ShanonMemberMarch 19, 2013 at 11:04 pmPost count: 2
In Feb 2011 I had a disk removed at the L4 L5 and all seemed good, in April 2011 they had to due a fusion of the L4 L5 S1 due to the movement and a pars defect that was noticed. By July things were not good and I had several injections to stop the pain, by Oct 2011 they had to refuse the L4 L5 S1 due to no bone growth. A year went by and I only experience some minor pain but was able to live through it. In July of 2012 I had an episode where I was unable to put any pressure on my left leg, felt like I had pulled my groin muscles and I could not stand straight up. They did and MRI and felt everything was okay by October this became a weekly occurance, my surgeon looked at the new MRI and CT and felt all was okay but the MRI showed that maybe there was no growth in the S1 region. I still have a burning pain down my left leg, pain in my hips and a sharp pain in my lower back that comes an goes. I am back in physical theraphy again, my doctor has me on a pain medication that doesnt do anything for the pain, and I am taking anatriptolin to keep my left leg from agitaion. I am at a point of total frustration and dispair. I cant even sit at my desk at work without being in pain all day from turning and moving, and not knowing when the next bout of serious pain will pop up and I wont be able to put pressure on my left leg or stand straight up.Donald Corenman, MD, DCModeratorMarch 25, 2013 at 12:41 amPost count: 8460
You had a disc herniation at the L4-5 level. Did you have pars defects (isthmic spondylolisthesis- see website) at that level also or at the L5-S1 level? You then underwent a fusion of L4-S1. You had to have a revision of the fusion six months later due to a lack of fusion bone (pseudoarthrosis). Did the original surgery or the subsequent surgery include BMP (bone morphogenic protein)?
The possibility is that you have a pseudoarthrosis in the fusion, pathology in the levels above your fusion or even a labral tear of your hip. The diagnosis starts with a good history and physical examination. This will probably lead to the suspected answer. If there is any question, diagnostic nerve or joint blocks are very useful. See the website for this information.
If I had a patient like you, I would also order an MRI and CT scan of the lumbar spine to determine the status of the spine.
Dr. CorenmanShanonMemberMarch 25, 2013 at 10:44 amPost count: 2
Dr. thank you for your response. I had the pars defect I believe at L4 and at L5,they found the first one when they took out the disc but felt that I would be okay for a long period of time due to my age. When things didnt get better they went in to do one fusion and found that the pars defect was on the L4 and L5 so this is when they did the fusion of L4 L5 S1. The first fusion my own bone was used and it started to produce and then after a period of time the bone was all gone, causing the revision, at that time they used the new stuff that they said would grow bone at a great rate they also used a cage. I have had many different injections at the site and none have worked. Most recent a few months ago. I have a current MRI and current CT scan of the lumbar spine. The leg and hip pain have become more and more painful along with the groin type pain. My original surgeon did feel that the hip could be a problem but felt pain management would help the problem. I have been in physical therapy for a few weeks again but she can not seem to keep the pain controlled enough for us to type to work at a faster rate. The pain management specialist said that the MRI showed that the front section of the L5 SI was not fused. I hope to see you soon to confirm your suspensions.Donald Corenman, MD, DCModeratorMarch 25, 2013 at 6:41 pmPost count: 8460
It would be unusual that these pars fractures would be discovered only at surgery in that these can be distinguished on an MRI and if any questions, a CT scan. The fusion mass should be ascertained by a CT scan and not by an MRI.
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