[glo]

#27620

Hello Dr. Corenman,
thanks for your quick reply.

the operative note was given to PCP by the surgeon. Would there be more detailed operative notes with the hospital medical records? I will call them Monday to ask for it. The fellow told my husband the dural tear was small but did not give any details.
I read through the link you sent regarding chronic radiculopathy. I actually have L4 nerve injury too as my left knee will buckle during walk and cannot balance on the left leg. I tested myself with the exercises you listed online and I failed them on both L4 and L5 nerve tests.

I’d contacted my PCP for an MRI and she referred me back to the UCSF surgeon. She has given me a referal to see a neurologist last August(before surgery). I will see if I could make an appointment with the neurologist for an EMG test and ask for a MRI.

Questions:
– would I need a MRI with contrast due to hardware in spine?
– would EMG test help to confirm the nerves damages and where they are?
– based on my symptoms, would my nerve damages during surgery recover over time?
– regarding your comment on “left L4 screw we placed after the TLIF to avoid hindering the TLIF view”, would his approach caused damages to my nerve roots during surgery?
– how would I find out who actually performed all the procedures during surgery?
(the op note said he did the decompression and hardware placement, might be the fellow did the dural tear repair, kwires placement, drilling, ???
– What other steps are done during TLIF & decompression that can be performed by fellow?

I greatly appreciate your help and advices. You had given me hope that I might NOT have adhesive arachnoiditis which is my BIGGEST fear!

have a wonderful Sunday!

best regards,
gabriela

[Donald Corenman, MD, DC]

#27623

Generally, contrast (gadolinium) is needed for tumors or recurrent herniation but I would include it here due to your nerve injury.

The L4 nerve exits at L4-5 so it certainly can be part of the nerve injury.

The operative report is what it is. There is no “secret” additional report. You can look to see who dictated it. At a university, it most likely is the fellow and not the attending surgeon.

An EMG will be positive for injury to the L4 and L5 nerves so you can get this test but the results are predictable.

Nerve damage can recover over time but the final results will be unknown. If the nerves were intact after the leak, and handled with great care during the repair, then there is a reasonable change they can recover somewhat. If there was a torn nerve, this particular nerve won’t recover.

Placing the screw in the pedicle after the TLIF could have created some nerve compression. A CT scan would be the study to obtain if that is suspected.

I cannot tell you what the fellow did and did not do. These surgeons are authorized to perform every part of the surgery. Some attendings allow the fellow to operate and some just want them to assist.

Drop your fear of arachnoiditis. The direct nerve injury (ies) is what is causing your current symptoms.

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]

#27643

Dr. Corenman
Thanks for your reply and your advice.
You made my day that I don’t have ARC！
Beside numbness, random stabbing/burning, electric shocks pain from knee to toes,I am super sensitive to gentle touch,I can’t wear socks or shoes and bedsheets touching feel like pin prickling from knee to toes. Also start having aching pain from my left buttock(sit bone) to my left outer calf. Are they also symptoms of nerve damage?
The surgeon ordered a ct scan to check on bone growth, I’m waiting for the radiology report. Would it show any nerve damages? Also per your comment “Placing the screw in the pedicle after the TLIF could have created some nerve compression. A CT scan would be the study to obtain if that is suspected.” Would the report show that?

Thanks so much for your time and advice
You’d given me more help than my surgeon and his team!
Best regards
Glo

[Donald Corenman, MD, DC]

#27644

I can’t tell you that you don’t have arachnoiditis but you are worried about the wrong disorder. You have a direct nerve injury. You have allodynia (“I am super sensitive to gentle touch,I can’t wear socks or shoes and bedsheets touching feel like pin prickling from knee to toes”), weakness and nerve pain (“Start having aching pain from my left buttock(sit bone) to my left outer calf”). These are all classic findings of nerve injury.

Hopefully the CT scan would show nothing significant.

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]

#27646

Good morning Dr. Corenman,
Here is my CT-SCAN taken 2/14/18:
FINDINGS:
Interval surgery with interbody fusion elements at L4-5 level and bilateral L4 and L5 pedicle screws. No pedicle cortex is seen inferior to the left L4 pedicle screw. Pedicle screws do not extend into the lateral recesses or the foramina. There appears
to be focal bony continuity across the L4-5 disc space. Slight anterolisthesis of L4 on L5. No acute vertebral body compression fractures. Pseudoarticulation of right L5 transverse process with S1 as before.
T12-L1 (focal posterior left of center disc protrusion with annular calcification noted without high-grade bony spinal canal or foraminal narrowing).
L1-L2 (disc bulge and facet joint degenerative changes. No high-grade bony spinal canal or foraminal narrowing).
L2-L3 (disc bulge and facet joint degenerative changes. No high-grade bony spinal canal or foraminal narrowing).
L3-L4 (disc bulge, facet joint degenerative changes and ligamentum flavum hypertrophy with mild spinal stenosis. Right posterior lateral disc protrusion might abut the extraforaminal portion of right L3 nerve sleeve as before).
L4-L5 (postsurgical level. Left foraminotomy. No high-grade bony spinal canal or high-grade bony foraminal narrowing.
L5-S1 (facet joint degenerative changes and spondylosis without high-grade bony spinal stenosis. Bony elements encroach upon the right foramen possibly affecting the exiting L5 nerve sleeve.
Mild to moderate bony narrowing of left foramen also noted. Bilateral SI joint spurring)
Paraspinal Soft Tissues: Mural vascular calcifications.

IMPRESSIONS:

IMPRESSION:
Interval surgery with interbody fusion elements at L4-5 level and bilateral L4 and L5 pedicle screws. No pedicle cortex is seen inferior to the left L4 pedicle screw.
There appears to bony continuity across L4-5 disc space.
No high-grade bony spinal canal compromise
Bony encroachment upon right L5-S1 neural foramen could affect the exiting right L5 nerve sleeve. Correlate clinically.

Questions:
1) Does CT scan show any nerve compression due to placing the screw in the pedicle after TLIF?
2) Do you see any bone growth indication in the report?
3) any issues with the finding of the report?
3) my surgeon kept saying nerves takes 6-12 months to recover from surgery. I need to wait for at least 6 months to suspect nerve damage or ARC. He is saying all my progressive symptoms are nerve irritation caused by handling during surgery. IS THAT TRUE?
4) Your comment “I can’t tell you that you don’t have arachnoiditis but you are worried about the wrong disorder. You have a direct nerve injury.” Would the direct nerve injury caused arachnoiditis down the road? Their Symptoms are so similar.
5) what are the best treatments for direct nerve injury/damage? PT, Pain Med, exercise, etc??

Your advices and help are greatly appreciated.

best regards
glo

[Donald Corenman, MD, DC]

#27649

CT shows no impingement of the screws. The inferior bony pedicle of L4 is missing so I assume that this was intentionally removed. There appears to be some fusion occurring (“There appears to be focal bony continuity across the L4-5 disc space”).

I think there was nerve damage during surgery due to your symptoms. It will take 6-12 months to determine what will heal and what will remain.

Arachnoiditis symptoms can commonly be minimal or even nonexistent. Your symptoms are from root injury.

Time is the best treatment for root 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.

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