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#7395 In reply to: Direct Pars Repair |
You can look at the pars fracture section in the website as well as the isthmic spondylolisthesis section to gain a better ideas regarding pars fractures and pain generation. The experience of surgeons varies greatly regarding the understanding of these fractures so it is not a shock to find different opinions from different surgeons.
If the diagnosis is unclear, pars blocks (lidocaine injection of the region of the pars), nerve root blocks and a discogram at the level of the fractures can give a much clearer picture of the pain generators. Since the pars fractures most likely occurred between the ages of 8 and 15, it would be unlikely that the disc would be fully intact without a tear 30 years later but stranger things have happened.
A pars repair in my practice in an older population requires a significantly symptomatic patient, an intact, non-painful disc (possibly diagnosed with the use of a discogram) without a significant slip on flexion-extension X-rays, proven pain generation from the pars (positive pars blocks) and no significant bone erosion between the fractured ends of the pars.
Unstable segments, painful discs or significant erosion between the fractured ends of the pars normally requires a fusion. Don’t fret if you need a fusion as there is about a 90% satisfaction rate for fusion in that case.
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.#7371 In reply to: L5 S1 extruded disc |Your history is classic for a disc herniation that the same level most likely has developed a recurrent disc herniation on top of the preexisting one.
Having a disc herniation for three plus years, most individuals have adapted to the nerve compression and the pain becomes tolerable. If the pain has significantly increased in the last six months, something must have changed. Most likely, another disc herniation had occurred at the same level in that six month period of time.
Remember that the tear in the disc wall (see website) never heals as the disc is avascular and incapable of healing. The same process that dried out the nucleus and allowed it to “flake off” and herniate the first time still occurs over time. Increased pain is most likely from a new hernation that now sits on top of the old one.
Your symptoms are typical for a herniation. The nerve is stretched over the bulge in the front of the canal. Extension (bending backwards) slackens the nerve and with less stretch, there is less pain. Bending forward tensions the nerve so more pain is generated.
You note no lower back pain of significance. Even if there was severe degenerative disc disease present, you have no symptoms from this. If that is the case, a simple microdiscectomy would be all the surgery you would need.
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.#7368 In reply to: bilateral numbness in feet |Bilaterally equal positional numbness in the feet can be related to lumbar spinal stenosis. Lying on the examination table, typically without a pillow under the knees will produce extension of the lumbar spine and increased compression of the lumbar nerves. The “burning” sensation that lingered in the legs could result from the prolonged compression of the nerves- from the hour requirement to lie still on the MRI table.
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.#7350Topic: Can't stand the pain in forum BACK PAIN |Teally hoping for some advice. I had back surgery in march. Originally the pain Seemed so much better. However, since then I have has increasing issues. I still have pain in my right leg with weakness. I had nerve test done with showed mild adnormLty in that leg. Since my surgery I have horrible pain in my butt when I sit. I can’t sit more than an hour without wanting to crawl out of my skin. Now I M having pain in my right side. With the pain in my leg butt and side I can’t stand it. I saw a pain doc who prescribes cymbaltA And nucynta. It’s been a month with no improvement. My latest MRI reads:
Sagittal images demonstrate slightly progressing discogenic endplate signal changes at l5 s1 now demonstrating a mild amount of increased stir signal intensity suggesting reactive edema. A mild amount of endplate enhancement is seen. There is a stable disc disk cation throughout the lumbar spine with stable mild to moderate loss of disc height at l4 s1.L1s1 l2 l3 stable appearance of a small filum terminale lipoma
L3 l4 l4 l5 there is a stable mild broad base annular bulge facet and ligamentum flavum hypertrophy resulting in mild canal and minimal left neuroforaminal narrowing at L3L4
At l5s1 there is a new right hemilaminotomy detect enhancing granulation tissue is seen within this region abutting the posterior lateral aspect of the thecal sac without evidence of deformity. Enhancing granulation tissue peridural fibrosis changes are seen extending into the disc operative defect. There is a small broad base posterior central disc protrusion indenting the ventral thecal sac. Stable superimposed mild broad based annular luging and facet hypertrophy again resulting in mild neuforaminal narrowing.
While this finding is thought to be postoperative fibrosis and underlying mild discitis and endoplate osteomitis would be diifficult to rule out.
L3L5 mild canal narrowing at L4
I don’t see my surgeon until January and feel like my legs are getting worse. Any insight would be appreciated.
#7300 In reply to: Recent Diagnosed Bilateral Pars Fracture with Pain |Hello Doc, it has been quit a while since my last posts. Since my last post I have gone thru a nerve ablation from l2 to s1 bilaterally. That was on August 17th of this year. I did get very little relief from that proceddure but nothing significant. Since that proceedure I got a 2nd opinion from a Dr. at a differnt spine center because I have been leaning towards fusion for my defect. Per our last conversations I did request a discogram and I was told by the Pain clinic not to do it as the benefit will not outway the pain and that is strictly presurgury. So this New Orth Surgeon had me do another Pars Diognostic Injection wth Cortizone and Lidocaine from a radiologist instead of the pain clinic. Well it worked!!! He used a ton of lidocaine and My pain went from a 4 to a 1. I still had some leg pain and foot discomfort but all together my back pain has still been at a lower lever since the injection last friday. My origianl injury was over a year ago and I have had a total of 6 transforaminal and 2 rounds of facets with no releif. I quess you were right about a lot of false negatives with the pars injection. My question is , now what do I do. Since te cortizone is working and the panus has settled down is it likely I will have a full recovery or it it more likely I will reinjure the Panus (since I am a firefighter and extension will be inevitable? ) Or does this relief mean that Im now a candidate for the fusion. I have been denied fusin by 3 different surgens. and also the city IME stated Im not a candidate for surgury and he suggests that the city retire me from full duty? Or do I go thru life with pain of 1 or 2 and live with what I have (non active life) please advise on your opinion on what you think is my next steps?
#7293Topic: Lower back pain, L4-5, disc bulge in forum BACK PAIN |Dear Sir,
My wife is having lot of pain in her lower back for the last many years.
The pain can be termed as 9/10. Recent MRI LUMBOSACRAL SPINE shows Findings as
Disc desiccation seen as reduced T2W signal intensity and reduced height of D11 vertebral body noted centrally-appear degenerative change.
Curvature of LS spine is straightened..
IMPRESSION: Lumbar spondylosis with disc degeneration and end plate changes at L4-5 along with reduced disc height and posterior disc bulge indenting thecal sac and nerve roots.
A spine specialist here in india has advised Ozone therapy for the treatment. I have no knowledge of the same whether it can be useful or shall have side effects. Kindl advise the best course of treatment for this.
Thanks
Ravinder Jain -
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