[BillL]

#28486

Okay, thanks. I will try to coax an MRI order hopefully in the next couple weeks or so.

One additional thing that he said after the post op visit that I thought a bit odd: he commented that he thought a possible NCV and EMG could be indicated and made a suggestion that he was a bit baffled how I could be still having significant pain/radiculitis in the face of a “normal neurological exam.” This was a bit strange to me since my neurological exam was normal and without sensory loss or significant motor weakness during the entire pre op period and continuing as such to this day. Maybe I am missing something but would think that in the absence of sensory or motor symptoms or exam deficits that the utility of such additional studies is questionable? And I would also surmise that perhaps my intermittent largely positional pain might not show EMG/NCV abnormalities? Possibility of attempting to use such tests (assuming normal) to validate an argument that nothing else is “significantly wrong”?
Do you see any virtue in these tests whenever the 6-8 week post op time frame arrives or at any point without sensory/motor symptoms or abnormal exam?
Thank you.

[Donald Corenman, MD, DC]

#28489

EMG/NCV is helpful only with motor weakness or peripheral neuropathy so I would not expect this test to reveal anything. See https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies-neck/.

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.

[BillL]

#28493

Okay, that is kind of what I was thinking and thanks for the links as well.

[BillL]

#28516

Dr. Corenman:
I am trying to hold off MRI another couple weeks until week 8 post op to be more to the looking of the original surgeon and maybe better accuracy….

I did speak with at least one local surgeon who does some far lateral access discectomies but for a second procedure Accessing from that position per his usual minimally invasive dilator method he was a bit cautious (even if a residual or recurrent herniation is confirmed on MRI). He suggested that at least with the minimalist approach that he would have to remove more bone laterally including some off the superior facet joint area. He seemed a bit concerned about how much bone was removed by the laminotomy and partial medial facetectomy. Suggestion was if not enough bone left only recourse would be a TLIF?

He also mentioned the symptoms of late mainly around the posterior right belt line, at times laterally about halfway between the iliac crest/femoral head, and occasionally just below the ASIS as maybe having hip or hip girdle Sx, yet hip exam normal. Sitting and rising from sitting after a while seems to somewhat briefly radiate a discomfort in one of those areas. My PT also started trying to track that direction due to this being “non-dermatomal” or maybe atypical. No problems walking or climbing stairs, etc.

I read one article that suggested there might be some paramedian approaches with a slightly longer incision (vs minimal dilator) that could completely spare bone removal laterally? I have concerns to avoid TLIF if at all possible and concerns about effects of violating the superior facet joint and it’s capsule…..? Instability? Arthritis? Facet pain? And not sure about this hip girdle concept as it seems the other doctor perhaps wanted to consider that before tracking to a revision surgery….

Any thoughts appreciated…

[BillL]

#28517

Dr. Corenman:
I am trying to hold off MRI another couple weeks until week 8 post op to be more to the liking of the original surgeon and maybe better accuracy….

I did speak with at least one local surgeon who does some far lateral access discectomies but for a second procedure Accessing from that position per his usual minimally invasive dilator method he was a bit cautious (even if a residual or recurrent herniation is confirmed on MRI). He suggested that at least with the minimalist approach that he would have to remove more bone laterally including some off the superior facet joint area. He seemed a bit concerned about how much bone was removed by the laminotomy and partial medial facetectomy. Suggestion was if not enough bone left only recourse would be a TLIF?

He also mentioned the symptoms of late mainly around the posterior right belt line, at times laterally about halfway between the iliac crest/femoral head, and occasionally just below the ASIS as maybe having hip or hip girdle Sx, yet hip exam normal. Sitting and rising from sitting after a while seems to somewhat briefly radiate a discomfort in one of those areas. My PT also started trying to track that direction due to this being “non-dermatomal” or maybe atypical. No problems walking or climbing stairs, etc.

I read one article that suggested there might be some paramedian approaches with a slightly longer incision (vs minimal dilator) that could completely spare bone removal laterally? I have concerns to avoid TLIF if at all possible and concerns about effects of violating the superior facet joint and it’s capsule…..? Instability? Arthritis? Facet pain? And not sure about this hip girdle concept as it seems the other doctor perhaps wanted to consider that before tracking to a revision surgery….

Any thoughts appreciated…

[Donald Corenman, MD, DC]

#28525

Most surgeons I know use the tube (Metrx/Medtronics) as the exposure for the lateral approach is through muscle (erector spinae-paramedian approach) which does not retract well but tubes work very well. You might not have to have any bone removed on the approach but you need to have the root completely decompressed and if a small (2mm) amount of bone needs to be removed, that would certainly be in your best interest. Much better to have a mildly thinned pars with a fully decompressed nerve root than a poorly decompressed root. Your problem is not a “hip-girdle” problem but a root that is compressed. Don’t get taken with incorrect theories that take you away from your obvious current disorder.

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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