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#8295Topic: Bilateral pars defect with strange noise in forum GENERAL |
Hi Dr. Corenmen,
I am writing you because I have had some strange happenings.
HX: 160lb, 34 male. No prevoius spinal trauma.
I had injured myself at work pushing a 150lb cart. I always turn left into a room and leave a room turning left with this cart. I noticed there was something wrong (12-19-13). Much like the rest of us I disregarded the pain and went on. By mid feb (2-13-13) I decided to see our hospital’s employee ARNP. She has referred me a D.C. The DC asked to get x rays (ap & lateral) the reading came back with bilateral pars defect with 7-8mm of anteriorlethesis. From here I was referred to ortho/spine. The ortho sent me to PT and stated for no lumbo sacral manipulation by chiro (3-14-13). Chiro continued to adjust. I feel worse after adjustments. My body is saying no.Rad impressions:
3-6-13
Bilateral pars defect are seen at L5, there is about 7-8mm of anterolisthesis of L5 on S1. Other wise remainder of the examination is unremarkable.3-13-13
8mm of anteriolisthesis or L5 on S1. Bilateral pars defects. Mild narrowing L5-s1 disc and posterior aspect of L4-5 discs. No other fx, malalignment or focal bone lesion. Normal bondy texture. With flexion and extension, there is no significant change in the relative postion of the vertebral bodies.(Strange the diff between radiologists impressions?)
signs/symptoms:
L4 spinous process is depressed visually on inspection.
Numbness/tingling down lateral left leg to pedis. This was present for 1 day only (3-11-13). Not painful or loss of function.
Mid-line pain over L4 is now chronic @5-7 no referral to other areas
flexeril (10mg) will not alleviate pain but does aid in lost sleep
Had 2 good days since initial injury 3-22 and 3-23 (actually wanted to do some normal activities)Had 2nd check/reeval today 3-28, still constant pain over spinous process no change until arrival at home. I parked the car turned left to exit, legs first followed by upper torso my L4-5 region clicked. Pain in minimal now? Felt like bone on bone click.
When I was first dx I was interested in getting the pars repaired, my ortho Dr is not familiar with direct pars repair. I know you need more info to do an eval…I’m wondering if I would be a candidate with anteriolisthesis? I don’t know who to talk to anymore. I feel like I’m in the acute phase here and not on the mend to recovery. I did mention a pars block…? She seemed hesitant and wanted to wait 2 more weeks.It has been over 3 months in total. Any help would be appreciated!
BTW I do not have an MRI yet???
Sincerely,
Erik#8280 In reply to: 2 Years Post 2 Level ACDF With New Type of Pain |Hello Dr. Corenman,
Just wanted to let you know that I did have a phone consult with Eric (sp?) your physician’s assistant about a week ago. It was very helpful and Eric was an exceptional communicator and highly knowledgable. He asked me to send in a write up of his performance, I hope these comments can serve as that. Simply put, he was outstanding.
As part of another second opinion with a neurosurgeon, I did have a new CT scan performed last week. I met with the neurosurgeon yesterday and the CT scan did show that I have pseudoarthrosis at C5-C6. You can see a horizontal line of non-union at that level as clear as day. However, the plate and screws at that level do look to be in excellent shape.
He also had an X-ray taken of my left shoulder to see if anything is going on. I had that done yesterday and am awaiting his comments. I also had X-rays done on my cervical spine in the flexion, extension and neutral positions.
The neurosurgeon suggested that I try to use a bone stimulator for 3 months to see if a fusion to take place. He is also suggesting that I try Botox injections to see if my very tight trapezius muscles will loosen and to see if my headaches and shoulders stop hurting.
Would you be interested in taking a look at the new CT scan and the X-rays of my left shoulder and cervical spine and giving me further opinions?
The spondylolisthesis may be an incidental finding but even if flexion/extension films do not reveal any abnormal motion, this disorder can still be a pain generator. The pannus (region of the old fracture) can cause local back pain and the slip can produce foraminal stenosis which can then cause pain in the L5 nerve distribution.
The loss of cervical lordosis is the result of degeneration of the cervical discs. The vertebral bodies are cylinders and without the discs in-between, there would be no lordosis. The lordosis therefore is due to the trapezoidal shape of the discs. Degenerative changes of the discs reduce the normal cervical lordosis. Of course, there are disorders (herniated discs and central spinal stenosis) that can cause antalgic positioning (adoption of a neck position to reduce pain).
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.#8260 In reply to: Post-Arthrodesis Instability in Cervical Region? |A fusion from C2-T2 is an extensive one and will place stress on the C1-2 and the T1-2 levels. This can eventually wear them out. Popping and clinking can be a sign of wear of the facet joints but also could be due to a pseudoarthrosis of one of the fused levels.
Pops can also be from the facet joint “releasing” similar to the pop caused by a chiropractor. Facet joints are under a vacuum and the pop is simply the release of the vacuum similar to the pop from taking a wet glass off a glass coffee table or granite counter.
The first diagnostic test other than a physical examination is standard X-rays with flexion and extension views.
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.#8251 In reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. |You do need a good reevaluation as your problems can be diagnosed. This does not mean that they can be remedied but at least you deserve to know why you have these symptoms.
The refusal by other surgeons to see you after surgery does not make sense to me. Half of my patients have had prior surgeries and we do not refuse to see them. Yes-it does take more time and understanding to diagnose these issues but it can be done.
You most likely will need a CT scan, flexion/extension X-rays and a new MRI to determine why you have more pain (along with a good physical examination). You might need an EMG/NCV test also but that is unlikely.
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.#8237Topic: C7 radiculopathy in forum GENERAL |hi Dr. Corenman:
I am a 51 y.o. female in very good health and shape. On 02/01/13 I developed intense pain/spasm in my right upper back, felt it in my right pectorals, going through my shoulder and down my arm, into my index finger. (I believe from doing a yoga pose). The pain initially was quite severe and was of a burning type sensation into the index finger. I used ice/heat, rest, ibuprofen and when I tried to stretch it out a week later, I developed intense pain in my right shoulder and then I noticed weakness of my right triceps.
I saw my MD, had a short course of steroid taper (which seemed to knock out the pain) and cervical MRI on 2/26/13: C5-C6 bilateral uncovertebral joint hypertrophy with disc bulging marginal osteophyte cause of midline, causing thecal impression more to right than left and at the midline, the AP dimension of the spinal canal as borderline stenotic, right C6 neuroforamen is markedly narrowed, left C6 neuroforamen moderately narrowed.
At C6-C7 disc bulging marginal osteophyte formation is seen causing broad thecal impression across midline. AP dimension at the midline is minimally stenotic. The right uncovertebral joint demonstrates some spurring as well. The right C7 neuroforamen is moderately narrowed left C7 neuroforamen mildly narrowed.
Impression: spondylotic changes seen bilaterally and across midline at C5-C6 cause thecal impression left and right, cause borderline spinal stenosis, and cause C6 neuroforamen narrowing right C6, moderate narrowing left C6 neuroforamen.
Broad thecal impression at C6-7 is also seen, right C7 neuroforamen is moderately narrowed, left C7 neuroforamen mildly narrowed. At C4-C5 a tiny central protrusion is seen.
A physiatrist on 3/14/13 recommended I have PT, Cervical nerve root block and consult a neurosurgeon. He said I’ll never regain 100% of my triceps muscle strength. He said I may get up to 80%, I am right handed and am a musician.
I tried acupuncture and after one visit, developed vertigo which lasted for just over a week. It affected my walking but the MD did not seem concerned. It has gone away.
I had a PT visit and he said my right triceps strength is 3/5 and I had decreased reflex right triceps.
I have an appointment with a neurosurgeon on 4/09/13. I am trying to schedule the C7 nerve root block, pending insurance issues.
Currently my right index finger is numb, the side of my middle finger is numb, and my right triceps continues to be weak. I am already noticing loss of muscle tone. My right hand is crampy and typing is laborious but I have to continue to work. I am practicing good posture but my symptoms are persistent. I have noticed some slight left arm/hand symptoms occasionally.
1. At this point, can a right C7 nerve root block take enough pressure off the nerve to avoid surgery or is this just a bandaid/temporary measure?2. Is it possible, in time, that the nerve can “unpinch” itself or are aggressive measures needed? Can a good PT and/or an osteopath with manipulations help unpinch the nerve?
3. Is it true that surgery/decompression does not guarantee that weakness will resolve? What would then be the point of surgery if I don’t have much pain at present? My main symptoms are weakness/numbness.
4. I have a huge dream trip to Europe planned for the end of July which is already paid for. This seems like terrible timing if I need surgery. If I had surgery say, early May, would I be able to go on this trip? (I will have help with luggage, won’t have to do much heavy lifting).
I read in one book “Do You Really Need Back Surgery?” that decompressive surgery has become so advanced that can be done as an outpatient procedure with patients back to work in a few days. Is this true?
If I wait until after the trip (July 26 – Aug 4), that will be going on 7 months, is that too long to wait regarding my right triceps weakness?
I know without examining me that you cannot answer all of these questions accurately but I do sincerely appreciate your time and expertise!
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