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#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.#7751 In reply to: When is it time for surgery? |The interbody grafts used should be made of allograft (cadaver) bone. Are you sure these were made of titanium? The X-ray would show a thick “very white” spacer in the disc space if these were made of titanium instead of bone (which should look similar to the density of the vertebral bodies next to them).
It would be unusual to use titanium implants for fusion. It also would be unusual not to use graft bone (or your own bone) to fill these cages. I would think that these are allograft Cespace struts in which case there would be no need for fillers.
Using a plate in front is typical but not absolutely necessary.
The fusion of allograft spacers or struts takes between 3-4 months before solid incorporation occurs. Serial X-rays including flexion/extension will determine if these grafts have incorporated. If there is any question, a CT scan can be used.
Not every surgeon uses physical therapy to rehab a patient but you might ask if he or she would write out a script for you.
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.#7744 In reply to: Abnormal signal intensity… |You bring many unanswered questions to this thread. What are your symptoms? What surgery did you undergo, why and when? What were the results?
Please seee the section under “Conditions”, “How to describe symptoms” to fully inform the forum of what your current situation is.
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.#7743Topic: Abnormal signal intensity… in forum GENERAL |My latest MRI results sound scary and I cannot see surgeon until next year due to finances. I won’t go into issues above L4-L5 but regarding L5-S1 I need to know if I could create futher permanent damage by waiting. Results:
Abnormal signal intensity involving vertebral bodies and pedicles.
Degenerative marrow change realted to previous discectomy.
Possibility of active infection indictes correlation with sedimentation rate and CRP
Questionable superiorly extruded disc at L5-S1 in the right subarticular region, possibly a free fragment. Apparent disc fragment appeared to be positioned adjacent and lateral to the right L5 nerve root sleeve.
Severe foraminal stenosis at L5-S1 on the right.
Please excuse any spelling or typing error. I am miserable every minute of every day. The nueosurgeon who did my previous surgery can’t see me until I can completely pay off the firt surgery so I have had no professional explain this to me. Any education would be greatly appreciated.
#7727 In reply to: Post ACDF pain |The question is where is the origin of the left neck pain. If the pain radiates into the shoulder or down the arm, the origin could be from the foraminal narrowing of the left C5-6 level that compresses the nerve root here. I would also be suspicious of a pseudoarthrosis (lack of fusion) at one of the two levels of your prior surgery. This can be revealed by X-rays including flexion/extension views.
If there is no pseudoarthrosis present, a selective nerve root block (see website) of the C6 nerve with good temporary relief (see pain diary) would indicate that compression of the C6 nerve is the most likely cause of your pain. If this is the case, a posterior foraminotomy can be performed (see website) to decompress the nerve. This is of course assuming that you have failed conservative therapy.
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.#7722Topic: Post ACDF pain in forum NECK PAIN |I am a 48-y.o. woman s/p ACDF C4-C5 and C5-C6 9/11/2012. I present now with left neck pain. My hx was prior severe right neck pain and arm numbness/weakness + many, many failed nerve blocks, facet injections and epidurals.
My MRI from this past week shows:
“….discectomy and fusion of the C4-C5 and C5-C6 levels….At C5-C6 there is some osseous productive change of the uncovertebral joins with moderate narrowing of the left neural foramen. There is minimal narrowing on the right.”
I didn’t want to bother with the rest of the report, because this is the part which seems abnormal in the area where I am experiencing moderate to severe neck pain. There is extension to my shoulder, but not down my arm/hand. I am just confused because the discectomy surgery seems fine and I did not really have pain on the left neck prior to the surgery.
Thanks for any clarification/advice you can provide me with.
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