Viewing 6 posts - 1 through 6 (of 8 total)
  • Author
    Posts
  • mand
    Member
    Post count: 6

    Hx:
    1991- Ant/post spinal fusion T11 to L4 age 14 (Idiopathic scoliosis) performed by Dr. Thomas Lowe. Continued active lifestyle until…
    2001- injury resulting in Ant/post spinal revision surgery L4 to L5 extension by Thomas LaGrone. Corrected pain.
    2010- April. Two children later… Began running and active lifestyle. Felt good with only manageable levels of pain- not enough to stop working out and enjoying life. Came off a plyometrics box about mid-thigh and felt like I was going to pass out. Acute pain.

    2010-present. Daily and nightly pain- disabling. Attempts to walk, swim, elliptical, cross country ski, climb stairs, bend, twist, sit… everything seems to agitate the back. Waited to go in due to insurance purposes. Added about 40 lbs. due to extremely sedentary lifestyle. Feels like bone on bone- no muscle no nerve pain. Just intense deep pain that is not ever fully alleviated.

    Today- Pain worsened to the point I had to go home from work. Ready to get this looked at. Pain is definitely in what I believe to be the L5-S1 region. Very week hips, stretching hamstrings agitates the injury… never recovered from injury in 2010…

    Questions: Do you do revision surgeries with this much going on? I have been turned away by several surgeons within Colorado. If you do not, do you have any ideas on where to go for this type of surgery? Can you recommend good articles or journals to research on spinal fusions that extend from sacrum to Thoracic vertebrae that did not maintain the lordodic curve? Would it be wise to seek the same surgeon as my second revision surgery? Thank you for your time!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    Your problem is very typical of long term results of this type of surgery. It has been well known that a long fusion down to L4 will eventually wear out the L4-5 level in approximately 10 years. That is exactly what happened. You had a fusion of L4-5 and continued your active lifestyle.

    Unfortunately, the L5-S1 level will then eventually wear out and again, that is most likely what happened. The condition is called isolated disc resorption (see website). The pain that occurs is bone pain from lack of shock absorption. Symptoms initially develop with impact activity and after some months to years, delayed deep boring pain occurs some hours after the impact event. Patients will say they “pay” for the activity later. Eventually, night pain can occur that wakes the patient up.

    If isolated disc resorption is the problem, the surgery is relatively standard. You may already have hardware in your back which can make the surgery easier. The procedure is called a TLIF and you can view a video of this on the website. If you have a flat back syndrome from surgery, this is a different matter and an osteotomy may need to be performed along with the TLIF. Yes I perform this type of surgery.

    You can send your films to the office or you can call for an appointment at (970) 476-1100.

    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.
    mand
    Member
    Post count: 6

    Wow- thank you so much for your time! I’m not sure how you do it! I’m definitely interested in pursuing and have more specific questions, but I will limit this to few one more.

    So, my obvious concern about a fusion from T-11 to S-1 is what part of the body goes next from daily wear? Do you have any resources or long-term studies on hips/knees/ankles? Or, can we assume that the thoracic and cervical vertebrae would be compromised? My goal is to make surgery number 3 my last (I learned my lesson- no more running for me) and get back to an active, low-impact lifestyle.

    Regarding films- I have my post surgery films and everything prior from 2001. When I went for a referral, they suggested waiting on finding a specialist before getting any done. X-rays have never shown much displacement or spacing abnormalities. Should I get a CT scan locally to send or should I schedule with you and have it done same/day to review after the appointment? Thankfully, I’m in Gunnison, CO and am thrilled that I may not be looking at coordinating an out of state surgery!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    If you have a fusion from T11-S1, there are two areas that need to be watched- the sacroiliac joints and the T10-11 level. You can mitigate the wear by doing just what you stated- low impact activities. The spine fusion should not affect your hips, knees and ankles.

    Swimming, cycling including mountain biking, hiking (without a heavy pack), rowing, reasonable gym workouts, cross-country skiing and snowshoeing are all activities that in general, would not harm your back.

    Intermediate activities that could cause increased wear are skiing groomed slopes, hiking with a heavy pack, heavy weight lifting and water skiing.

    Acivities to avoid are all impact activities such as running, tennis, volleyball, basketball, soccer as well as others that increase the load on the back.

    Normally, both a CT scan on a 64 slice scanner and an MRI on at least a 1.5 tesla machine are necessary for the workup. In-office standing x-rays with flexion and extension view are necessary.

    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.
    mand
    Member
    Post count: 6

    Thank you very much for your time. I’ve never heard of wear on the sacrum joints as I thought they are already fused. I will do my homework and be calling you soon!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    The sacroiliac joints have 1-2 degrees of motion when young and get much stiffer when we age. They still have some minimal degree of motion even in the elderly. A long fusion can cause some pain in these joints. Treatment normally is injection therapy and it is extermely rare to consider surgery of these joints.

    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.
Viewing 6 posts - 1 through 6 (of 8 total)
  • You must be logged in to reply to this topic.