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#7645 In reply to: Lumbar 3 scyatica |
BODY=Report Dictated By: Blake,Meghan MD||EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST|HISTORY: Chronic back pain radiculopathy.|COMPARISON: None.|TECHNIQUE: Sag T1/T2, Ax T1/T2.|FINDINGS: There is a moderately severe rotary levoscoliosis of the |lumbar spine with apex at L2-3. There is prominent endplate bone |edema and peripherally directed spur rightward along the concave |margin of the curvature and the disc at this level is markedly |degenerated and narrowed. Conus and cauda equina are normal.|Level by level analysis:|L1-2: Minimal bulge.|L2-3: Moderate to moderately severe right-sided foraminal stenosis |from right lateral endplate spurring. Remodeling and edema-like |signal change along the bony endplates suggests active motion segment |instability.|L3-4: There is a 2 mm broad-based protrusion, very mild facet |hypertrophy and mild foraminal narrowing.|L4-5: Thickening of ligamentum flavum and facet capsular tissue with |mild left subarticular and left foraminal narrowing. There is a 1 mm |broad-based protrusion.|L5-S1: Disc is desiccated and significantly narrowed, facets are |overgrown and there is moderate to moderately severe left and |mild-to-moderate right foraminal narrowing, disc desiccation and |height loss with vacuum disc phenomenon and more limited reactive |marrow change than seen at L2-3 here left at midline. There is also |a small annular fissure. Overgrowth of the left facet is associated |with mild capsulitis.|IMPRESSION:|1. There is degenerative change along the concave margin of |scoliosis at L2-3 with disc desiccation, large lateral endplate spurs |and reactive endplate change which suggests motion segment |instability. The right L2-3 neural foramen is stenotic.|2. At L5-S1, there is leftward endplate spur and lesser reactive |marrow change also with significant disc dehydration and height loss |and a moderate-to-moderately severe left foraminal stenosis.|CREATED=01-16-2012 04:20 PM
I have tried physical therapy, inversion table, pain meds and muscle relaxers, just recently tried acupuncture and it did not work. I get really bad pain in my lower back, left hip down to my foot, for the past two days my lower back and hip has felt like they are actually on fire, the burning feeling gets so intense.
#7636 In reply to: To be microdiscectomied or not to be? |Hi Doc, a quick update of my condition. On sept. 9 , oct. 3 I had an epidural injection (transforaminal). It didn’t work as i hope it would, so I saw a local ortho and ordered an MRI.
MRI FINDINGS:T12-L1, L1-2 the intervertebral disc is normal.
L2-L3,L3-4 the intervertebral disc, neural foramina and facets are normal.
L4-5 there is loss of disc signal without focal abnormalities. There is mild facet hypertrophy and foraminal stenosis.
L5-S1 there is loss of disc height and signal intensity with an irregular right sided disc extrusion which measures 14 x 6 mm in the axial plane x 10 mm in the sagittal plane. This compresses the right L4 root in the lateral recess. The exiting L5 root is not compromised. There is bilateral facet arthropathy.
IMPRESSION:
At L5-S1, there is a right sided disc extrusion compressing the right S1 root.I told the ortho my medical history and he did some test on me and in a nutshell he recommended fusion surgery . He said for sure L5-S1 and he said he would do discogram on L4-L5 to see if it’ a pain generator. By the way Dr. Corenman he also offered laminectomy but mention that it might be a temporary fix because the disc is already extruded( IDR ). He also mention about Hybrid fusion, fuse lower level and do artificial disc on top. I was very shocked when i heard I needed fusion.
I did have another shot coming up on oct. 31. It was a facet injection ( Bilateral ) on L5. As soon as I got up , I felt a tremendous difference. Pain was gone. I was back to work the next day. Sad to say it didn’t last. Today is Dec. 21 I scheduled a second and third opinion. Dr. Corenman kindly advise me to what you would do if you were to operate on me? I hope you would be my 4th opinion.
Again Dr. Corenman, thank you.#7630 In reply to: Looking for a Solution for my Spondylolysis |You have what is described as an isthmic spondylolisthesis- grade II at L5-S1 with a concomitant mild degenerative disc at L4-5. Please read the extensive information regarding this on the website.
The slip amount at L5-S1 is larger than “normal” (Grade I) and this is why it probably creates more pain. Pain can be back pain and instability or leg pain or both. The leg pain would initially be caused by standing and walking and relieved by bending forward and sitting. After further degenerative changes, this leg pain could wake you up at night.
If you could respond to therapy and epidural injections, that would be the next step as long as you have not developed motor weakness.
The repair is the “blue plate special” (if you are old enough to remember that), a very common surgical repair. The surgery is called a TLIF with a Gill procedure and can eliminate pain and restore function. You can find a description of that surgery on the website.
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.#7623 In reply to: Pain in the Neck |It looks like you have obtained good care up to this point. I will assume that the second surgery to gain a fusion at C5-6 was successful. Please tell me if that has not been assessed fully yet.
I will also assume that your pain is mainly neck pain and headaches without significant shoulder or arm pain.
Pain can be generated from the facets or the discs. Have your upper facets been included in the diagnostic facet injections? These facets commonly can cause headaches.
Have you had standard X-rays including flexion/extension? These can yield a treasure trove of significant information.
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.#7591 In reply to: spondylolisthesis |Hello Dr. Corenman,
I had my CT scan and the results match the flexion/extension xray..ie lots of movement. What else should I ask about in regards to my CT?
Also, I had a week long episode of perineal numbness and urinary incontinence that was relieved by traction from my physiotherapist. I thought this was an urgent symptom, however, I will not get in to see the surgeon until January. Am I at risk of serious sequela? Is it likely to happen again? I have also developed weakness in my left foot and am limping. I cannot brake while driving with my right foot and must use my left foot. The back and leg pain is severe, unrelenting. A few times I have felt icy cold sensation creeping into my thighs.I am trying to get strong for surgery by doing core work….small movements really, just engaging the muscles. And short walks.
Any advice or comments please, would be very appreciated. Thank you so much.#7576 In reply to: Effects of a poor posture |I would love this to be fully true but unfortunately, it is partially true. The effects of gravity do create a toll on the human frame. The main problem is the thoracic kyphosis (the forward curve of the middle back or chest) advances with age. This does create greater strain on the neck and lower back. Extension exercises which most of us do not do would be helpful.
The problem with this theory is that spines deteriorate with exercise too. SInce the discs are essentially avascular, injuries to the discs are permanent. The effects of occupation, daily living, trauma and genetics produce wear in the spine. Many patients who come into the office suffer from antalgia- the abnormal posturing of the body to prevent pain.
If you had lumbar stenosis (see website), you would bend forward at the waist to prevent your lumbar nerves from being crushed. If you had significant symptomatic lumbar degenerative disc disease, you would bend backwards at the waist to unload the painful discs.
I agree that individuals need exercise to stay healthy and posture is one of the more important items to focus on but it is not the only one that needs to be addressed.
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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