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  • rojotoni
    Member
    Post count: 9

    Hello Dr Corenman,

    I did have the myelogram which was not as easy as I thought it was hard for them to get into the space and one doctor said nerves were most likly in the way. Could you please look this over and let me know what you think. I had surgery on June 13th with Myelogram done on Sept 15

    Post operative changes of L4-S1 lumbar fusion and present with transpedicular screws at L4, L5 and S1 levels on the right and facet screws at L4-L5 and L5-S1 on the left side. Disc space cages are in stable position at L4-L5 and L5-S1 levels. There is no evidence of hardware failure.
    There are 5 nonrib-bearing lumbar type vertebral bodies. Post operative changes as described above. There is no evidence of hardware failure. The vetebral body heights and disc space heights are well-maintained. Osseous structures are intact. The conus medullaris ends at L2
    T12-L1 No disk bulge or protrusion. No central canal stenosis or neural foramial narrowing
    L1-L2 Same as above
    L2-L3 Same as above
    L3-L4 Minimal diffuse disc bulge is present. There is no central canal stenosis or neural foraminal narrowing
    L4-L5 Left-sided neural foraminal narrowing dur to a small osteophyte and diffuse disc bulge.
    L5-S1 Right-sided moderate neural foramina narrowing with osteophyte arising from the posterior inferior margin of L5 bertebral body.

    Please Dr. Corenman is this why I still have pain right lower back into right butt sometimes to right calf and great toe goes numb. Most pain when standing and/or walking for more than an hour or more. When I sleep my great toe will go numb, pain right side when I turn at night. And I only sleep one to two and a half hours of sleep. Thanks again I know the weekend is coming up but if you get let me know as soon as you can. Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    You are now about three months out from your TLIF surgery. You still have right lower back pain into the buttocks and down to the foot. Your pain is stenotic (worse with standing and somewhat improves with sitting or lying down).

    The CT myelogram notes residual compression of the right foramen at L5-S1. There are times that radiologists can “read too much” into the studies but in this case- it might appear that you still have residual compression of your L5 nerve root. You do not mention what the surgeon used for bone graft and that can make a difference. If he or she used only your own bone graft or donor bone graft- your fusion might take a year or more to consolidate. If he or she used bone morphogenic protein (BMP) along with the graft, your fusion may heal in less that six months.

    The reason I feel a solid fusion might help is there is still motion in your surgery site. When you stand, the vertebra rocks backwards and compresses the nerve. When you sit down, the vertebra rocks forward and some compression is eliminated. A solid fusion might prevent this motion and the leg pain might improve.

    There is a technique to prove that the L5 nerve is the problem child. You could get a selective nerve block of this nerve (see web site) and if you had temporary relief (see pain diary on web site), the L5 nerve is most likely the culprit. This injection might also give you longer term relief. There still is the chance that this could be chronic radiculopathy (see web site) but with pain upon motion, this more likely is still a mechanical problem.

    If it is a mechanical problem, you could ask the surgeon to see if he would consider a redo decompression of that nerve root.

    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.
    rojotoni
    Member
    Post count: 9

    Thank you again. You have been great I have told many people about your site and you. I even had one person thank me because they could understand more. Thanks again

    rojotoni
    Member
    Post count: 9

    Hello again Dr. Corenman,

    I was nice to see you on the program this morning. I wish you had a clinic here. I have gone to a new nero doctor. I had a new MRI and he said the cages at L3-4, L4-5 have move and are pressing on the nerve and I have a spinal leak at one of the levels. He said he can’t say what the doctor did or how much he can repair until he is in there. Also L5S1 will probly not fuse. I do not remember everything because of shock. Do you have some questions I should ask? Thank you again

    rojotoni
    Member
    Post count: 9

    Is there anyway I can send you MRI and Myelogram?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    I am concerned that there are significant problems based upon your report. If the cages are migrating, this means that stability of the spine is compromised somewhat. I am unclear what the surgeons means by the presence of a spinal leak at one of the levels. If there is a “leak”, there should be a collection of CSF (cerebral spinal fluid) in a pocket outside of the dura (called a pseudomeningeocele). Ask the surgeon to point this area out to you on the MRI so you can understand it better.

    It might be helpful to have a CT scan to look at the position of the cages, the screws and any fusion bone that has formed. Ask your surgeon if that test would help him or her to further understand the problem.

    If you would like to send your images to me, please call either Diana or Sarah at (970) 476-1100 for more information.

    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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