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  • glo
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    Post count: 9

    Hello Dr. Corenman,

    I was disgnosed with DDD, spinal stenosis mostly on foramins, degenerative spondylolisthesis on L4-5. I have back pain for 30 years and sciatica on left leg 2 years ago. I saw 5 surgeons(3 NS and 2 orth.spine) and selected the NS at UCSF spine center. My surgery is on 11/6/2017. He did a MIS TLIF on L4-5 with hemi-laminectomy and removed the faucet joints on left. I was told surgery will take 3 hours and it took 8 hours due to complications: dura tear and repaired with own fat graft and glue, bone at L4 left side pedicle too soft to insert the screw. But they did it anyway. They claimed all Post-op X-rays were OK.
    I woke up with numbed left knee to toes. I was released home 3days later and started PT a month later. I have weakness on left leg as knee will buckle when stand or walk. I cannot fully doxiflex my left foot and cannot walk on heel. I have mild drop foot with a slap gait during walking. For the first 2 months, I worked hard to strengthen my left leg and starting the 2nd month, I have stabbing pain like electric shocks from my knee down to toes on left leg. I also feel cold touch to my outer calf area and sometime ants crawling on my leg. I didn’t have these pain until 2 months post-op. I called UCSF and they told me to double my nerve med(gabapentin and baclofen) for pain but they will not order a MRI with contrast to rule out adhesive arachnoiditis which have symptoms like mine and can be caused by dura tear or complications during surgery.
    I would like to ask if my symptoms and the facts that I only have numbness immediately after surgery but electric shocks pain 2 months post-op resemble the progression of adhesive arachnoiditis??
    I would greatly appreciate your professional advices and possible routes that I can confirm or rule out the possibility of adhesive arachnoiditis?
    Thanks in advance of your help.

    Best regards,
    glo

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    It sounds like you unfortunately had a nerve injury during surgery. Your comment ” I cannot fully doxiflex my left foot and cannot walk on heel. I have mild drop foot with a slap gait during walking” is an indication of an L5 nerve root injury. This fits with your surgical level (L4-5).

    Your symptoms do deserve a new MRI. You can also read the operative report (which is yours to read by law) to help to understand what happened during surgery.

    You probably do have some form of arachnoiditis after surgery but it sounds more likely that there was a direct nerve injury.

    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.
    glo
    Participant
    Post count: 9

    Hello Dr. Colenmann
    Thanks for your reply and advices.
    You said I have some form of arachnoiditis, would it progress to adhesive arachnoiditis over time? If so, how fast does it progress? That is my BIGGEST FEAR! I don’t want to live in pain for my rest if life! Anything I can do to slow it down or reverse it? Your advice would be greatly appreciated!

    The Ucsf surgeon told me to wait for another 3 months before they will order any more imaging! If I waited for another 3 months for an MRI, would my arachnoiditis or nerve damage get worse? Did the dural tear caused L5 nerve root damage? The operative report said the rural tear is at L4 axilla. It also said soft bone when drilling the Pedicle at Left L4. Should I ask the surgeon how L5 nerve was damaged? He told me the surgery was a success! He kept telling me “I’m still early in recovery, need to wait for one full year for full recovery”. He said “he won’t diagnose me with arachnoiditis until after a full year”.
    What should I do now? Sit and wait in pain until a full year? Should I see a neurologist for MRI and second opinion? Your advices could be greatly appreciated!
    Thanks
    Glo

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Your loss of motor strength should be your biggest concern due to L5 nerve injury. You most likely have chronic radiculopathy (see https://neckandback.com/conditions/chronic-radiculopathy/). Even if it is arachnoiditis (which is less likely than chronic radiculopathy), “getting worse” would not be something that can be augmented. Surgeons generally want the surgery “to go right” but at a university, there are residents and fellows also involved which can complicate the surgery.

    A dural tear does not fully describe what happened in surgery. Was it a “pinhole” leak where there really is no root involvement or a full dural tear where there is “spaghetti” all through the incision with injury to the nerve root trying to put “everything back together”?

    I think a new MRI is warranted.

    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.
    glo
    Participant
    Post count: 9

    Hello Dr Corenmann,
    thanks for your reply. here is the operative report from the surgeon:
    We place a right iliac stealth pin and arc and did intraop oarm ct and registered stealth navigation system. We use stealth to localize the 2 MIS wiltse plane incisions and created a 1 inch incision over the bilateral L4-5 pedicales.(BUT MY FINAL INCISIONS ARE 2.5″ EACH SIDE). We used stealth as she had very abnormaly angulated L4-5 pedicales and we navigated with a cannulated drill and created L4-5 pilot holes and placed kwires and tapped and placed L4-5 pedicle screws bilaterally (left L4 screw we placed after the TLIF to avoid hindering the TLIF view). We used cannulated cortical fix expendium pedical screws as she is osteoporotic. The left L4 screw purchase was not as solid as the right L4 or bilateral L5 screws. The inferior L4 pedicle was weak and eroded when we placed that screw due to osteoporosis. However, we inspected the exiting nerve root and the screw was not touching it so we left the screw in place. We did a left L4-5 facetectomy and laminotomy and decompressed the exiting and traversing roots using microscope and microdissection techniques. We had a small dural tear on the left L4-5 lateral dura and repaired this with microsope and micro sulture w 6-0 prolene and a small muscle autograft. We placed duraseal over this repair. We did L4-5 discectomy from left and interbody arthrodesis and cage placement with globus cage and placed local autograft and iliac bone marrow aspirate autograft and mosaic graft extender into L4-5 disc space to complete the transforaminal interbody fusion. We expanded the TLIF cage to get sold purchase. We connected rods to the screw heads and locked the locking screws and placed right sided posterolateral arthrodesis w local bone graft into the L4-5 facet. Hemostasis was achieved with bipolar. The wound was closed in a layered fashion. I was present for all key portions of the procedure. I did the decompression via microscope and hardware placement w navigation myself. The sponge and needle counts were correct per the nursing staff.

    Sorry being so long.
    Did it sound like the surgeon did all the work, I was told he has his fellow assisting and she did the closing of the incision. They have to sultured it with graft and duraseal glue–would it still be pinhole or large/spaghetti??

    I really want an MRI ASAP! The earliest I can ask for one is at my 6 months post-op in late April. Do I need one with contrast since I have hardware in the spine? Would you think I can see a neurologist for EMG and request him to order an MRI? Would you order an MRI for me if I request a remote consultation with you? Please advise.

    thanks again for all your help and advices.
    best regards,
    glo

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I am confused as to why he did not place a pedicle screw into the left side (the TLIF side) because “left L4 screw we placed after the TLIF to avoid hindering the TLIF view”. Normally, that screw is necessary to perform a TLIF as it is needed for temporary distraction. As normal for a dural tear repair in the op note, there really is no expansive description of the tear or repair. It would be impossible to note if the attending did all the work through this note.

    I cannot order any tests for a long-distance consultation patient as I have not met with them face-to-face. I can suggest recommendations that can be carried out by your family doctor if he or she feels this is a relevant suggestion.

    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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