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Hello Dr Corenman,

I have asked a question here previously regarding a TLIF. I have consulted a surgeon back 5 months ago and he didn’t think it was the correct time for surgery as I didn’t seem in a lot of pain and symptoms were intermittent. Although he did express I will likely need it inevitably at some point.

I have a grade 1-2 spondylo at L5/S1. With moderate/severe exit foramina stenosis. There is also Pffirmans grade 4 degeneration of the L5 disc. I am also 31 years old and fit and healthy. My symptoms have been very intermittent with low grade back ache mainly in the morning. More recently I am experiencing more frequent intermittent altered sensation bilaterally with strange muscle aches is the only way I can explain it. There is also a horrible hamstring tensions on the left side pretty constant which I believe is from nerve irritation I also feel as if I can feel the L5 moving sometimes when I sit up. Also if I wake up on my back after a night sleep it seems to be at it’s worse. My questions for you are:

1) When do I know it is the right time for surgery, as I don’t want to leave it too late and have lasting nerve damage?

2) I’m a new grad chiropractor, how long would I expect to be off work from treating patients roughly?

3) Can I expect to have a long career still as a chiropractor after having a TLIF surgery in your experience?

Hello!
I just recently saw the results from a MRI I had back in 2020. I wasnt given the results at the time of the test. At the time I had lessened sensation in my rt leg and also developed an inability to urinate for which I was catheterized for 2 months, which resolved on its own. I am now experiencing severe left sided facial pain, it feels nerve to me and it is constant and waking me up at night. I have an appointment with a neurologist in june, but I am wondering if I should see a neurosurgeon. I am 41 years old.
This is the result of my C/T spine MRI:

Mild multi-level disc desiccation most pronounced at c6-c7. posterior elements and paraspinal soft tissues are normal. There is a 6mm linear focus of T2/STIR signal hyperintensity within the right hemicord centered at the c6-c7 level. There is no abnormal enhancement.
c4-c5 – There is facet and uncoverterbal joint arthropathy which contributes to mild to moderate left neural foraminal narrowing.
c5-c6 – There is a right paracentral disc herniation and ligamentum flavum thickening causing mild spinal canal stenosis without foraminal narrowing.
c6-c7 – There is a disc osteophyte complex and ligamentum flavum thickening which contributes to moderate spinal canal narrowing and moderate bilateral neural foraminal narrowing, left greater than right.
Thoracic Spine
There is mild anterior loss of height of the t8 vertebral body with an intravertebral disc herniation along the superior t8 endplate. normal curvature.
There is an intravertebral disc desiccation the t6-t7 level with an associated right paracentral and subarticular disc herniation which mildly remodels the right ventral cord.
IMPRESSION:
1. Cervicothoracic spondylosis, as detailed above, most prominently contributing to moderate spinal canal narrowing and moderate bilateral neural foraminal at c6-c7 level.
2. Linear focus of T2/STIR signal hyperintensity within the right hemicord at the c6-c7 level is nonspecific and may reflect myelomalacia in the setting of the aforementioned spondylosis. There is no abnormal enhancement. While a demyelating lesion and cord edema may have a similar appearance, they are considered less likely but cannot be entirely excluded in the absence of prior imaging.

Thank you for your help