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  • MASpinept
    Participant
    Post count: 17

    Hi Dr. Corenman,

    I had a long distance consult with you a few months ago, it was very helpful; i am hoping you can provide some insight based on the latest information. It appears based on my CT that i finally have a solid fusion in 2/3 locations of the L5-S1 TLIF (performed in 8/2020). The fusion status was questionable until last week when the CT finally noted solid fusion on the left posterior and anterior interbody. I also asked my surgeon for flexion/extension xrays, the report only comments on the L5-S1 level and it notes no motion in this segment. Though this is good news, i’m having considerable pain. My surgeon was concerned about adjacent segment issues at the l4-5 level, i am waiting for a call with him to discuss the images and his thoughts on what to do so that is TBD.

    My symptoms are very positional and activity based-i’m having a hard time even getting through an 8 hour shift at work. I try to rotate positions but standing gives me pretty significant, stabbing back pain (L>R) and sitting gives me leg pain. I do have chronic radiculopathy in L5-S1 but now i feel nerve pain going down the front of my leg through my knee. I do exercise quite a bit and depending on the form of exercise my sx are made worse-mostly it flares the sharp back pain. A more noticeable symptom of late is feeling like i need to roll my pelvis down to “open up” my lower back. I feel like i need to brace my back by engaging my core and forward flexing my hips. This is particularly noticeable when standing for a little while, its a bit hard to explain.

    I had discussed having injections done at this level with the pain mgmt MD but he did not feel injections would be helpful in my lumbar spine because my back had been altered by surgery so much. He felt the issue was more structural and since i had no relief from a previous injection, and instead had many side effects from the type of steroid that was used- he did not think another injection would be helpful.

    I’m wondering if you can look at the latest images and let me know your thoughts on the alignment of the lumbar spine and the level above my fusion.

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8339

    Your symptoms have changed since surgery or are the same? More intense?

    Pain symptoms in the front of the leg are more suggestive of a higher level involvement (L3-4 or L4-5 roots).

    Your posture to relieve pain “feeling like i need to roll my pelvis down to “open up” my lower back” flattens the lumbar spine (flexion) and could be indicative of a facet problem or a foraminal narrowing.

    Call Slavina, my nurse and send images. I’ll review them.

    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.
    MASpinept
    Participant
    Post count: 17

    Ok thank you, I will work on getting something set up.

    I think the specific, stabbing back pain is more noticeable, the leg pain in consistent to what it has been in L5 and S1 but it’s more distinct through the front of the leg and knee. I thought it was a screw, especially on the left side of the back, which was causing pain over the past several months. But when I pointed to where it hurt the spot is above the screw in L5.

    Looking forward to getting your interpretation of the images. Thanks again.

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