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#7547 In reply to: MRI Results and increased pain/weakness |
You have a number of problems going on at once. Let’s break them down to simpler elements to allow some basic understanding.
The HLA B-27 is a genetic marker that makes you more susceptible to autoimmune phenomenon that can affect the musculoskeletal system. That is, you might have your own immune system attack your spine causing pain, stiffness and aching. Have you been diagnosed with a disorder called Ankylosing Spondylitis?
The pain in your neck and right shoulder/arm/hand more likely than not is not related to an autoimmune phenomenon. You have a disc herniation at C6-7 that is compressing the right C7 nerve root. This can cause neck pain that radiates into the shoulder, arm and hand, especially into the middle fingers. Sound familiar?
You have what I like to refer to as CNS or “crappy neck syndrome”. You have four consecutive discs in your neck that are degenerative. The upper three discs bulge and efface the thecal sac, the sack of water (CSF) that surrounds the spinal cord. By your description, other than at C6-7, these bulges do not compress the spinal cord. These upper discs can cause local neck pain but should not cause arm pain if they do not press on the nerve roots.
What is the percentage of neck pain vs. shoulder and arm pain? This makes a big difference in prognosis. If you have mainly neck pain (let’s say 70%) and only 30% shoulder and arm pain, surgery for the C6-7 level will probably only give you 40-50% total relief as the neck pain is most likely caused by all the problem discs. Fixing one disc will only relieve about 20% of your neck pain (about 1/4th of 70%) and should eliminate most of your arm pain (the remaining 30% due to arm pain for a total sum of about 50%)
If we turn the numbers around and assume you have 30% neck pain and 70% arm pain, then you can speculate that you should have a total of 80% relief of pain (1/4 of 30% is about 10% and then add elimination of the 70% of arm pain for a total of 80%).
There are some bold assumptions made with that prognosis but that is the general thought process for relief of pain by surgery.
Grinding and popping in the neck is normally related to the facets. Normally, noises made by the neck are not painful but if you do have pain, degenerative facets could cause this. Do you have a degenerative spondylolisthesis on your flexion/extension X-rays (see website for explanation)? If the facets do generate pain, these can be diagnosed by facet blocks and possibly pain reduction could come from rhizotomies (see website).
Visual disturbances, ringing in the ears and trigeminal neuralgia are all mediated by intracranial processes and are not my specialty. You would have to consult a neurologist for information on those processes.
An elevated white count could originate from many different processes. If you have an elevation from your autoimmune process, this elevation should be able to be ruled out as an infection by the appropriate specialist (rheumatologist or hematologist). This should hopefully clear the way for surgery (most likely an ACDF) at C6-7.
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.Your surgeon notes that the slip has slightly increased and “there is no obvious consolidation in the lateral gutters” which probably means that the fusion is not progressing as intended. The lack of fusion and the increased slip might indicate foraminal stenosis which would explain the significant leg pain.
With the intensity of your current symptoms, you might ask this physician if she might order a CT scan or an MRI. The CT scan will determine what the current state of your fusion is along with denoting foraminal stenosis. The MRI would not help with fusion status but would delineate the state of compression of the nerve root.
If that plan does not work, you could consider a second opinion.
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.#7506Topic: Dura Deficeincy in forum GENERAL |What could a person expect in the way of symptoms in the event of a long term dura deficency? Say 7 months or more. I had a spinal fusion surgery in 1997 (11 vertebrae 6 discs). Ten years later had some minor events occur. Found rods broken in the thoracic region. After an auto accident started suffering major muscle spasms & weakness, trunk to both legs numbness, falling down as well as other issues. MRI and CT scans showed normal. Only thing obvious was where the rods broke. Surgon decided he would repair the spot where the rods were broken. During the operation he discoverd the dura in fact was gone. He removed the vertebra to get where the dura was missing and placed a patch over it and reinstalled vertabrae using bone grafts and new hardware. I am now having MS symptoms with MRI of brain showing few hypointensities (very small)no white matter. EMG normal. Neurologist gave up after that and told me to go to the Mayo Clinic. Perscribed 6 months of physical theapy. Therapist (who works with a lot of MS patients took one look atme and I should be on disability becase I had MS. Help!!!!!!!!!!!!!
#7494Topic: Need a diagnosis in forum BACK PAIN |History:
I had bent slightly while picking up a computer and suddenly felt a shooting pain originating in my lower right back and moving up the right side of my spine. This occurred over 4 years ago. The MRI at the time revealed a disc bulge at L4-5 with a superimposed left foraminal annular tear and fluid in the facet joints bilaterally.
At L5-S1 there is a disc bulge with a superimposed central posterior disc herniation with indentation of the ventral margin of the thecal sac.For several years after the initial injury the pain was minor and tolerable as long as I stayed within reasonable limits of activity. It has increased over the past year and now that I am in a prescribed core exercise therapy routine it has gotten much worse. My primary physician can not explain why this is so.
My most recent MRI (March of 2012) was unrevealing according to him.Location:
Primary pain is located in the lower right back area and begins to extend first downward into the right buttock and thigh, then upward just to the right of the spine after extended upright sitting or increased physical activity.Percentage of pain is 70/30 on average.
Quality and Intensity:
The quality is a constant ache with movement at level 2 on the VAS (10 months ago). This is the pain level with minimal activity. During increased activity such as core exercise therapy (Current) this pain level rises to a constant 3-5 and becomes more of a stabbing type of strong discomfort and a cramping type of pain occurs in the upper part of the right buttock as well. Then there is a crippling failure (crises) at level 9 (Crippling failure happened on Oct. 30th after crouching and has happened approx every 2 months before that for the past year) after increased activity which occurs after bending, lifting, kneeling or crouching following the 3-5 VAS pain level.
Skin at the location is hypersensitive to touch and heat.Weakness:
There is some weakness associated with the condition and exists in the right leg. Climbing stairs and extended walking are negatively effected. There is a pronounced limp after increased activity or sitting upright for extended periods.Activities:
The most painful are lifting, bending (both shallow and deep), kneeling and crouching. Sitting upright in a standard type of moderately padded office chair begins to become difficult after 1 hour and pain spreads down the right leg and up the right spine. Intolerable at the 2 hour mark. Reclining in a more padded chair provides some relief. Standing also temporarily reduces the pain from sitting upright provided that I favor my left side. Standing becomes difficult after 2 hours due to increased back and leg pain.
Walking is limited to 1/2 mile before rest is required. Pain increases over time while standing, walking or sitting upright. Pain increases sharply with repeated kneeling, bending, twisting, lifting or crouching. Jumping and running are out of the question. Both of these activities cause extreme pain instantly. Biking on an actual mobile bicycle is out of the question due to impact issues but stationary biking is tolerable for up to 1/2 hour.
There is instability pain as described above, after increased activity and increased pain levels leading to crises mode which cripples me for weeks.
Daily function varies with activity and pain levels. I try to greatly limit my bending, crouching and anything described above that causes sharp increases in pain levels.Occupational restrictions:
I was effectively released from my position due to these back issues and they have made it impossible for me to keep a job. At any moment I can suffer crippling back failure and can barely stand, walk or sit. I was an IT consultant which required me to move a lot of equipment weighing up to 50 lbs. Now any repeated lifting, bending, twisting, kneeling or crouching is out of the question. After inactivity and healing over the course of months I can lift a 40Lb object and move it 100 ft once with tolerable discomfort but not repeatedly. Since I can not sit upright for any length of time or stand for very long this leaves me in a permanently disabled and effectively unemployable state.Treatment:
Initial physical therapy failed and caused more pain. Secondary therapy was slightly better. Now enduring a 3rd round of therapy that is proving largely unsuccessful. My primary physician claims that core exercises and medication will alleviate the condition. He is incorrect. Core exercises may strengthen the surrounding muscles but cause the actual injury to weaken and fail at crises levels. Currently in low impact hydrotherapy which helps the muscles become stronger but also increases the pain and discomfort in the injured area.
Years ago a spine specialist told me that I was not a good candidate for surgery and that I would have to live with the discomfort and would probably never work again. At that time I thought I could continue to heal and be capable of most of the things I did before the injury. Now I know that is not going to happen.Here’s the immediate issue….My primary physician tells me that I should not be experiencing the problems I am experiencing based on my latest MRI. He continues to prescribe medication and core exercise therapy and admits he has no idea why I would be in so much pain. I need to know what is going on here and why I keep experiencing crippling back trauma over and over again. Why the exercise therapy seems to be aggravating the injury instead of strengthening and stabilizing the area. Any insight you may have would be most appreciated.
#7468 In reply to: standard mri vs stand up nd chronic back pain helpp |My issue is, I have to trust the MRI images implicitly to be absolutely accurate in performing surgery. The good news is that these images have to correspond with the history and physical examination and if they don’t make sense, I can have other tests performed to confirm the findings. There are times the Fonar images can be used for surgical planning but I have seen times that a more precise scan is necessary.
The only time that I think an MRI scan needs to include motion images is in the rare case of a hydraulic disc causing radiculopathy. This is a disc that bulges posteriorly with load and the bulge reduces with unloading. Flexion/extension X-rays will not diagnose this disorder. However, this type of disc can be diagnosed with a discogram. I see this type of disc about once every two years so ordering a motion MRI for every radiculopathy case would not be cost effective as the necessity for possible repeat scanning.
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.#7455 In reply to: Help! Effectiveness of prior surgery without disc removal? |The change in your disc appearance over time most likely indicates a non-solid fusion. Flexion/extension x-rays do not have to demonstrate gross motion for a non-union to be present but there are subtle signs that can indicate motion without measurable motion being present.
See if you can ask your current doctor for a CT scan of the L5-S1 segment. The scan should be on a 64 slice or 128 slice scanner for the best accuracy.
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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