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  • Avatarsnowbunnie
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    Dr. Corenman,
    First of all, your website is wonderful. You explain things so well.
    I have a very important decision to make regarding the future of my spine and I would appreciate your advice. I will try to be brief with my history.
    I am 42, female, BMI 26 and very muscular, highly active in extreme sports most of my life – snowboarding, volleyball, wakeboarding, paddleboarding, surfing, kickboxing, and recently retired from roller derby. I have had multiple injuries over the years, but with chiropractic care, stretching, and exercise I have maintained good spine health. In Oct of 2019 I started to experience debilitating sciatica of my right leg with numb toes and leg weakness, but zero back pain. An xray showed less than grade 1 spondylolisthesis of L4 over L5 and a herniated disc was suspected, so I tried a bunch of conservative care treatment but my symptoms continued to get worse. I am currently functional only with narcotic pain management. When I finally had an MRI the 1st week of Jan 2020 my discs look great, but I have a large synovial cyst on the ligamentum flavum that is impinging my L5 nerve root. I met with a physiatrist who said the cyst cannot be aspirated and referred me to a neurosurgeon. The neuro said the cyst has to be surgically removed and in doing so he will have to remove a piece of bone that will weaken my otherwise healthy spine. He is recommending a fusion to stabilize the spondy and says if we do not stop that abnormal movement the cyst will likely return and the spondy will progress.
    Of course I have read all the horror stories about the domino effect of fusion so I am terrified. If I fuse my L4-L5 will I be able to continue to snowboard and play volleyball? I absolutely cannot become sedentary. I do not know quite how to explain this, but without my sports, I do not think I would want to continue living. I know that sounds dramatic, but staying active is the only good way I have found to battle depression.
    I know I have to have the cyst removed, but I have to decide if I want the fusion done at the same time. My questions are: What do you think about continuing my normal activities without a fusion? Will the spondy progress and will the cyst return? What if I have the fusion and continue my normal activities? Will I be able to avoid the adjacent segment problems that I keep reading about, say by keeping my core super strong or wearing a brace? Does the fact I am young, strong, and have an otherwise healthy spine change the outcome of a fusion, say in comparison to someone with a bunch of already existing degenerative issues?
    I know your opinion of things like Coflex device because I have read a bunch of these forums. I notice that most of the people asking about it have disc problems so what you are saying make sense. But do your feelings about the Coflex device change at all in a situation like mine, where my discs are healthy and where the sole purpose is to stabilize a spondy? Is there another device or fusion alternative you can recommend that will allow me to keep snowboarding to a ripe old age?
    I have an appointment scheduled for Jan 27th with a surgeon that uses the Coflex device, and also just to get a second opinion. I would greatly appreciate your advice before I make a decision that will affect my entire life so much. Thank you so much.
    Cari

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7288

    You note that “Oct of 2019 I started to experience debilitating sciatica of my right leg with numb toes and leg weakness, but zero back pain. An xray showed less than grade 1 spondylolisthesis of L4 over L5 and a herniated disc was suspected”.

    You then note “MRI the 1st week of Jan 2020 my discs look great, but I have a large synovial cyst on the ligamentum flavum that is impinging my L5 nerve root”.

    Then finally you note “The neuro said the cyst has to be surgically removed and in doing so he will have to remove a piece of bone that will weaken my otherwise healthy spine. He is recommending a fusion to stabilize the spondy and says if we do not stop that abnormal movement the cyst will likely return and the spondy will progress”.

    One of the important factors is how stable (or unstable) this degenerative spondylolithesis really is. Stability is judged by flexion/extension X-rays and you don’t mention those. There are many degenerative spondylolitheses that produce ganglion (or synovial) cysts that are compressive to the nerve root. If your disc looks good and the spondylo level is stable on flexion/extension X-rays, you could have a simple cyst excision with the understanding that this level can go on eventually to need a fusion.

    I do not endorse the Coflex device as this device will eventually fail and does not address the problem of cyst compression of the nerve root.

    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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