[Jtal19305]

#20877

Hello Dr Corenman

I appreciate your responss to my questions. I would like to know if the cord irritation which has caused brining pain is likely to get better over time? I can say the burning pain in my foot has gotten better over five months since my surgery but it is still there. Can anything else help it get better other than just time? Ive had an outside expert review the decompression and he thought it looked sufficient. I will ask my doctor again about his technique. I am told this type of nerve pain could take years to dissolve away.

So the pain I have in my outer left thigh requires some more imaging and diagnostics. If the decompression were done correctly at L2/3 I should feel better by five months post surgery? This area may require revision surgery based on the Mri , x rays and other diagnostics. What is the best approach to further decompress L2/3 if there is something other than scar tissue impinging the nerve root? How long should I wait?

Thanks again for your help. I will keep strong and continue to seek a solution to my pain no matter where it may take me. I need to find the best medical professionals who are committed to helping those that need it.

Thanks
jerry

[Jtal19305]

#20878

I just want to add the burning pain in the sole of left foot started as very severe burning pain in what seemed like the whole bottom of the foot. Today, a little less than five months later, the burning pain is now mainly in the heel of the left foot and less intense but still very aggravating.

So is this an indication that the cord irritation is getting better? Is this something my body can come back from and expect to be “normal”? Or am I looking at a permanent injury? I imagine doctors avoid retraction for a reason but I wonder why my doctor would even entertain this surgery knowing any amount of retraction may cause permanent pain. He indicated the area was very compressed and he felt confident in time the pain would go away. When someone is in pain everyday like myself and I was not in this pain prior to surgery, you can imagine the frustration and concern I have. I am looking for a hope but also the truth on what to expect.

I also get some burning pain in my left calf. There have been fasiculations in my calves that started two months prior to surgery and I still have them but they come and go.

Since I am five months post surgery I would imagine the vertabrae are fused together. I understand it may be two years before that area is fully healed and I will not feel like myself until that time period.

Thanks
Jerry

[Donald Corenman, MD, DC]

#20879

The burning pain should improve over time but we are talking months to years. The cord is incredibly slow to heal. If the decompression at T12-L1 looks adequate, only time will improve your symptoms. You might look into the medications Neurontin or Lyrica for help with the symptoms.

Posterior surgery at a cord level will have some risks for cord irritation after surgery no matter how meticulous the surgeon is. I am sure it is frustrating having new symptoms but hopefully, time will allow regression of these symptoms as they already have regressed somewhat.

As far as the L2-3 level, you should have relief almost immediately after the decompression. There are some patients that have had a significantly compressed root for months and it does take some time for these roots to heal. 2-3 months should be enough time for healing (unless motor deficit is involved which takes up to a year).

You have to understand why the L3 root is involved before you undertake any surgery again. Is it foraminal collapse, lateral recess stenosis, instability, scar, chronic radiculopathy or disc herniation that is causing the root dysfunction? Each of these has a different treatment protocol.

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.

[Jtal19305]

#20904

What is the best method of confirming that decompression was adequate? Is it an MRI or ct myelogram? If for some reason the area is still compressed, is there anything that can be done?

I’m a dissappointed my doctor performed such a risky surgical procedure knowing the potential for spinal cord injury approaching front be posterior. I was not aware of all the variations to spine surgery prior to going into surgery. I have only become knowledgeable because I’m in constant pain looking for solutions so I have educated myself.

I’m meeting my doctor tomorrow and plan to ask some questions. I must admit I am not filled with confidence he understands what’s happening with me and cares enough to find a solution. Since he performed the surgery he may not be willing to admit any faults.

I’m seeking a new doctor but after having appointments with the several ortho and Neuro surgeons in the south Florida area I am struggling to find someone who can help me. The doctors I have met have done less than what I have been able to accomplish with you through this forum. Also when I try to schedule with a spine surgeon at a major university, they want to review my MRI and surgical reports to decide whether they want to see me or not. I’m trying to get in at the university of Pennsylvania and hope I do.

I want to thank you for your valuable answers and opinions on my case. I have never been to Colorado, but if I cannot find a good spine doctor in south Florida or the Philadelphia area, I may plan to be seen at your clinic. I am sure can understand and appreciate that when person is in pain, he or she will go to far lengths to find the right specialists who can find solutions based on proper diagnosis so I have the best chance at resolving any issues.

I was in pretty good health with the exception of some anterior leg pain prior to this surgery. I had sudden leg weaknes which led to the MRI and findings of moderate to severe stenosis and l2/3 and what I was told was spinal cord flattening at t12/l1 due to a narrowed canal at that level as a result of disc bulging/osteophytes. Surgery , sooner than later , was recommended by the doctor I saw who came highly recommended in south Florida area. I am now in more pain after surgery than before. Maybe this is expected following my procedure and I need to be patient but I can’t sit by and do nothing to find out why. In my efforts to find out why, I have seen other Neuro and ortho doctors in both south Florida and the Detroit area of Michigan where I grew up, and have received many different opinions. I don’t feel I’ve been to the right doctor who is asking me the right questions and looking for the right solutions based on what I’ve been through. You can imagine the confusion and frustration I feel at this point I my life. I hope I can find the right doctor/clinic that can help me. So far that has been a great challenge.

Thank you again for your time to assess my concerns and questions. I am very grateful for people like yourself who are out there helping those of us in pain.

Jerry

[Donald Corenman, MD, DC]

#20905

To review an area that has already had a decompression and fusion, I tend to use a 1.5 tesla MRI (lower strength magnet so there is less metal distortion) with gadolinium and a CT scan. Occasionally I will use a CT myelogram if the MRI images are too blurred.

You need a careful, experienced, meticulous surgeon who will take the time to figure out what is the current state of affairs and give you a direct and honest answer. I am sure there are those in Florida but it can take some time to find them.

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.

[Jtal19305]

#20939

I had a follow up appointment today with my doctor. They performed X-rays with me laying on a table curled up and bent back as far as I could both on my left side in addition to an X-ray laying flat on my back. I suppose those are the flex extension x Ray. I asked the tech why these were not done standing up and she did not have an answer. The doctor didn’t go over them in detail with me as I was his last appointment of the day and he seemed exhausted. I have the images on a cd.

After I mentioned the chronic burning pain in the soles of my left foot and neuropathic pain in my left calf and leg, he did not have an answer. I asked again about the surgical approach and he insisted that he did not have to retract the thecal sac to get the cage in. He also noted that many surgeons are now using a far lateral posterior approach for the thoracic spine versus anterior or side approaches. He also stated to me that he presented my case and images at a recent conference. I asked him to review my x rays for any instability and compression. He said he would order a current MRI with contrast of my spine and look over all the images then. He seemed confident nothing was off during his surgery.

This is the quagmire I find myself in. I have to use this doctor because he is handling my disability claim but I’m not getting the level of diagnosis that my pain deserves. He feels the pain will still go away in time. When I mentioned that the burning pain in the foot could be due to the cord being irritated during surgery, he was not in agreement but offered no other explanation. The PA mentioned that the pressure on the spinal cord was released and the painful feelings I have in my legs and feet are in response to that. I find that hard to believe and I did not have this pain prior to their surgery.

So I hope insurance approves my additional MRI. I will here him out but I’m really eager to find another doctor who will revisit my case objectively and with the detail it needs. I need a doctor that will go through my images in painstaking detail like that of the outside independent expert I hired. I really need to find another doctor that will provide answers and a path forward. If there is something wrong that can be corrected I would like to know this sooner than later. If nothing is anatomically wrong I would like to know this as well. This pain I feel is about constant and I know it is not normal. I can’t be the only out there who has this type of pain. There must be an explanation. Medical science and technology in the right hands should be able to solve this puzzle. I know nerves are complex and much is not known, however, this pain I have started right after the surgery. So this should be the first place to start looking at.

I’m trying to get an appointment at Penn Medicine but I have send my MRI and surgical reports with a brief history to them so they can decide whether they want to see me or not. It’s not an automatic appointment. This is frustrating because they may decide not to see me. I will have to wait and see. Well thanks for hearing me out and providing sound advice as I continue through this ordeal. I greatly appreciate your time and contributions toward my cause.

Jerry

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