy.

AP and lateral X-rays (especially without flexion/extension films) are generally unhelpful to determine fusion status, especially with a lucency of a screw on a previous film. A lucency is a halo around a screw-a dark area around the “light” bone that could indicate cavitation-an indication of lack of fusion.

The most common symptom that indicates a lack of fusion is lower back pain at the three to six month mark after a fusion. A CT scan is the gold standard but these images have to be generated on a 64 (or above) slice scanner with one millimeter cuts and include sagittal and coronal reconstruction (front to back and side cuts).

The pain generated by the pseudoarthrosis is generally from the motion of the non-fusion interface. Pain could be generated from the screw-bone interface in a pseudoarthrosis but generally this is not the case. Now there are rare exceptions where you could have a solid fusion and still have some discomfort from the screw-bone interface. Removing the hardware in this particular case can be beneficial but I remind you this is a rare condition.

If you do have a loose screw, this would be an indicator of a lack of fusion as the screw would not be loose in a solid fusion. Thigh pain that returned sometime after surgery could be continued nerve irritation from a pseudoarthrosis, scar of the nerve root, another level not initially involved in the surgery or rarely a screw irritation of the nerve root.

The CT scan will be very helpful in determining the cause of continued 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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