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#34819Topic: another l5S1 problem in forum BACK PAIN |
HI there-
I had a very very painful herniation l5S1 2.5 years ago and the microdiscectomy was an emergency as I was getting all the nerve damage into my foot pretty badly. He pulled the disc material off the nerve and I woke up feeling amazing and fully out of pain from the get go. I had an excellent recovery and diligent with PT and was able to be back at my trail running lifestyle pretty smoothly within the next 6 months. Fast foward to now– In the past week I am now experiencing a repeat of nerve pain in my glute hip and hamstring and targeted pain in the lower lumbar that feels very very similar to 2.5 years ago. Each day this week the pain is intensifying and I have stopped all activity except for my PT’s recommended mckenzie pressups. I’m a busy mom and sitting in the car and driving kids is the worst — I don’t know if I can handle a month of dealing with this only to end up back at surgery again. Do you ever see different outcomes? Or is it already weakened from the first surgery and it’s no use waiting again? My husband is a Radiologist and very conservative views on surgery– and is probably going to discourage imaging and taking action so fast. It will definitely be disruptive to our life- however this is starting to be just as disruptive and my nerves took two years to heal because I waited so long with this pain last time (6 weeks) I guess my long winded question is– is there any hope of this pain going away with exercises or do you see this often on people on the same disc/nerve once they’ve already had a microdisecectomy. I’m 43 years old. Thank you so much!#34816 In reply to: Neck Pain with Numbness/Tingling of right arm and hand |Shoulder pain can be a result of cervical radiculopathy (nerve generated pain) or shoulder generated pain (rotator cuff syndrome or other). Cervical radiculopathy commonly is triggered by neck and not shoulder motion. The act of lateral bending or extension to the side of the pain increasing the pain in a good indicator of foraminal stenosis where the neck motion narrows the nerve hole and pinches the nerve.
If you keep the neck still and move your shoulder (especially elevate or “up”) causing pain, this generally means a shoulder problem. A careful physical examination can help to identify and differentiate these disorders.
Your MRI is about 1 1/2 years old so a new one is warranted. The radiologist did not distinguish between foraminal stenosis and central stenosis (“C3/4, central disc protrusion. Right-sided uncovertebral hypertrophy. No significant stenosis”). I assume this means no central stenosis but probable foraminal stenosis on the right present.
You are probably not in danger currently. In these days, a spine surgeon might be required to order a new MRI. You need to get an examination and a new MRI.
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.#34815Topic: Neck Pain with Numbness/Tingling of right arm and hand in forum NECK PAIN |I Have Ankylosing Spondylitis. I am on daily NSAIDs and have been taking an infusion medication (anti-TNF I think). Since my late teens through early 20s, I have dealt with pain starting in my lower spine and SI Joints that has slowly worked it’s way up to my neck. I have been through so many physical therapists, oral steroids and injections, nerve blocks, nerve ablations, and trial for spinal cord stimulator. None of it ever gives me any long term relief (more than 3 weeks and symptoms return).
About two months ago, I started to have severe pain in my right shoulder/arm pit area if I tried to tilt my head to the right (ear to shoulder stretching). About a week later, I began having tingling in my lower right arm (below the elbow) and hand (thumb, index and middle fingers only). This has continued to worsen for the past several weeks and now my neck (right side) is in pain most of the time. If I move my head in certain stretches (tilt up/down, tilt right ear to shoulder) the pain in right shoulder/arm pit area increases and the tingling in my right arm and hand/fingers increase until I return my head to a neutral position. When I lay down on my bed on my left side, my entire lower right arm below the elbow tingles until I move positions.
My most recent MRI of my cervical spine was dated 07/28/20. These are the written notes:
MRI CERVICAL SPINE WO CONTRAST
IMPRESSION:
1. Mild multilevel degenerative changes. This is only mildly progressed compared with prior study from January 11, 2006.
END OF IMPRESSION:
INDICATION: Cervicalgia. ICD 10 code M 54.2. Patient reports neck pain with bilateral upper extremity radiculopathy
TECHNIQUE: Multiplanar multisequence imaging cervical spine, without contrast, standard protocol
CONTRAST: None.
FIELD STRENGTH: 1.5 Tesla magnet
COMPARISON: MRI thoracic spine April 25, 2019, June 19, 2013. MRI cervical spine January 11, 2006
FINDINGS:
There is mild straightening of the normal cervical lordosis, without significant prevertebral soft tissue swelling. The cervical junction is maintained.
There is no acute fracture or traumatic subluxation. On fluid sensitive sequencing, there is no abnormal bone marrow edema or soft tissue edema. There is no ligamentous injury.
Right-sided rounded foci of increased T1 and T2 signal involving the T1, and T2 vertebral body levels. This is best seen on sagittal image 8. This is consistent benign focal fat or benign hemangioma. Multilevel bony spurring is seen. This is most pronounced from C4, through C7. Otherwise, vertebral bodies of the cervical spine are normal in height and signal intensity.
Cervical spinal cord signal appears to be normal. There is no evidence of underlying cord compression or cord contusion.
Limited images to the posterior fossa demonstrates no suspicious abnormalities. Assessment of the regional soft tissues demonstrates no definite discrete suspicious soft tissue abnormality.
At C2/3, no significant stenosis.
At C3/4, central disc protrusion. Right-sided uncovertebral hypertrophy. No significant stenosis.
At C4/5 broad-based degenerative disc osteophyte complex. This mildly effaces ventral thecal sac. No stenosis.
At C5/6 broad-based degenerative disc osteophyte complex. This effaces the ventral thecal sac and just abuts the ventral spinal cord. Question minimal central spinal stenosis. No significant neural foraminal stenosis.
At C6/7, broad-based degenerative disc osteophyte complex extends to both lateral recesses. In conjunction with bilateral uncovertebral surgery is minimal central spinal stenosis and perhaps mild bilateral neural foraminal stenosis.
At C7/T1 no significant abnormalities are seen.
With my current symptoms, my doctor tried to schedule a new MRI but insurance is denying the claim. I have been scheduled to see a Neurosurgeon in a couple weeks. Will the Neurosurgeon be able to help without current MRI? What exactly is the risk involved with not addressing the numbness/tingling while waiting to get approval from insurance for a new MRI, which could take several months of appeals? Having these symptoms progress to this state in two months has me concerned that damage may occur before I get any meaningful treatment. What should I be asking my doctors, especially the Neurosurgeon and Rheumatologist? I am a 44 year old male caucasian, history of Rheumatological illness throughout family, including RA, and other autoimmune diseases in immediate family (Father had MS).
#34801 In reply to: Post Cervical Disc Replacement pain |It is distinctly uncommon to have any significant pain in a well working ADR. Motion at C6-7 was probably limited before the ADR and that could have been one of the reasons for failure (if that is even the presenting problem). You can use the flexion-extension films now (you need them) and measure the current motion of C6-7. That will give you an idea of any loss of motion but i expect you have little to no motion at that level now if the disc has failed.
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.#34797 In reply to: Coflex Removal |Coflex is a device that has limited use. The problem with the device is that the vertebra is forced into flexion, the supraspinous and interspinous ligaments are removed and pressure on the spinous processes can erode or even fracture them. I would recommend a CT scan to determine spinous process status for prognosis. If your pain is generated from that particular disc, removing the device can be helpful. If the disc is very degenerative and the level is stable on flexion-extension X-rays, you should be OK removing the device.
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.#34796Topic: Coflex Removal in forum BACK PAIN |Hi Dr Corenman
I had a Coflex l4/5 and a non instrumented ls/s1 facet fusion surgery performed in February 2021 by a surgeon who puts coflex in a lot of his patients combined with decompression. Unfortunately i didn’t get a second opinion and watched a couple of coflex testimonials on youtube.
About 6 weeks out i started to feel a host of new symptoms.
I have pain in extension from l3 to t12 and in flexion at t11/12, L1. My TLJ feels extremely painful and there is a burning irritation in the mid and lower back, Pain around the tops of my illium and into my groin and what feels like the SI area. Both sides. My left leg weakness also seems to be getting worse.
The only pain i had before surgery was mechanical lower back pain.
The operating surgeon kept saying the symptoms should resolve. I have lost confidence in him.
I have seen another surgeon who believe some of the symptoms could be coming from the Coflex as my discs are very degenerate. He is willing to take it out on the NHS.
Myquestion is what problems could possibly arise as the supraspinous and interspinous ligaments have been removed?
Thank you
Stephen -
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