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  • john123
    Member
    Post count: 30

    Hi Dr. Corenman:

    I posted last August but could not find my last post.

    As mentioned, I was rear ended 3 years ago. I have a grade one spondy with major disc herniation at L5,S1. Since the accident I have experienced exercise intolerance which, after a tilt table test, indicated that I have mild orthostatic intolerance or POTS for which I was prescribed medicine.

    I can walk short distance with a rigid back brace. Without it I can not walk very far at all.

    1.) Is this an issue of simply rebuilding my core to replace the brace? PT has not helped very much in the past.

    2.) Will spinal fusion surgery exacerbate POTS symptoms ?

    3.) I am 39 yr old male and would prefer not to go through stomach. What is your preference for spinal fusion (one level) – ALIF or PLIF?

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    Three years after injury with continuing disabling symptoms would mean you are a surgical candidate. A grade one isthmic spondylolisthesis with a disc herniation should be handled with a TLIF-a posterior surgery. This will stabilize the disorder and remove the disc herniation which will decompress the nerve roots.

    I am generally not a fan of an anterior approach.

    Generally, spinal fusion will temporarily aggravate orthostatic hypotension as the fluid shifts from surgery will cause some temporary swelling. You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run.

    Dr. Corenman

    john123
    Member
    Post count: 30

    Thank you kindly.

    “You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run”

    1.) Can you please elaborate on the above? It sounds as though pots could effect my rehab/walking, any specific instruction ?

    2.) what is difference between TLIF and PLIF ?

    3.) I have one surgeon that wants to make incision through right side of my back where disc herniation is to clean out disc space, then do laminectomy (remove pars defect) and use bone from laminectomy to put in cage for fusion. Does this sound accurate or would you suggest a different method?

    sorry for all the questions !

    Thank you

    john123
    Member
    Post count: 30

    DR. Corenman:

    sorry to keep bugging you. would you be so kind as to explain the below in a little more detial?

    “You can have anesthesia ‘run you dry’ during surgery which might help as some patients with heart failure need to be run”

    Thank you

    John

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    The term “running you dry” means that when under anesthesia, the anesthesiologist will limit the fluids given to your while you are asleep. Normally. an anesthesiologist will give much more fluid than you eliminate, as much as three to four liters. This fluid overload keeps the kidneys safe but you will need to eliminate this fluid the day after surgery.

    Some patients are incapable of fluid elimination (such as patients with a bad heart- congestive heart failure) and the extra fluid would end up in the lungs-a bad thing. These patients are “run dry” to prevent this problem called “third spacing”.

    This could be the same technique that could be applied to you. “Running you dry” could prevent extra fluid from building up in the semicircular canals (the balance area of your brain) to prevent POTS from exacerbating.

    TLIP and PLIF are similar but PLIF requires exposure of both sides of the nerves which increases the chances of nerve irritability.

    You need a central incision to expose both sides for pedicle screw placement (or bilateral incisions). A unilateral (one sided-not central) incision is not adequate in my opinion to allow the best result of surgery.

    Dr. Corenman

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