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#8420 In reply to: Acute Back Pain After L5-S1 Disc Reherniation |
Back pain is generally caused by degenerative discs and facets, not by disc herniations. The most likely reason you had increased pain in your back after these two herniations is that the shock absorbing “cushion” of the disc (the nucleus) displaced into the canal. This reduces the impact absorption of the disc. The disc now has less stability just like flattening a car tire and then driving the car. The tire won’t “hold the road” well.
There are occasions that disc herniations can contribute to some of the lower back pain complaints. The herniation can “tent” the posterior annulus (see anatomy of the lower back for full description of annulus). This annulus contains pain fibers that contribute to lower back pain. Sometimes, removing the herniation can reduce lower back pain. I tell all patients that are undergoing a microdisectomy to relieve only lower back pain to expect a 50% success rate for satisfaction.
The reason some patients elect to undergo this microdisectomy with a 50% satisfaction rate is that the other potential surgical procedure for relief of lower back pain is fusion. Fusion of course is a procedure that has a longer recovery time than a microdiscectomy and is a more extensive procedure. Failure of the microdiscetomy to relieve lower back pain does not preclude a potential fusion surgery in the future.
Do you need a fusion? No one can answer that question but you. You have to look how this pain affects your life, thoughts and occupation. See the section “When to have lower back surgery” for further understanding of this issue.
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.#8415 In reply to: Baastrups disease |Baastrup’s disorder is the fictitious belief that the spinous processes will abut each other under extension and will cause significant pain from the bones compressing into each other. This is simply not true as in all my years of treating patients, I have never seen this disorder but I have seen many patients with spinous processes that abut without pain.
Most active individuals who have extension pain have either facet disorders (see website under lumbar spine facet disorders) or have a pars or facet fracture (see isthmic spondylolisthesis).
One of the trademarks of isthmic spondylolisthesis is tight hamstrings.
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.#8411Topic: Nuero or Dental? in forum NECK PAIN |Dear Dr. Corenman,
I had ADCF on c5/6 in 2011 (almost 2 years to the date) I was not having any pain associated with my disc prior to the surgery, but suffered some bowel and bladder problems. At the time of my MRI and meeting with the neurosurgeon, he stated that I had problems at c4/5 and c5/6, but felt c5/6 would benefit more from the surgery. It worked, I have only a couple of instances with the issues I had before. Also, prior to discharging me from his care, he stated that I had cervical myelopathy. He has since moved his practice and I can’t seem to find him to answer my question on current issues.Since 2012, I have had some consistent spasms on the front left/right side of my neck. Typically, they only hit one side at a time, and spasm into the jaw line. The spasms can last anywhere from 5 minutes to hours and have increasingly gotten worse over this past year (more frequent and more intense). 2 weeks ago during one of the spasms on the left side, (the joint where the jaw meets the ear) began to burn and continued down my face and chin. This lasted for about 10 minutes and then went away. Since that time I have noticed that both sides of my jaws are stiff and my range of motion is not very good. I have taken ibuprofen, heat, ice, muscle relaxants and pain medication to try and give it time, but it’s not getting any better. The jaw pain appears to be worse after a bout of spasms. I am not having any other dental problems.
Could this be caused by my neck? or is it a dental problem?
#8402 In reply to: How serious is a flattened cord? |“A flattened cord” could be only somewhat concerning or a significant finding that needs to be addressed surgically. This depends upon two things. The central canal space which is the entire space for the cord and your examination findings and symptoms.
The cord typically is shaped like a kidney bean when viewed on end. A bone spur or disc bulge can efface the cord and allow the cord to flatten at this area of stress. If there still is room for the cord behind the flatted area (which will be viewed as and area of white signal due to the CSF-water present), then the risk is not as great.
If there is no further room behind the cord, then this places the spinal cord in jeopardy. The reason is that the spinal canal changes in volume with neck position. When you bend your head backwards (extension), the spinal canal actually looses 30% of the volume. A fall onto the front of the head will force a quick backwards bend. This can pinch the cord and cause a central cord injury (find a description this on the website).
If there is still room in the back of the canal as noted on the MRI, the chances of this injury lessen.
The other problem that could occur with cord flattening is myelopathy (again-look on this website for description). This is a chronic malfunction of the spinal cord and has specific signs and symptoms that are associated with this disorder.
With either case (severe narrowing or presence of myelopathy), it is my opinion that this cord compression needs to be addressed surgically. If neither problem is present, then your risks of cord malfunction are lowered.
Your neck pain is most likely derived from degenerative disc or facet disease. You can find full explanations of these disorder on this website.
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.#8397Topic: How serious is a flattened cord? in forum GENERAL |Hi.
I am 41 years old and I have been diagnosed with Degenerative Disc Disease. I had an MRI done on my neck after neck pain, numbness in arm and hand and fingers asleep an hour or two even after I wake up. (I also had carpel tunnel surgery in the same hand to try to relieve some of the symptoms in the hand.)The impression from the MRI reads as:
1 Multi-level disease with degenerated discs seen at all levels.
2 Left paracentral disc protrusion seen at C5-6 which effaces the cord.
3 At C6-7 large disc protrusion is seen that extends into the neural foramina and neural canal the displaces and flattens the cord.
4 normal marrow signal with bones in anatomic alignment.To me this is greek.
The Dr that ordered the mri (pain management dr) did not have much to say about it other than an injection could help but eventually surgery will be the answer.
In another place of findings, the page also reads
Facet arthropathy is seen on the left at C3-4
C4-5 left neural foraminal narrowing is present with facet arthrosis. Small central disc protrusion is seen. There is no effacement of the cord.
C5-6 broad based left paracentral disc protrusion is noted. This effaces the cord and displaces it. The disc measures 10 mm in length. Neural foramen on the right is patent; the left neural foramen is encroached upon diffuse disc bulge.
At C6-7 left paracentral disc protrusion is present that extends partially into the neural foramen measuring 17mm in width. There is flattening, effacement, and displacement of the cord. Lifting of the posterior longitudinal ligament is seen on the sagittal images.
Could you help me understand what this impression means? Is this a very serious or common thing? (And to what degree?)
For 10+ years I had problems with back pain and eventually that lead to surgery (XLIF) on my back, and I am just hoping my neck is not too serious to need more surgery.
To my understanding this is not normal for my age.
I believe I posted this in the incorrect forum and I will try to move it to a different forum about reading mri’s.
ps: I Tried to figure out how to move this to a different forum, but I cannot figure out how. My apologies for posting in the incorrect forum.
#8394 In reply to: C5-C6 Protrusion |Hi Dr Corenman,
Just to provide a follow up of my appointment with my orthopedic.
In regard to the mri and xray he said the disc protrusion was very minor but could be the source of my pain in the shoulder. I inquired about the RNB and his reply was not needed.
Was a bit disappointed by this to be honest as could save me some time by knowing whether it is the torn suprspinatus or the C5-C6 causing the pain.He has sent me for 20 sessions of physio on the neck, as he does not believe in osteopathy for my situation.
I had the first session today, bearing in mind it is with my health insurance, so 20 patients two physios.
They placed 4 electrodes in suction caps on my neck and upper back for 10 minutes with a heat lamp.
Then 10 minutes in a neck, pulley and weight device. Bit medieval! Sitting in a chair with my head in a harness and a counterweight adding some extension to my neck. Started with 2kgs. They said they will add more weight over the following sessions.
Then 20 minutes of basic neck exercises.
None of this was hands-on, basic setup and instructions.
So in summary, I am not that much the wiser. Have an ortho follow up in 4 weeks, after completion of the 20 sessions of physio.
Wish there was something new and exciting to report but am still a bit in the dark.
Am hoping still that i am a case of CNS!!
Kind regards as always.
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