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#7945 In reply to: L4-5 bulge w/ tear |
Was able to post 6 saggital slices 8-13, with 10-11 looking to worst.
w w w DOT flickr DOT com/photos/charlestonbraces/
Hopefully you can view the pics. In my last post, I answered your request for the disc pathology as “bulging with tear”, but after reading your extensive website material on anatomy and disorders, is that just the same thing as herniation?
Anyway, worried about the epidural steroid gaining rapid access to the periperheral circulation. After only 10 tablets of 4mg Medrol in two days, my hips do not feel great. And I think it is more than sciatica related since there is also some popping of the hip joint (L >> R) and occasional minimal popping of my R ankle.
#7936 In reply to: Facet Joint Injection after ACDF |Pain generated by a pseudoarthrosis is difficult to diagnose by anesthetic blocks. The pain is generated by the non-fused bony surfaces and getting a block into that irregular interval is a heroic act by an injectionist.
Facet injection into C2-3 and C3-4 are generally reserved for base of the skull pain (occipital pain) and occipital headaches. If you have mid-neck pain from the pseudoarthoses, these upper neck blocks will not give relief as you have noted.
The question if blocks can be performed at the previously attempted fused level (pseudoarthrosis level) is yes but these blocks will not really yield any important information as the pain is generated by the non-united bony surfaces and not the facets in this case. I cannot comment on the previous plan.
With regards to “stability”, I think the surgeon means that the level will not “fall apart” with untoward activity. Your head will not fall off and roll down the stairs but It does not mean that the level is not degenerating or causing pain.
If the level is stable, there will be no motion and therefore no pain. Yes, a pseudoarthrosis can be painless and patients can live with it without symptoms going about their normal daily activities. Motion of the level (as noted by haloing of the screws or change in position with flexion/extension X-ray films) can cause pain. Progressive collapse of the graft noted on serial X-rays is an indication of instability.
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.#7924Topic: dizzyness in forum GENERAL PROFESSIONAL QUESTIONS |For the past few months i am getting dizziness ocassionally and some of the following symptoms may be associated or may not be associated. I do not get vomiting or nausea . I get dizziness when
1.When on some days when i get up from the bed.
2 if i sleep turning to the right side of my body.I observed this on two or three occassions
3.When i bend my neck down or look up towards sky to see a aircraft
4.if i read paper while standing looking down
5.when i pick up something off the floor or bend my body down
6 when i see my left shoulder by bending my neck left side.
The dizziness lasts for a week in which time i take Stugeron 25 mg twice a day.When i get pain in the neck region i take zero dol p or some diclofenac.
I am a vegetarian and 70 years old.
My medical history is I had IHD 37 yrs back no complications/mild Hypertension (Under control)Diabetes (since 2010) Hyperthyroidsm(2011). All are under control.
When i saw an ortho , he said that i have cervical spondylosis and the vertebrae are degenerating, and suggested stugeron .But i am not thoroughly satisfied with his findings. Hence i am seeking your opinion. Kindly study my case and advise the most probable reason for this dizzyness.#7915 In reply to: 2 Years Post 2 Level ACDF With New Type of Pain |Hello, Dr. Corenman. I cannot thank you enough for the extremely quick response.
Thank you for your thoughts. If you do not mind, I have some more questions:
(1) That is a good point about pseudoarthrosis that I had not considered because my neurosurgeon insisted at the time of the CT that my fusion is rock solid and I took it as the gospel.
The CT that I had was performed 11 months after my ACDF was performed. My neurosurgeon did look at the CT himself and declared the fusion solid. The radiologist’s report does seem ambiguous, as you stated. I did not catch that on my own all this time how the radiologist wrote those comments.
My question is, how likely is it that the fusion was not solid after 11 months? My surgeon used two plastic discs filled with bone material and did not use an autograft or allograft. I did wear an electric bone stimulator for 4 hours a day for 4 months after the surgery.
If the fusion is in doubt and a new CT should be made, do I need to do the CT in conjunction with a myelogram or can it be done without a myelogram?
(2) In regards to the potential facet degenerative changes at C2-3 and C3-4, what would be the diagnostic testing that would be performed on those higher levels to see if that is the problem and what would be the course of treatment if the diagnosis indicated that I have facet degeneration and it is the cause of my pain? I am allergic to all NSAIDs, so if inflammation of those facet joints were the issue, that course of treatment would be a non-starter for me.
(3) Should I try to rule out a shoulder disorder (rotator cuff syndrome) before seeing an experienced spine surgeon and if so, what kind of physician should I see and what kind of imaging would be needed on my shoulder?
(4) Are the upright MRI images worthless because of the weaker magnet that the Fonar machines use? There were some comments in the radiologist’s report that concerned me:
“Spinal canal stenosis is sent at C4-C5 with concentric disc bulge and posterior ligament hypertrophy. The CSF space is erased anteriorly by the bulging disc. Minimal flattening of the cord is also seen at this level”
and
“Spinal canal stenosis at C4-C5 and C5-C6 levels is seen.
Bilateral foraminal stenosis at C3-C4 and C4-C5 levels is seen.”(The radiologist’s report is contained in my initial post.)
(5) Would you be willing to look at any of imaging that I have had already done and would it be worth it? If so, I would be happy to electronically transfer them to you and if you do not have that capability I could mail/UPS/FedEx them to you.
Please note that I have had two flexion/extension X-rays, one CT scan post-myelogram and 3 MRIs done in 2012. The details of each of the 3 MRIs is in my original post.
Again, thank you so much for your time.
Michael
#7911Topic: Child in distress, please help! in forum GENERAL |My daughter is 15 years old. 3 weeks ago she had acute back pain while washing her hands. No trauma at all to the back. The pain progressed to the point of her being numb and/or tingly from the waist down. 1 bout of urinary incontinence. MRI reveled herniations at L4-L5 and L5-S1. Treated for pain control during hospital admission then sent home with a walker and barely able to stand. A week after coming home, she fell in the bathtub and was readmitted to the hospital. CT of cervical spine states:
C5-C6 Posterior disc/osteophyte complex and facet osteophytes. There is a paracentral protrusion that measures approximately 2mm with a minimal hyperintense T2 signal, likely representative of an annular fissure. There is mild-moderate canal stenosis with mild flattening of the cord.
MRI of lumbar spine states:
Disc space narrowing and dehydration are most significant at L4-L5 and L5-S1. There are facet osteophytes throughout the lumbar spine.
L4-L5: Posterior dis/osteophyte complex and facet osteophytes. There is a paracentral focal protrusion measuring 6mm in radial dimension with mild canal stenosis. There is slight increased T2 signal likely representative of an annular fissure.
L5-S1: Posterior disc/osteophyte complex and facet osteophytes result in mild bilateral foraminal stenosis. There is paracentral focal protrusion with increased T2 signal likely representative of annular fissure. This abuts the S1 nerve roots within the lateral recesses.
The docs that ordered the tests (ER docs), shared the results with a neurosurgeon that recognized the problems but would not treat because of her age. He said that she had the spine of a 60 year old woman. They sent us to a pediatric neurosurgeon who actually said, “there’s nothing wrong with her,” and recommended physical therapy. We went to PT, and they won’t touch her. They feel her issues have not been properly identified and are worried about causing further injury.
In the meantime, she’s in constant pain. Can you explain the results more clearly for me and offer any suggestions? Currently I’m trying to get a referral to an orthopedist and request a bone scan. What 15 year old has these kinds of issues and yet still goes undiagnosed and untreated? Please help. Oh and for the last week she has intermittent temperature spikes of 100-102. She is also having shoulder pain on one side.#7905 In reply to: pain pain pain |Neck pain in the center of the neck is normally caused by degenerative disc disease with degenerative facet disease a second cause. Shoulder pain is typically caused by nerve compression but referral from degenerative disc or facet disease is a close second.
When pain radiates into the arm, this is typically generated from nerve compression although shoulder disorders can mimic that pain also.
“Uncovertebral spurring c5-c6 with moderate to severe foraminal stenosis. I also have some spurring on c4-c5” could be the cause of the shoulder and arm pain along with the neck pain. The uncovertebral joint is the joint in the neck right at the exit of the nerve root and commonly becomes degenerative. When this joint develops bone spur formation, this spur compresses the nerve root and causes pain (see website).
The best technique for determining the cause of your pain is the SNRB (selective nerve root block-see website). Trigger point injections will not diagnose the disorder. The epidural injection should not cause intense pain but it is technique dependent.
You need to see an experienced and well-skilled spine surgeon for a consult.
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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