Viewing 6 posts - 43 through 48 (of 53 total)
  • Author
    Posts
  • Lollipop
    Participant
    Post count: 31

    Hello and thank you so much.
    I am shying away from such intense surgery. I see my surgeon tomorrow and have one major question for you. Is the revision of L4-5 something I should do now or can it wait? Could I do more damage to the area if I wait?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I don’t think that waiting to repair the L4-5 level will cause any unsolvable problems. There is the possibility of hardware breakage as motion can fatigue the metal but that would be unusual and still a problem that can be overcome. I am concerned that you might not need an L3-S1 fusion so another opinion would be helpful.

    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

    Hello Dr. Corenman,
    I saw my ortho surgeon this morning. He said he wouldn’t do a TLIF at L4-5 due to the scar tissue present and increased possible nerve damage with that procedure. I have had a L4-5 decompression with partial discectomy in 2012 and had the rod and pedicle screw fusion one year ago, so I do understand the increased risk of damaging nerves. This would be the third surgery there in four years. He said he would use BMP and place a larger screw at Left L4, leaving the other screws in place if the look good.
    He said he would do rod and pedicle screws at L3-4… I THINK because of the loss of disc height and foraminal narrowing… He said he would do a TLIF at L5-S1 as there is no disc space and some of my symptoms are indicative of that.
    What are your thoughts, and do ALL pseudarthroses require a revision? Thank you again, as always!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    First, you have to ask what the pain generator is and what needs to be done to fix it. The most likely pain generator is the pseudoarthrosis at L4-5. It is hard a this distance to know what L3-4 and L5-S1 looks like or how they correlate to your symptoms. I am not a fan of simply fusing them for degenerative changes if your symptoms stem more from the L4-5 level. That correlation needs to be done by an accurate history and physical examination, careful perusal of the images and then possible further diagnostic testing such as discogram or SNRB. A three level fusion does limit your future activity and should not be taken lightly.

    Second, I would disagree that a TLIF should be avoided at L4-5. Yes, BMP will be helpful to create a fusion but with the fusion bed of the posterolateral gutter already scarred by the prior attempt of fusion, I would recommend a TLIF to make sure this level has the best chance of fusion. Scar tissue should not be a factor as this is dealt with every day by spine surgeons.

    You need to have reasons to have a three level fusion. You might have them but without symptom correlation or testing to determine what levels are causing what symptoms, I would be very cautious proceeding.

    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

    Hi Dr. Corenman,
    I got a second opinion today from a neurosurgeon regarding my arthrodesis and wanted to update you. He showed me the CT scan and totally explained that the Left L4 pedicle screw was not placed at an angle but pretty much straight in. It is moving and is impinging on nerves. It has also caused a new pars fracture on the Right due to movement and the Right L4 screw is starting to show a halo affect. He said that I have no arthritis, which is a BIG relief to me, in that we can fix this and I can move forward. I thought some of my pain was due to beginning arthritis.

    He does not feel the Left L4 will support a screw anymore so he will do a TLIF at L4-5 using a cage, some of my bone and BMP. He will remove all previous hardware. He will place new rods and pedicle screws L3-5 on the Right and pedicle screws at L3 and L5 on the left, if I understood him correctly. He sees no need to involve L5-S1 at this time, as my orthopedic surgeon had planned. I also had x-rays today to help him see and maintain the proper curvature of my spine. I am encouraged and plan to get this done between Thanksgiving and Christmas.

    Thank you so much for your encouragement to get a second opinion. You are so kind to have this forum!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Excellent! I am glad that you will have a revision with a TLIF. I assume that the L3-4 level has to be involved du to a lack of good screw positioning but I wonder if you need the L3-4 level involved? Even if there is a “bad screw hole” in the L4 pedicle, a hook can be used above the lamina at L4 instead of involving the L3-4 level. These hooks are “old school” but a valuable technique to avoid involving another level.

    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.
Viewing 6 posts - 43 through 48 (of 53 total)
  • You must be logged in to reply to this topic.