[Cjdegood]

#32558

Dr. Corenman
I thought it best to continue to use my original thread for this concern. I have still been dealing with this intense low back pain. Due to this i cannot put complete weight on my left side. The pain does keep me from doing certain activities and my regular work (I have desk position as a mortgage originator) My meetings with clients can sometimes be 2 hours or longer. So i feel odd standing up while they are sitting in front of me. I know the MD worked as i had a little while of no pain and feeling quite normal through the holidays. To keep it short here is the timeline and where i am now.
Jan 2020-Dr.appt.- explained low back pain and shifting feeling/ was given steroid shot in the office.
Feb 2020- contacted dr.to see if chiropractor could help me with the low back pain. No was the answer and PT was ordered as well as oral steroids. (aquatic PT)
Feb 2020- Dr. appt. went over the extreme low back pain again… received oral steroid pack and 800mg Ibuprofen.
March 2020- Dr. Appt. Still suffering with this low back pain and feeling of movement. Received 2 steroid shots (one on each side) He said it sounded like Facet joint inflammation. I felt fantastic for the rest of that day! but pain was back the next afternoon. (still doing PT)
May 2020- Dr. Appt- i am fed up with this pain.. so they took Xrays in the office. He said i have options..1 being a fusion as there is movement, something about no cushion?? or continue to treat with steroids ( I hate the oral pills!!) New MRI has been ordered and waiting for appt. I do not have any significant leg pain.. my left is still weaker and there is a pulling feeling down the inside of it, but it is secondary to this low back ache. I cannot do much of anything and i want it gone. Could a fusion resolve this pain? Its another surgery i really do not want but willing to if it will take care of it for good. Now what I am scared to mention is something new and i have not even told my husband in case it is just my nerves (anxious nerves, not literal ) For the past 4 to 5 weeks my left arm has been aching extremely bad. i have never felt this pain before, i can take the 800mg ibuprofen and the Robaxin( I take the Robaxin 750mg at night) and it will let up.but.. what scared me is earlier today the ache was accompanied with the loss of the use of my arm (lifting it) and my index finger and thumb were numb. I got the feeling back, arm is still weak?? Can what i am experiencing in my low back have an affect on my arm on the same side? I have no idea what that could be? I hate to call with another ailment! or if it could just be the stress and lack of rest i am getting with my back. I am tired! Time is just flying by, although at least i am not missing out on too much right now with the virus.. otherwise i would be missing bowling, ziplining.. all of the things me and my family love to do during the summer months! one being in your area (rafting Royal Gorge) which is a blast!! Not sure if i can ever do those things again the way i feel now. I hope all is well for you and thank you for your time that you give each one that writes to you.

[Donald Corenman, MD, DC]

#32563

Your back pain is not atypical for the aftermath of a large herniation in the lumbar spine. About 10% of individuals with a disc herniation will develop chronic lower back pain. You might be a candidate for a fusion but you need a workup to determine the pain generator. This includes standing X-rays, an MRI and a diagnostic block to help indicate what is painful. Treatment could be a simple as physical therapy, chiropractic care or injections. Depending upon the source of pain, radio frequency ablations, or even fusion surgery can be quite helpful.

Your new complaint; “For the past 4 to 5 weeks my left arm has been aching extremely bad. i have never felt this pain before…but what scared me is earlier today the ache was accompanied with the loss of the use of my arm (lifting it) and my index finger and thumb were numb. I got the feeling back, arm is still weak”.

This sounds like either a radiculopathy or Parsonage Turner syndrome. Both of these would not be related to your lower back but commonly, the genetics of this disorder in your lower back are similar to the genetics of your neck. See: https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/, https://neckandback.com/conditions/parsonage-turner-syndrome-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ (the C6 nerve).

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.

[Cjdegood]

#32616

Good morning Dr. Corenman
well I had an MRI completed last month after in office Xrays revealed something the Dr. saw. I met with the Dr yesterday and we really did not over the results, he just said i re herniated and needed a fusion. Then had me take more xrays in the office. Once he looked at those he said fusion would be the way to go as the space is collapsed? Here is what i can see on the written report:
Transitional anatomy is seen at the lumbrosacral junction with L5 sacralized on the left and either sacralized versus partially sacralized on the right. The caudal most disc space will be labeled L4L5, similar to the convention used on prior MRI from 09/19/2019. Confirmation of spinal numbering/anatomy would be advised prior to any planned intervention.

Postsurgical changes are seen to the left of midline at L4-L5 presumably from prior disc resection
Correlate with the specifics of the patient’s surgical history.

Lumbar alignment is preserved There is no significant listhesE. Thoracolumbar levocurvature is
seen without scoliosis by criteria.
No acute fracture, compression deformity, or frank aggressive osseous; lesion Small intraosseous
hemangiomas are noted.

The corms medullaris terminates normally at L1-L2.
T2 hyperintensites are seen in the lower kidneys suggestive of renal cysts.

There is disc desiccation with moderate disc height loss L5-S1 including discogenic endplate
changes. The remaining intervertebral disc heights and signals are preserved.
Evaluation of the individual lumbar Levels demonstrates: Ll -L2:Unremarkable.

L2-13: Unremarkable.

L3-L4: Mild left greater than right faucet arthrosis. Trace facet effusion on the left possible.
Otherwise, unremarkable.

L4-L5: Granulation tissue is seen in the left lateral recess, though evaluation with post-contrast
MRI may be helpful for further assessment.
A posterior central disc extrusion is present spanning 12 mm in craniocaudal extent tracking below
the level of the disc space measuring up to 10.5 mm in AP dimension and over 14mm transvers.
‘This narrows the thecal sac to 9 MM and encroaches on the subarticular zones likely contacting the
bilateral descending L5 nerve roots (series 7, images 27-29). Mild left greater than right facet
arthrosis with a left-sided facet effusion and 4-5 mm synovial cyst also projecting into the left
subarticular recess contacting the descending left L5 nerve root, new since 09 /19 /2019.
Mild right and moderate to severe left neural foraminal stenosis “with a foraminal disc bulge near
the exiting right L4 nerve root and a left foraminal disc protrusion up to 4 mm contacting the
exiting left L4 nerve root.

IMPRESSION:

1. Transitional anatomy again seen at the lumbosacral junction with the caudal most disc space
labeled L4-L5. Confirmation of spinal numbering anatomy would be advised prior to any planned
intervention
2. Postsurgical changes are seen to the left of midline at L4-L5 presumably from prior disc
resection.
Correlate with the specifics of the patient’s surgical history.
3. L4-L5: Granulation tissue is seen in the left lateral recess , though evaluation with
post-contrast MRI may
be helpful for further assessment
Posterior central disc extusion tracks below the level of the disc space measuring up to 10.5 mm
in AP.
My other question is this. He said he would go through my abdomen and then two small holes in my back? is this considered Anterior? which is fine, but i am curious if my having 3 c-sections and one abdominal hysterectomy is a problem? i hope not as i have heard you heal faster going through the front. I am not sure how i feel about all of this just yet, but i do want to feel better and get back to life. Do you think in your opinion this is the best and/or only way to go to get relief and back to somewhat normal? thank you again for your time. I truly value your input .

[Cjdegood]

#32617

Dr. Corenman
the Doctors office just called and i asked exactly what i was having done.. He said i am having a 360?? i should prepare and pack for at least 2 nights.

[Donald Corenman, MD, DC]

#32620

Well, you sound like you are set up for a “360” or a front and then a back approach to your spine. That might be OK but I have some reservations.

Your canal has a significant amount of intracanal compression “posterior central disc extrusion is present spanning 12 mm in craniocaudal extent tracking below
the level of the disc space measuring up to 10.5 mm in AP dimension and over 14mm transvers.
‘This narrows the thecal sac to 9 MM and encroaches on the subarticular zones likely contacting the
bilateral descending L5 nerve roots’ and “4-5 mm synovial cyst also projecting into the left
subarticular recess contacting the descending left L5 nerve root’ and ” moderate to severe left neural foraminal stenosis “with a foraminal disc bulge near the exiting right L4 nerve root and a left foraminal disc protrusion up to 4 mm contacting the exiting left L4 nerve root”.

That’s a lot of canal compression which may not easily be addressed with a “minimally invasive approach” which sounds like is planned, Make sure your surgeon is going to address the canal compression directly and not just fuse the spine “where it stands”.

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.

[Cjdegood]

#32622

Thank you Doctor
I think my problem is that i am not confident when talking with him. I do not think its any fault of his, I just tend to feel intimidated by the whole thing. I don’t know what to make of any of the reports, so I am completely relying on him to do what is best. At this point, the problems i am experiencing has disrupted my life for the past year. It has been quite the journey to say the least. I Hate surgery, because it seems like i have done nothing but recover these past months, and never really got complete relief. I really want a One and Done kinda thing, although there may not be such a thing. I still have not even addressed the left arm pain and numbness/slight tingling in the index finger and thumb. I am worried there will be something else to deal with. So i just take the Robaxin prescribed and the ibuprofen. which I understand i have to stop taking by next Wednesday due to the scheduled surgery date. I am not sure if i should cancel and get another Dr. to look at this, or build up enough confidence to ask the important questions involved with correcting the problem. I so appreciate your time as i know it is valuable. As of right now i am scheduled for this 360 fusion June 23rd. And i am pretty sure i will need to cancel our vacation for July 10th.. which involved a 2 hour flight. I had to cancel last years as well due to this. I just want to make the right decision. I will talk with my husband tonight and see if he would like to talk to the doctor before going through with the planned procedure. I understand that I have one the best spine orthopedic in Houston area… but Houston is quite large :) Thank you again and have a wonderful blessed weekend.

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