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#34168Topic: Back Pain & Sciatica 5 months after microdisectomy in forum BACK PAIN |
Hi Dr. Corenman, Hope you are doing well.I had back pain for about a year and started feeling pain down the left leg towards end of 2019.Got MRI and it was L5/S1. The doctor recommended epidural injection, which helped the pain but started feeling numbness and pins & needles. It lasted for about couple of months before getting better up to the point where I had almost no pain. Just as I was getting back to normal I had another back flare up while trying to lift a rug and fell back to the excruciating sciatica pain. My surgeon suggested microdiscectomy which I said yes to without thinking too much due to the pain I was in.
Got Microdiscectomy done early February this year. No leg pain for about 2 weeks (I was in complete bed rest with few mins of walking every hour) but slowly the pain crept back in the leg but nowhere as bad as before. Started physio & returned to work week 4. I got back flare ups and mild sciatica pain once every couple of weeks which the surgeon put down to back and nerve still in recovery process.
However last week (5 months post op) my back started hurting really bad after a 2 hour drive and the sciatica pain started the very next day. Its getting worse everyday and the shooting pain moving down the leg giving me memories of the first time I had the excruciating pain (it’s not not reached that point but it’s moving down the leg). I had an MRI done last week (requested by my surgeon) which says below:Findings: There s loss of signal intensity from in the L5-S1 disc there is a posterior annular tear and some posterior disc bulgng more towards the right of midline. Minimal indentation on the theca! sac. There is some loss of signal intensity n the 1_5-S1 disc The other discs were of normal signal intensity and were intact. The canal was of good dimensions. No canal stenosis seen. There was a partial laminectomy Solving the left lamina of 1_5. Postsurgical changes noted in the soft tissues of the back to he left of midkhe. Post contrast there was enhancing tissue to the left of the spinous process extending through the surgical defect and enhancing tissue on be left lateral aspect the theca! sac and tissue enhancement extendrg u;) to the adjacent nerve root. Them was some fluid the left 1_5-S1 apophyseal joint. No abnormality seen in the cauda equine or cones. A very smaN Tarim cysts noted in be sacral canal.Does this mean I have re-hearniated? My next appointment is about 10 days away but fearin— \/ it’ll get way worse before that
#34158Topic: Trying to understand my post op problems and work-up in forum NECK PAIN |Hello,
I had a C5 corpectomy with C4-C6 arthrodesis in 9/18 for cervical kyphosis with radiculopathy and myelopathy. These were all upper body symptoms. Right after surgery I developed leg weakness to the point of needing a walker and my arms were still very weak and pain still went down my right arm as before. They did an extensive work up with EMG’s, CT Myelogram, cervical facet injection, . . . I was unable to have an mri due to having a medical device for my bladder for interstitial cystitis. I. Saw a neurologist who looked at my past history from 20 years ago where I had some trauma with losing family members and diagnosed me with functional movement disorder. I got a second neurologist to do another EMG/NCS and he found an abnormality in the NCs showing radiculopathy and suggested I could have cervical myelopathy but would need an mri. I had to wait about 6 -8 months for a new lead wire to come out that was mri compatible so I could have another surgery to have it replaced. Then I could have an mri.
In the mean time I was diagnosed with this functional movement disorder. I mean no disrespect to anyone who has it, I was going to just go on and work hard and try to get better, but I was given the impression that “this was all in my head”. I was treated with a lot of disrespect by PT/OT and physicians from other disciplines because of this diagnosis.
I decided to go to the Cleveland clinic for another opinion after getting the mri compatible device. The mri and the Cleveland clinic diagnosed me with cervical myelopathy, pseudoarthrosis, cervical kyphosis below my surgery, congenital spinal stenosis, and cervical cord compression. I underwent a posterior cervical fusion from C4-C7 with rods and pins and laminectomies as C6 and C7. Needless to say I had a rough go of it. I was in rehab there for a month. I am still using a walker and the surgery was in 10/2020. I am Back to square 1 because the neurosurgeon believes I should be much better by now. I am not. I can barely hold my head up after walking 200 ft. I have nerve pain down both arms if I move my arms in a certain direction. I feel like I am walking in quick sand. mRI shows fusion is starting and good placement of hardware. A neurologist cannot find anything on exam, but did bloodwork. The only thing that came back low positive was an RNP antibody index. The ANA was negative as well as the rest of the ENP panel. He has now diagnosed me with functional neurological disorder. I’m devastated. In your opinion, can you think of anything else that would cause my symptoms? I have trouble raising my arms, my hips are week, I can walk now about 235 feet and then I have to sit down and I can barely hold my head up. This is after months of physical and occupational therapy including 2 inpatient stays in rehab. I am trying really hard. I want to get better!#34150 In reply to: Severe Coccyx pain that is affecting rectal area |Good afternoon Dr.
i did not use my original thread from months ago..(titled severe Coccyx pain) as i do not have that any longer. the 2nd injection back in December worked really well. I am only just now having some of that discomfort come back and pain dr. said he would burn the nerves next time if needed. Anyway.. i am always hearing about Flare Up? my question is how do you determine if it is just a flare up? I was told from a surgical standpoint i no longer had restrictions (back in November) so i went on vacation and have been living life normal. I am careful and do not get carried away with things. i started back exercising and small weights. (16lbs total) I am up to 4.5 miles pe60 r day walking. I love to walk, it is the best exercise i get. I have managed to drop another 20lbs since my 360 (L5 S1) fusion last June. I noticed about 5 weeks ago, that i started feeling low back pain. Not as intense because it is not keepin me awake at night. Leg pain is awful though! Same left leg as before.. i am not taking anything other than gabapentin 300mg at night before bed and 800mg of ibuprofen. this is driving me crazy.. and i am concerned and have been taking it easy for the past few weeks. I do not want to experience that type of back and leg pain ever again. It has not let up but has not gotten worse either. I am worried about it, so called the doctor and they said i could be in a flare up? how do you know? thank you so much for your help#34136Topic: Severe Neck Pain-Myelogram and MRI. HELP! in forum NECK PAIN |Hi Dr Corenman,
I am having chronic, severe pain in my neck, radiating down my right arm and thumb and index finger. I am also having weakness and numbness and tingling in those areas as well. I seem to be finding that the drs that I see are not really wanting to go any further than steroid injections or radio frequency ablation therapy, which I have already done MANY times to no avail.
Here is my current Myelogram and MRI that was just recently done. I have not seen the Dr since the scans, but was wondering your thoughts on this. I have had both a lumbar and cervial fusion as well as a foraminotomy.MYELOGRAM WITH CT CERVICAL, LUMBOSACRAL SPINE: 6/4/2021
CT CERVICAL SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
CT LUMBAR SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
MYELOGRAM SEDATION: 6/4/2021 10:00 AM
HISTORY: Previous neck and low back surgeries. Persistent neck and back pain.
COMPARISON: ARA MRI of the cervical spine 05/24/2021. ARA MRI of the lumbar spine 05/13/2021.
TECHNIQUE: The risks, benefits, and alternatives to myelography were explained to the patient who understood
and agreed to proceed. Signed consent was obtained.
Using sterile technique and local anesthesia, the tip of a 27-gauge spinal needle was placed within the spinal canal at
the L2-L3 level under fluoroscopic control. Contrast was instilled and maneuvered into the regions of interest. Total
contrast administered on date of service: 13 ml Omnipaque 300 – Intrathecal.
Multiple spot and overhead films were obtained. The patient tolerated the procedure well and was sent to CT where
multiple axial sections were obtained through the areas of interest. Images were viewed both in bone and soft tissue
windows. Multiple coronal and sagittal reformations were viewed as well. Utilization of dose lowering technique that
included adjusting the mA and/or kV to protocol and/or patient size.
Fluoroscopic Dose Area Product (uGy*m2): 1066.7
OBSERVATIONS: The cervical myelogram images show tiny anterior extradural defects between C2 and C6. The
right C6 nerve root sleeve is asymmetrically effaced. Both C5 nerve root sleeves are partially effaced.
The lumbar myelogram images show a small anterior extradural defect at the L1-L2 level.
The lumbar nerve root sleeves are normally and symmetrically filled.
Mild C5-C6 posterior listhesis is probably related to facet degeneration with subluxation. When allowing for
physiologic motion at the C3-C4 and C4-C5 levels, there is no indication of cervical instability when comparing
flexion and extension standing lateral radiographs.
Lumbar alignment is normal. There is no indication of lumbar instability when comparing flexion and extension
standing lateral radiographs.
There is no indication of bone destruction or acute fracture.
The anterior hardware stabilizing the C6 and C7 bodies is well-positioned without evidence of loosening or failure.
Solid interbody fusion has been achieved. The posterior elements of C6 and C7 are partially fused on both sides.
The anterior and posterior hardware stabilizing the L5 and S1 levels is well-positioned without evidence of loosening
or failure. Bilateral L5 pars defects are noted. The posterior elements of L5 and S1 are not fused at this time.
The L5-S1 disc prosthesis is associated with solid interbody fusion.
There is no indication of discitis, osteomyelitis, arachnoiditis, or epidural abscess.
C2-C3 disc: Normal. Uncinate spurring produces moderate bilateral foraminal encroachment.
C3-C4 disc: Normal. Uncinate spurring produces moderate right and mild left foraminal encroachment.
C4-C5 disc: Slightly narrowed. Minimal posterior protrusion of disc material approaches but does not deform the
anterior surface of the spinal cord. There is ample CSF posterior to the cord at this level. Mild to moderate bilateral
foraminal encroachment is noted.
C5-C6 disc: Mildly narrowed. Posterior protrusion of disc material approaches but does not deform the anterior
cord surface. A small, right posterolateral disc herniation is best seen on images 63 and 64 of series 4. The right C6
nerve root is probably compressed as it enters its neural foramen.
C6-C7 level: No canal encroachment. Facet overgrowth produces minimal right and mild left foraminal
encroachment.
C7-T1 disc: Normal.
T11-T12 disc: Posterior annular bulging slightly flattens the anterior thecal sac but does not deform the anterior
surface of the distal spinal cord.
T12-L1 disc: Normal.
L1-L2 disc: Moderately narrowed. Left posterolateral protrusion of disc material is associated with early marginal
spurring. The left anterior thecal sac is indented. There is no foraminal encroachment.
L2-L3 disc: Normal.
L3-L4 disc: Normal.
L4-L5 disc: Normal. Early facet degeneration is noted without significant foraminal or canal encroachment.
L5-S1 level: No foraminal or canal encroachment. Mild listhesis produces early bilateral foraminal encroachment.
IMPRESSIONS:
1. Routine postsurgical appearance at the L5-S1 level with solid anterior fusion.
2. No new disc herniation or significant canal narrowing at any lumbar level since 05/13/2021.
3. Routine postsurgical appearance at the C6-C7 level with anterior and posterior fusion.
4. A small, right posterolateral C5-C6 disc herniation probably compresses the exiting right C6 nerve root.MRI CERVICAL SPINE WITH AND WITHOUT CONTRAST: 5/24/2021
HISTORY: Cervicalgia with radiculopathy, right upper extremity, for two years. Spinal stenosis, history of two
surgeries, arthrodesis status.
COMPARISON: MRI-08/18/2018.
TECHNIQUE: Appropriate pulse sequences were employed in multiple planes. Total contrast administered on date
of service: 9 ml Gadavist – IV.
FINDINGS:
General Comments: Again seen is artifact related to hardware used for anterior fusion at C6-7. Cervical vertebral
body heights are within normal limits.
Alignment: There is mild reversal of normal cervical lordosis centered at C4-5 which has progressed. There is no
significant listhesis.
Cord: No evidence of a mass or intrinsic T2 signal abnormality. After contrast, there is no abnormal enhancement.
Craniocervical Junction: The cerebellar tonsils are normally positioned. The regional osseous anatomy is within
normal limits.
C2-C3: Uncovertebral hypertrophy bilaterally is causing moderate foraminal stenosis, similar to the prior. Patent
canal.
C3-C4: Uncovertebral hypertrophy bilaterally is causing mild to moderate right and mild left foraminal stenosis,
similar to the prior. Patent canal.
C4-C5: Uncovertebral hypertrophy bilaterally is causing mild to moderate bilateral foraminal stenosis, similar to the
prior. Patent canal.
C5-C6: Shallow dorsal disc/osteophyte complex with posterior annular fissure is present along with mild bilateral
uncovertebral hypertrophy. Mild right and minimal left foraminal stenosis is similar to the prior. The canal dimensions
remain adequate.
C6-C7: At this postsurgical level, the canal and right foramen are patent. There may be mild left foraminal stenosis,
not significantly changed.
C7-T1: Patent canal and foramina.
Other: The paraspinous soft tissues are within normal limits.
IMPRESSION:
1. Anterior fusion changes at C6-7 are redemonstrated. Mild left foraminal stenosis is suspected, similar to
08/18/2018.
2. Multilevel bilateral foraminal stenosis from C2-3 through C5-6 as detailed above, similar to 08/18/2018.
3.Reversal of normal cervical lordosis has mildly progressed compared to the prior. No significant listhesis.Thank you in advance for all your help and advice. You have helped me get through the last 6-7 years in the midst of all of this.
#34130 In reply to: 5 Level Cervical Laminectomy w fusion |Dr. Corenman,
I really appreciate your feedback – thank you!
Your 100% correct, the benefit of an osteotomy, is unknown at this point. My neurosurgeon said he didn’t want to address the neural foraminal stenosis with a posterior procedure, because it would weaken the spine more (I’ve had posterior bilateral medial facetectomies and Foraminotomies at C5, C6 and C7 ) and most of compression is coming from (front) uncovertebral joint’s.
What I’m confused about is my neurologist and 2 surgeon’s told me that all three ACDF procedure’s left residual bone spurs, which is now part of the fusion and can’t be removed? No one has explained why removal is not possible. In addition, Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7 is noted with some progression. Can post laminectomy kyphosis cause movement in these segments? Can an MRI with contrast help explain what’s going on or a flexion extension MRI? Would it make more sense on a redo ACDF’s with placement of wedge shaped allografts to help restore natural cervical lordosis? Just brain storming.
#34087 In reply to: Spinal cord injury |Thank you for your reply, she had slight toe movement and mild sensation to the knees straight away. 8 months now down the track and she can wiggle her toes sometimes and feel me touching her in areas of the leg sometimes and Has felt me doing bowel program sometimes. How long can it take for spinal cord swelling to calm down and is it true anything can change in the first 2 years? She does intensive rehabilitation and there has been slight flicks of muscle contractions and she has gained her core mostly back after being diagnosed as a T4.
Thank you!
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