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#7768Topic: 4 surgeries and still in pain in forum BACK PAIN |
Hello Dr. Corenman, I have several things wrong with my spine but I will keep this short. My first surgery, a laminectomy, L5-S1 was done 9/08. Shortly thereafter my disc ruptured. This led to an L5-S1 fusion in 2/09. Next surgery was 9/09 – right SI joint fusion. This fusion failed and in 9/10 I had the iFuse surgery to the same SI Joint. I had no pain for the first 15 days. I followed post op instructions to a T. It’s over 2 years later I am in more pain now than I was before the SI joint surgeries. A couple of months ago I had another Cat Scan and Xray and it showed the pins were still stable. I am currently enrolled in a pain management program however I have problems with discs in my thoratic spine that prohibit me from doing many of the exercises for my lower spine. I can barely move as the pain in my right SI joint is so severe. I have tried many things, most recently acupuncture, physical therapy (again), Tens unit, etc. and while it’s too soon to give a fair report on the acupuncture, I feel so much worse after the physical therapy. My physical therapist uses ultrasound and massage and I can barely move for days, sometimes weeks afterwards. I am at my wits end. Nothing I do improves my pain, it only makes it worse. Do you have any suggestions? Thanks. Susan
#7766 In reply to: spondylolisthesis |The MRI is very poor at denoting fusion mass. Bone, cartilage, tendon and scar can all show up as a black signal on MRI so this study is ineffective to demonstrate fusion generally.
CT scan is a generally good study to look for fusion mass but this study also can be deceiving. Certain CT scanners are less detailed oriented and can fool a reviewer. Generally the 64 and 128 slice scanners are the best but also the technician who takes the scan can make a difference in the quality of the outcome of the images.
The flexion/extension X-rays are very good in noting motion. If there is motion, there is not a fusion (generally with some rare exceptions) regardless of what the MRI notes.
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.#7761 In reply to: Abnormal signal intensity… |I have more information but I am still confused. What was the date of your surgery? Have your symptoms changes or just not improved? Do you have spasms in your back now that you did not have before? Have you had any feeling of being “sick” (nausea, vomiting, fevers, chills, sweats, feeling tired and generally poor)?
You MRI may indicate a possible infection and this needs to be ruled out. This surgeon needs to pay attention to you now. It is unacceptable that he will not take your calls. If he doesn’t respond, go to the next town and visit a spine surgeon who will pay attention to you.
There are three laboratory tests that can help determine if there is the chance of an infection. These are the CBC with differential, the CRP (C reactive protein) and the ESR (erythrocyte sedimentation rate). Ask you doctor if he will order them for you. You might also consider visiting an infection disease specialist. This doctor can help determine if you have an infection.
If the infection is ruled out, you can start to plan a process that will give you some improvement of your symptoms.
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.#7758 In reply to: spondylolisthesis |I am confused. If you had a solid fusion of L5-S1, there would be no movement on flexion/extension films. Also, if there was no motion of the fusion site and the other levels were relatively normal, motion should not cause increased pain in your back or your leg.
It is possible that you have chronic radiculopathy (see website) but I would be suspicious of a pseudoarthrosis of the L5-S1 level with motion and intermittent compression of the nerve root.
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.#7755 In reply to: Abnormal signal intensity… |I’m sorry. Some history would be helpful of course.
I am 46 year old female. I have never had a serious back injury. In 2009 I began having chronic lower back pain. Within six months I started having tingling, burning and sharp stapping pains in my right leg and foot. I saw two Doctors who diagnosed a pinched nerve. No physical exam or diagnostic tools were used. By Jan 2010 I had started losing control of my right leg, numbness and pain in back and foot had significantly increased.
June of 2010 I waited in ER for 22 hours. Pain was very bad. I had an MRI and everyone was really nice to me afterwards. L5 ruptured and L4-5 bulging. They set appt with nuerosurgeon for Oct, gave me a pain presription and I went home and back to work.
Met with nuerosurgeon in Oct he stated phys therapy no longer an option because I had waited too long. Scheduled disc repair for December. Had outpaitent surgery. Went home and back to work. Over the next 3 months I called his office several times to see if I could talk to him because I was still in alot of pain. The pain and symptoms never went away. I doubt this will make sense but the pain and symptoms just moved. Met with his PA twice, had 8 injections in spine for pain. They were not effective.
After the 3 months I was told that if I wanted to see the Doctor again I would have to start with another consult and pay additional fees because further treatment was no longer related to surgery. So I didn’t go back.
The pain and symptoms didn’t go away. Pain has steadily increased and I am now starting to lose control of functions that I would prefer not to. My Primary ordered an MRI and those were the findings related to just that disc. There are changes and degeneration from L2 down. No one has explained the terms to me…my primary doc is great I love him but he says he is not qualified to read the results and I respect that. My doctor sent results and referral back to original nuerosurgeon. The did not respond. I called to try to set up appt. First time I was put on hold for over 30 minutes and sent to VM. And second and third. Third time I left a msg asking how to go about getting the MRI (my doctor only had the findings not the actual). I was called back immediately and told to go to the center where I had MRI and could pick up CD which I did. The business office called and left message that no further appts would be made at center until my balance was paid in full. I work full time have pretty good insurance but with the surgery and all the injections there was thousand of dollars remaining.
I live in a mid-size town with two care networks. The only surgeons who perform back surgery in my insurance network are all located in the same center. My options are to pay off balance and see if I can get someone to explain the MRI and that will take about a year or go out of network cross my fingers and pay double.
#7752 In reply to: spondylolisthesis |Hello again, Dr. Corenman,
I had a consult with a neurosurgeon today. Apparently, although the flexion-extension x-ray showed 12mm movement, the CT scan indicated the fusion is intact and there was 6mm movement. I had my legs elevated for the CT scan (comfort position)and am not sure if this “flattened” out my spine, changing the images.
Next, I am having a contrast MRI. The surgeon thinks there is nerve involvement and does not think this has anything to do with my MS (neither do I). The pain, numbness and weakness are affected by movement and bedrest settles things down somewhat. The L5-S1 area is very warm (to my physiotherapist also)and I wear an ice belt for some pain relief.
My question to you is what could be the cause of the pain if my disk is fine and the fusion appears to be stable on CT? I am still on large amounts of narcotics for pain, it keeps me awake and I am slowly becoming despondent!
Thank you again for your time. I very much appreciate your forum and hope the questions/answers can assist others who read them. -
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