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#33495 In reply to: Disc Bulge after Thoracic Microdiscectomy |
Most likely, this is part of the healing process as long as these sensation don’t occur consistently with any particular type of back motion such as extension.
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.#33481 In reply to: a year past ACDF, new MRI what does it mean? |If you have continuing symptoms and pain in the pathway of the C7 nerve root, you can elect to wait but after a year, your fusion should be solid. If it is not, then where is the pseudoarthrosis? A CT will reveal the non-union (along with flexion/extension X-rays). If a pseudo is present you could have revision ACDF, ACDF with posterior fusion or posterior decompression and fusion.
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.#33480 In reply to: a year past ACDF, new MRI what does it mean? |Thank you for this information. guess I didn’t realize the same issues that I had surgery for – could resurface again a year later. I feel defeated right now.
I had xrays, but not including flexion/extension ones. Nothing abnormal was found on those, all looked good again.
My best hope is for solid fusion, obviously – but if I do NOT have solid fusion, a revision ACDF would take care of it – or are you saying both an ACDF and Posterior surgery would then be the next step?
Do you think if I am only 1 year out – that things could just spontaneously improve yet from the surgery? Or has that window pretty much passed?
Thanks again for your help – it’s appreciated tremendously.
#33477 In reply to: a year past ACDF, new MRI what does it mean? |First of all, having a 4 level ACDF fusion has a higher chance of pseudoarthrosis (lack of fusion) so immediately, my thoughts start with that possibility. Pseudoarthrosis is best diagnosed with CT scan followed closely by X-rays including flexion/extension.
You have significant foraminal stenosis at C6-7 left (“moderate to severe left neural foraminal narrowing”) so you could have a Left C7 radiculopathy either from a residual compression or a developmental compression from a pseudoarthrosis. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
The way I would consider a workup is to have the CT and X-rays, determine fusion status, then use a SNRB at C6-7 left (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/) to determine if the C7 root is involved. If the SNRB is positive (gives you temporary relief), then you have two choices.
If the CT scan shows a solid fusion, you can have a posterior foraminotomy. If you don’t have solid fusion, you can have a revision ACDF and clean out the foramen from the front at the same time or have a posterior foraminotomy and a posterior fusion at the same time.
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.Dr. Corenman,
I appreciate your timely response in regards to my surgery and the possibility of a reherniation. I do not have the actual imaging itself, but I have the results of my MRI, and I do not know if they are good or bad. I was wondering if you could look at them to see if the results seem positive or negative! Thanks!
TECHNIQUE: Multiplanar, multisequence MR imaging of the thoracic spine was
obtained without contrast. Image quality is adequateFINDINGS:
Alignment: Unremarkable. No vertebral body anomalies.Bone marrow: Unremarkable. No fractures. No nonfat containing geographic marrow
signal abnormalities.Thoracic cord: The cord is intrinsically unremarkable without intrinsic signal change or
syrinx. There is flattening of the thoracic cord at the T11-T12 level as described below.Disc spaces: There is a persistent asymmetric broad-based disc bulge, right greater
than left, at the T11-T12 level. This produces mass effect on the ventral portion of the
thoracic cord and moderately narrows the central canal. Previously noted epidural disc
material is improved when compared to the prior exam particularly in the right lateral
recess when compared between the prior study (axial image 61) and the current exam
(axial image 24). There is post surgical change at this level from a right laminotomy. The
remainder of the disc spaces are preserved.Soft tissues: Axial imaging redemonstrates a round lobulated T2 hyperintensity in the
medial aspect of the right hepatic lobe. Differential is as before.IMPRESSION:
PERSISTENT MASS EFFECT ON THE THORACIC CORD AT THE T11-T12 LEVEL
THOUGH SLIGHTLY IMPROVED FROM THE PRIOR EXAM.#33470 In reply to: Continued Pain 3+ months post microdiscectomy |Do you have L3-4 foraminal symptoms as you noted that your pain was consistent with L5-S1 in a prior post? If you have foramina stenosis as a pain generator, McKenzie methods would not be as helpful as this treatment technique uses extension mobilization as a tool and extension can aggravate the nerve root in a narrowed foramen.
Make sure you aggravate your symptoms prior to the TFESI and keep a pain diary for three hours after to get a diagnosis.
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. -
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