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#33563 In reply to: Post OP Cervical Artificial Disc Replacement C5/C6 |
Are the symptoms changed in intensity or in distribution or are they the same as before surgery?
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.#33554 In reply to: Disc Bulge after Thoracic Microdiscectomy |Also, in relation to my last question, I am also having intense upper right shoulder pain since my PT. Could that actually correlate to a re-herniation at my T11-T12 or not?
#33540Topic: surgery opinion in forum BACK PAIN |hello
12 years ago I had a l4l5 laminectomy, no back pain but feet were falling asleep.
10 days later I bent over and a popping sound and intense pain went down my left leg. I started leaking spinal fluid. I had a 2nd surgery to fix the leak. A month later the pain in the left leg was still unbearable. I felt sick also. 2nd opinion showed an infection. 3rd surgery to clean out the infection. My L4L5 disc was gone and it fused naturally. 2 months of pt helped the pain and I have been pain free until Jan 2019.I now have pain along my waistline. Sometimes higher but no pain in my legs or feet. Had an ablation of l3l4 l4 l5 and l5 s1. 75 pain relief for about 5 months. Had a epidural shot Dec 2019 and again March 2020 Some relief for a couple of months. Saw a surgeon to see if their was anything I could do besides shots. He did not recommend any more surgeries because of the 3 prior surgeries with spinal leak and infection would be to dangerous for another surgery.
I saw another surgeon In Dec 2020. He recommended a Laminectomy l5 S1 and Lami L3L4. He also wanted to see a ct scan. I met with him this month and he is now reommending a fusion at L5 S1 and leave the L3 L4 alone. My L5 disk was showing black on the ct scan. I still do not have any pain in my legs or butt.
My MRI from June 2020 which I had done at your clinic.L1 L2
Disc desiccation with annular bulging. A small 2mm left paracentral disc extrusion with slight cephalad migration of the disc maaterial. Slight effacement thecal sac and moderate facet arthropathy. No Appreciable neural element compression or stenosis.L2 L3
Disc desiccation with annular bulging A 4 mm left postero lateral disc protrusion. Mild facet arthropathy with thickening of ligamentum flavum.
Stable mild 2mm retrolisthesis is demonstrated. There is end plate remodeling. Mild to moderate central canal stenosis and left sided foraminal stenosis. Minor narrowing ofthe right neural foramen.L3L4
Disc desiccation with annular bulging and endplate remodeling. Moderately advanced facet arthropathy with cartilage loss. thicking of the ligamentum flavum. Moderately severe central canal stenosis with mild to moderate bilateral forminal stenosis.L4L5
Ankylosis of the disc space. There is endplate remodeling. Posterior laminectomy defect. There is partial ankylosis of the facet joints The central canal and neural foramina without stenosis.
L5 S1
Advance disc degeneration disc space narrowing, disc desiccation, and vacuum cleft. Abnormal annular morphology with posterior bulging of the annulus and a 6 mm broad based porterior disc herniatin. Associated marginal endplate ridgeing. Moderaltely advanced facet arthropathy worse the left with thicking of the lifamentum flavum. Moderately severe to severe left and moderate right foraminal stenosis. The central canal is the the lower limits of normal in size. Moderately left sided subarticualar recess narrowing with mild narrowing to the right.So would like to know of I should have surgery because of prior surgeries in your opinion. Also since my pain is present more with kayaking, skiing, and hiking. Better with biking. Im a very active 70 year old women.
Thank you.
#33531 In reply to: buttock nerve pain post microdiscectomy |Hello Dr. Corenman,
I’m coming back to you with an update of my situation.
I still have sciatic and buttock pain but not as intense as when I’ve send you the first message.
It’s been 6 weeks since I had a microdiscectomy at L5-S1, a few days ago I had a post op MRI (Lumbar spine MRI without contrast) and here is the result(I had to use a web translator, there might be mistakes ,hope you will understand):
Native MRI examination of the lumbar spine reveals:-postop status for left paramedian disc herniation L5-S1 left bone edema at the level of adjacent vertebral plates, with a left paramedian hernia recurrence, caudally migrated with maximum dimensions of 10/14/20mm, which compresses the left S1 root.
– diffuse edematous infiltration of the lower lumbar paravertebral muscles
Could you plese tell me what are my options now?
How can you explain that the pain level is lower compared with 2 weeks ago considering that there is a reherniation? For example, 2 weeks ago when I was trying to do the SLR test I could hardly lift my leg because of the buttock pain, now I can lift if to, let’s say 60 degree angle before starting to feel that pain.
In the case of a new surgery , what is the success rate , is that efficient or the risk is even higer than the first time?
Thank you very much.
#33512 In reply to: Please help me understand my MRI report |Dr Coreman, please can you tell me if this is permanent or canit be repaired please and thank you, as i am very symptomatic
Clinical history ..Rule out any lesion for trigeminal
Vascular Loop..The superior cerebellar arteries crossover the superior aspects of the cisternal segments of the trigeminal nerves bilaterally with possible mild indention
Cavernous sinus and Meckels cave..normal ..no masses
internal auditory canals..unremarkable
Brainstem and cerebellar ..normal no mass acute infarct , or demyelinating lesion.
Mnndible unremarkable
muscles of mastication ..unremarkable
skull base bones..normal marrow signal without mass or abnormal enhancement
Remaining Brain Parenchyma…No accute infarct , hemorrhage , hydrocephalus, no signiciant burden of white matter chronic small vessel diease
TOF MRA time of flight MRA demonstrates no hemodynamically significient stenosis of bilateral proximal ACAs MCAs or PCAs .There is ectasia of the cavernous segment of the left internal cartoid artery.Right fetal PCA. Right dominant vertebral artery. No large aneurysms or AVMs.
Other findings ..paranasal sinus and mastoids are clear ..T1 isointense, T2 hypointense subcutaneous lession over the left parietal scalp , most likely in keeping with an epidermal inclusion cyst verses trichilemmal cyst.
Summary
The superior cerebellar arteries crossover the superior aspects of the cisternal segments of the trigeminal nerves bilaterally with possible mild indention , which are equivocal findings to neurovascular complexCan you please explain this MRI to me section by section please and thank you …And what are my options for this to be corrected ..Greatly appreciated very much ..Anxiously awaiting for your reply, thanking you in adavnce..Happy Belated New Years
Sincerely Laura
#33508 In reply to: buttock nerve pain post microdiscectomy |Hello Dr. Corenman,
I had a microdiscectomy at L5-S1,4 weeks ago, after 8 months since everything started.
The pain I had before the surgery was the most intense in my buttock and the exterior of the hip and less intense down the left leg up to the ankle on the exterior of the calf,and it ocuured mostly when seating and when getting up ,or when bending forward.
Right after the surgery, I was feeling a little bit of pain on the exterior of the calf but not in my bottock, then in the first week post op.the pain was also present in my buttock, at a mild level, not as it was before the surgery, my surgeon told me that is normal if the pain is not very intense.
I started walking outside the house in the following days and the pain got more intense,sometimes greater than before the surgery or comparabale and sometimes it fells a little different than before and on a larger part of my leg, the difference between before and after is that the pain is not so bad when sitting or getting up, but is greater when walking or standing up or even when laying down.
Initial recommendation was to begin kinetotherapy 2 weeks after surgery, buy I informed the surgeon about the pain and he said to not do anything yet.
I took diclofenac and mydocalm for a few days,during this time I felt better, but my concern is that taking this meds I will never know my real level of pain or recovery.
Should I continue to take meds?
If the nerve is not compressed anymore, should I still feel this kind of pain, or shouldn’t that go away little by litlle every day?
Should I wait for the pain to completly go away in order to start any excercises, kinetotherapy?
Is phisiotherapy also indicated?
Is an MRI relevant on this stage of recovery? Would the images reveal the real or actual nerve situation or would that be prevented by the scar tissue?Thank you very much.
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