[Bugmesh]

#9392

DR. Corenman,

I have stenosis at C3/C4, C4/C5,C5/C6, T1/T2 and L6/L7. The C4 and C5 vertebrae themselves appear to be chipped/cracked (damaged) on the anterior side as well. I experience chronic pain and have reduced range of motion when looking to the left. There is occasional sharp,piercing,burning pain on movement. There is constant feeling/sound of gravel when I rotate my head. I suffer from headaches and occasional numbness in the left arm with a myoclonic tic.

I have lower back pain with burning sensation in my right buttock, I occasionally lose my balance and sometimes fall. In physical therapy it was noted that L6/L7 was not flexing as it should, it appeared to stick and had to be manipulated to work.

my physician would like to continue injections but I feel I am not getting any long term benefit from them.

with this much disc degeneration disease, is it still possible to expect to achieve normal spine movement and function if I have surgery and can/should these all be done at one time?

I appreciate your time and consideration

[Donald Corenman, MD, DC]

#10776

Surgery for the cervical spine generally will not increase range of motion. The exception is with pain generation associated with movement. Surgery that relieves pain will increase motion.

The sound of gravel in your neck is from wear of the facet surfaces. This sound by itself is not dangerous and is nothing to work about. However, it can be associated with pain if the joint surfaces are severely worn down and there is bone-on-bone contact.

Headaches can be related to worn facets at C2-3 and C3-4 (rarely at O-C1 or C1-2). Facet blocks (see website) will help to diagnose this 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.

[Mlinton]

#10778

Dr. Corenman Please Help Me! I am in Horrific Pain! I am Post-op 7 Months and had a Discectomy and a Lisectomy? L5-S1 plates on both sides and 6 screws. My new Surgeon had immediately ordered a MRI w/Contrast (I went with a new Surgeon because he actually said to me lets check you for Lupus UGH!) because of my Debilitating pain! It showed Scare Tissue around the L5 area and a huge amount of liquid in the area of surgery. I had a 6 hr. surgery and they had to give me 2 liters of blood afterwards. I had a drain tube as well which the other Surgeon had taken out a week after surgery and it was still filling up with a lot of blood. I am having headaches, severe pain above the waist and below the waist, Burning down both of my thighs, muscle cramps in both legs all the way down to my toes on both sides with some numbness in my feet ETC…! I hope you can understand what I am saying but I can barely stand up or walk and I feel like my life will never be the same again! Thank you I hope you can give me a little bit of information of what is going on here.

[Donald Corenman, MD, DC]

#10784

I am unclear as to your surgical description of the procedure you underwent. I understand a discectomy but do not understand a “lisectomy”. You apparently underwent a fusion at L5-S1 but normally, four screws and rods are used. By your description of “L5-S1 plates on both sides and 6 screws” leads me to believe that you had L4-S1 fused as six screws are used with a two level fusion.

Scar tissue and “a huge amount of liquid in the area of surgery” indicates a seroma, hematoma, infection or dural leak. This collection of fluid can cause nerve compression leading to buttocks and leg pain.

Two liters (2000cc) of blood loss from a fusion surgery is a very large volume. I normally lose from 50-200cc with that type of procedure. The extreme blood loss is confusing. Drains are normally left in for 1-2 days. Removing after one week is something that is distinctly abnormal and with continuing drainage even then is concerning. Could this be CSF from a dural leak?

Headaches that are positional (become worse with being upright and get substantially better when you lie down) can be dural leak related.

How long ago was surgery performed and why was the original reason for the surgery? What did the original surgeon state regarding the performance of the surgery? Are you having chills, sweats, fevers and a temperature? Were there any lab tests performed and if so what were the results?

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.

[Mlinton]

#10873

I apologize Dr. Corenman for not getting back to you earlier as I have been in and out of the Hospital. I am still in a significant amount of pain!
So, here is what happened: I had A Discectomy and a Laminectomy Surgery from L4-S1 last October 2013. I have had 2 Mri’s within the last 2 months and there has been Drastic changes and more pressure and Pain.
Here is what the first and second Mri (a month apart) so that maybe you can understand what is going on:
MRI March on March 13th 2014: Findings:, The Lumbar Lordis is preserved. No compression deformities or suspicious focal marrow lessons in the lumbar spine. There is susceptibility artifact from L-1 through S-1 related to surgical hardware as described below. The conus terminates at L-1. No abnormal signal in the conus.
There is evidence of Laminectomy, right-sided facetectomy, discectomy, and posterior fusion from L4/S1 Consisting of bilateral transpedicular screws, posterior vertical stabilization rods, and a single posterior horizontal connecting rod at L4/L5 and Metallic disc implants are present. There is no significant spinal stenosis at L4-5 and L5-S1, and no significant foramina stenosis within the limits of the exam which is degraded by Susceptibility artifact. Suspect scar tissue surrounding L5 nerve which may be thickened. A post-operative fluid collection with thin rim enhancement is sen in the dural soft tissues measuring up to 2.5cm and maximal AP diameter, 9.6cm is maximal craniocaudal extent, and 6.4cm in maximal transverse extent. The collection abuts the dorsal theca sac at L5 without significantly compressing it. Ill-defined enhancing soft tissue in the dorsal paraspinal soft tissues probably representing post-operative scar tissue.

Impression:

Post-surgical changes from L4 through S1 as described above without significant spinal stenosis or definite foramina stenosis within the limits of this exam. There is suspected scar tissue surrounding the exiting right L5 nerve root which may be thickened. Post-operative fluid collection with thin rim enhancement is seen in the dorsal soft tissues extending to the dorsal aspect of the theca sac at L5 without compressing it. This could represent a bland or infected fluid collection; correlate with fluid sampling if clinically indicated.
Second Mri 4/25/14: History of prior spinal fusion. The patient has no recent trauma, however complaints of severe low bad pain radiating to both legs, right greater then left.
FINDINGS:
Fluid collection within the posterior elements extends from the superior endplate of L4 to the inferior endplate of s2 abutting the thecal sac, is smaller. Normal alignment . No evidence for acute fracture. the collection measures 8.4 CM in craniocaudal by 3 CM in t AP parentheses at the superior endplate of L5), by 5 CM in transverse dimension at the inferior endplate of L4. There is still a peripheral ring enhancement. Differential considerations include post-op changes with normal granulation/scar tissue versus infection. Correlate clinically and if indicated fluid sampling may be additional benefit to exclude infection.
L1L2-L3-L4: No significant spinal canal stenosis. There is hypertrophy of the L4/L5 facet joints, without significant foraminal stenosis.

L4/L5: Although there is some degradation from metallic artifact, there does appear to be significant spinal canal or foraminal stenosis. There is moderate facet joint arthropathy.
L-5-S1: This area is partially degraded by metallic hardware. I suspect there may be some right neural foraminal stenosis. The left appears widely patent. There is some increased signal on the sagittal STIR images along the lateral margin of the left L5-S1 disc, which may represent metallic artifact versus edema versus inflammation/infection.
FINAL, IMPRESSION: Stable L-4 fusion when compared to the most recent exam from 3/13/2014. The hardware degrades evaluation of the spinet some degree, althoughI do not see an area of severe neural foraminal or spinal stenosis. I do suspect there may be some stenosis or scar tissue abutting the exiting nerve L5-S-1 level (best visualized on the sagittal images).
The perviously described fluid collection within the surgical bed along posterior elements extends from the superior endplate f L-4 to the inferior endplate of S2 abutting the thecal sac, is smaller. There is still peripheral ring enhancement. Differential considerations include post-op changes with normal granulations/scar tissue versus infection. Correlate clinically and if indicated fluid sampling may be of additional benefit to exclude infection.

I apologize for my long reply but I just wanted you to understand what is going on. The last time I was in the hospital they took a sample and there is a slow growing Bacteria in the fluid in my back. The bacteria I think is called “Propionibacterium”. I have a lot of pressure and pain above the buttock and there seems to be like a “Bubble” in my back. The fluid moves side to side depending on which side I am laying on. I have an appointment with Nuclear Medicine to see if there is a leak in my back. Do you think this is some type of leak as it is filling up more space in my back? I also have an appt. with an Infectious Disease doctor to take care of the slow growing bacteria in my back. Does this type of bacteria cause pain? What do you think is going on as I am in excruciating pain? Should this Fluid on my back be Drained? If so, how? Thank you for you expertise and I hope to hear from you soon.

[Mlinton]

#10956

Update: Hi Dr. Corenman I have a update for you and questions that I hope you get soon!
I was checked into the hospital for a Nero-Radiologist to put in some type of contrast to see where the CSF Leak was coming from and they actually did not do the procedure. The Radiologist said that he went over all of my MRI’s and Cat scans with my current doctor and that they came to the conclusion that I do have a CFS leak in the Lumbar region. The Radiologist said that the procedure was to risky and could cause another CSF Leak. So I just went to see my surgeon a few days ago and I am very confused. He explained to me that he didn’t really know what to do because he is unguided of where the CSF Leak was and then he said you could get another doctors opinion if I wanted to. I did not now at that moment what to say! I am in excruciating pain and this is my second doctor already. The weird thing was he just looked at me for an answer???? I asked him what about a revised surgery and he said that they could do that but there is still a chance of not finding the CSF leak. So we made the decision to do a revised surgery and I hope I am not making a Huge Mistake by doing this. You had said before that you take out your drain tubes within 3 days after surgery since the doctor that did my surgery waited over a week to take out the drain tube do you think that that is the most possible possible place where the CSF Leak could be coming from? What do you think about a revised surgery? I am also wondering if there was a way for you to go over the information that was gathered since my surgery last year (Oct. 2013) and see what you think should happen. Thank you in advance I look forward to hearing from you….

[Author]

Posts