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#7133 In reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. |
I preformed the test you recommended for motor weakness, the results are my left non-painful leg did well was able to preform both tests with a lil unsteadiness. For the painful leg wasn’t able to complete the heel raises, as for as the toe raises was able to preform them. The pain was minimal, but then i sit down or walk to pain is intense especially in the area of surgery it feels like the bones are ripping apart. So its a weird thing, its been 7 weeks is it possible that in this time if nothing is wrong i should be feeling better? And if it is re-herniated should i go with surgery in other words if i let it go could it get worse?
#7132Topic: Disc Herniation plus other things in forum GENERAL |Hello Doctor,
Thank you very much for answering people’s questions.
Will try to be as brief as possible.Background:
38 year old male, active in sports.
Over last year have been doing pretty extension jiu jitsu and playing soccer at least twice a week.I injured my knee playing soccer end of august and that kind of opened up a can of worms :(
Up until that point i was ignoring off and on pain in my left shoulder blade and the fact that my left arm would “fall asleep” every night(only the two smallest fingers).
to cut the long story short, pain in left shoulder blade became unberable(i was still trying to do jiu jitsu and boxing with injured knee…) it was fine when i would lie down or sit down or even standing was ok but as soon as i started walking pain in my left shoulder blade would become very intense and i had to stop after about a minute.
i went to chiro, othropaed(who treated my knee), everyone dismissed as simple pinched nerve.
my left arm was getting better but after right arm started feeling tired off and on i became more concerned and went to see a neurologist.
EMG found pinched nerve at left elbow(so that explained that), it is getting better but still sometimes at night it would fall asleep. Anything i can do here?
EMG also found curpal tunnel right wrist(I had this injury off and on so no surprises there).
But otherwise they said everything is great and whatever I feel is not coming from my neck.Neuro also ordered MRI.
Thoratic is fine
Cervical:
Normal alignment.
The spinal cord demonstrates normal signal intensity. Bone marrow, etc. normal, unremarkable.C3-4 minimal disc bulge, slightly larger on the left side.
C6-7 There is a moderate-sized right paracentral disc extrusion with slight flattening of the right ventral aspect of the spinal cord and mild narrowing of the right lateral recess.
No cord edema.
Everything is unremarkable, some disc degeneration but was told everyone is like that…Ok so that maybe explained the tiredness in right arm but if it is extruding to the right why is my left shoulder blade “killing” me :)
I have seen injury doctor who specializes in jiu jitsu, basically saying not a big deal as i can move my neck every which way and it doesn’t bother me and I don’t have any limit to my range of motion anywhere.
Neuro checked me pretty good(her words) and strength is good and everything is great, just the disc.
Was told to stay off the mat for a month and then can return to jiu jitsu but no sparring for another months.
Meanwhile knee is getting better and have been oked to run and play soccer. Every time i play left shoulder blade hurts but not a lot i can play though it.
I can walk about 15-20 minutes and then usually it starts with throbbing on shoulder blade and then will eventually turn into pain(but pain is bearable). Also some activities will make shoulder blade throb(like someone is gently tapping on it) and will turn to pain eventually. If i walk with hands behind my back its much better but will turn to pain eventually.
Right arm getting tired is still there but I think it is less often and maybe less extreme, kind of hard to tell.Of course, now, I have been paying too much attention to everything that rattles me… can’t say I am happy about it but…
I have been very eager to return to sports, I am confused what can or can’t I do, and what can I do to help myself.
It has been about 1.5 month since my shoulder blade initially hurt and I have about 3 more weeks to go before I was told I can go back to jiu jitsu.I have been going to physical therapy, for knee initally and now for neck, they have been doing traction and exercises but honestly I don’t think any of this is helping just time.
I know this was long but from reading other threads you want the details so you can have all the info at your disposal.
I also have a sitdown job but try to be active in the evenings.
Thanks,
D.#7127 In reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. |Pain with sitting and “jolts” down your leg might signal another disc herniation. There is the chance that there is no new herniation but the nerve root is still so swollen from two compressive injuries in a short period of time.
To check for motor weakness, there is a simple test you can perform yourself. Balance on one foot on the painful leg while steadying yourself on a counter or wall with your hands. Just use your hands for balance and do not support your weight with your hands. Perform ten heel raises on the painful leg. Then do the same on the non-painful leg.
Compare the ability to do these heel raises one side to the other. If you are substantially slower or cannot complete the ten raises with your painful leg, there is most likely motor weakness. Do the same test but this time, raise the ball of your foot off the floor ten time (toe raises). Compare both sides. Again, if one is substantially slower or you cannot complete ten on the painful side, there is motor weakness present.
Either the current intensity of your pain or weakness if present should warrant a new MRI. If the nerve is compressed by another herniation, surgery should be considered. If the nerve is inflamed, an epidural injection or even an oral dose of steroids might be helpful.
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.#7119 In reply to: Procedural Questions for iFuse SI Joint Implant |Dr. Corenman,
Much appreciated for your quick reply, especially over the weekend.
The majority of the peer-reviewed literature indicates that severe muscle spasms also accompany the other primary symptoms of SIJD. Since the onset of this condition about 12 months ago, I’ve experienced increasingly more intense spasms, especially upon waking first thing in the morning. The spasms are ridiculously bad in and of themselves, but also leave me completely unable to roll over — whether lying on my back, or on my side, it’s almost as if my entire sacral region is “locked”. Once I’ve had help out of bed, I’m unable to stand up anywhere *near* straight for at least one hour, and I’m unable to take normal-lengthed strides… I’m guessing those who’ve had this condition, or currently wrestle with it, can completely understand my describing it as, “my hips and low back prevent my legs from stepping any further out than about 6-inches.” If the police are at the door, a tornado is coming, or the house catches on fire, it’ll take me about 4 days to walk eight feet. This improves some throughout the day, but by far, the dysfunction in those joints prevents a normal heel-to-toe gait.
Some follow-up questions:
1. After the surgeries, and given adequate time for healing, will the intense, severe spasms subside? The joints will be stabilized, but will the complex of ligaments, tendons, and muscles also “settle down” after the fusions? Will my ability to walk with a more normal gait improve once the SI dysfunction has been stabilized?
2. I understand your explanation regarding the leg length discrepancy… thank you for addressing that question. I’m considering seeing a physical therapist prior to my surgeries to assess whether any gentle, subtle adjustments can be accomplished. In your opinion, would a PT assessment be beneficial prior to the fusions? My attending surgeon suggested that while PT won’t “fix” the severe degeneration in my SI joints, it might help in simply having the ligament and muscle complexes evaluated and assessed to possibly alleviate some of the leg length discrepancy. Or, am I just eternally condemned to one shorter leg and walking with a limp? You mentioned post-operative PT, which my attending surgeon also stressed upon solid fusions. For a patient with lumbosacral instrumentation to S/1, and with bilateral SI instrumentation, what modalities of physical therapy might be prescribed? Will I be limited in what types of PT I can do? What will be the ultimate goal of my post-operative physical therapy?
3. Just to clarify… Much of what I’ve read regarding SIJD seems to attribute a good degree of the pain to a subluxation of the sacrum, or a “locked sacrum.” If the orthopedic surgeon performing my fusion(s) identifies a misalignment of the sacrum or other lumbosacral structures, would he repair or otherwise adjust these issues during the surgery?
4. I saw an online news article yesterday which addressed the fact that some insurance plans in a few states do not cover the iFuse procedure. Kansas was identified as one… Do more insurance companies than not cover this procedure? I’ve tried to search my insurance policy information online, but I’m unable to find any indication as to whether it’s covered or not. I also searched my insurance company’s medical code guidelines, but don’t see any summaries of what types of arthrodeses are covered. I plan to call Monday. Have you ever run into a situation, or heard of one, in which a patient’s insurance didn’t cover iFuse?
5. If the iFuse procedure isn’t covered by a carrier, are there other similar or just as reliable SI fusion procedures that *are* covered so a patient can have this condition stabilized?
Again, your help has been appreciated. Thank you.
S.W., NC
#7116 In reply to: To be microdiscectomied or not to be? |Unilateral pain deep in the gluteus muscle is more likely radicular pain from a compressed nerve. The leaning position could indicate foraminal stenosis (see website for description) as this position opens the foramen. McKenzie exercises (back extension position) should not relieve your pain if this disorder is foraminal stenosis as this maneuver narrows the foramen or lateral recess even more.
The microdiscectomy is not the problem that “undermines” the disc. It is the original degenerative changes of the disc and the full annular tear that allows the nucleus to “squirt out” of this through and through tear. The real problem is related to genetics and activity.
I do not generally recommend other physicians as I do not really know the quality of their work. Ask around. Get some word of mouth recommendations. Look up the surgeon on the internet. Look at this site for questions to ask the surgeon.
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.#7115Topic: Procedural Questions for iFuse SI Joint Implant in forum BACK PAIN |Hi Dr. Corenman,
This past Thursday, I underwent diagnostic testing for suspicion of SI Joint Dysfunction. All 5 provocative maneuvers on the sacral and pelvic area were positive (with the first 2 maneuvers being the most critical). The exam was actually intolerable at some points. I then underwent a bilateral SI Joint anesthetic injection under fluoroscopy, which after 10 minutes resulted in a 95% resolution of my pain. The orthopedist conducting the procedure also said that the replication of severe pain upon the needle entering the joint (especially when she introduced the dye) was another positive indication of degeneration in the joints. I told her that was just great, but that I’d prefer to not do that again for another 50 years. Or ever.
Until Thursday’s injections, I had been experiencing intractable, chronic pain between 7-10/10. Twenty minutes after the injections, I left the medical center *carrying* my cane, and walking with completely upright posture. Flexion and extension, even with my lumbar instrumentation, was both possible and painless … had there not been a good chance of the police showing up, I would’ve seriously contemplated a celebratory pole dance in the parking deck.. By 11:00 pm that night, the anesthetic dissipated, so I was back to my usual symptoms — but, that was the best 7 hours I’ve had in years.
I’m now scheduled with an orthopedic surgeon who is one of 400 surgeons in the US trained by iFuse to perform the SI Joint fusion implant surgery. He’s done a good number of these, and is highly regarded insofar as successful outcomes. In the meantime, and prior to my surgical consult with him, I had a few questions for you about the iFuse surgery, and I’d really appreciate any input or advice:
QUESTIONS:
1. I need bilateral SI Joint implants. Obviously, I’ll have one side done, recuperate, then have the other done. What is the general recovery time for an iFusion procedure? Partial or non-weight bearing? How long before I could ideally return to the classroom, stand, and lecture for about 4 hours per day? How about driving, household cleaning, and other daily stuff?
2. I’m an avid Harley-Davidson rider. Can patients return to riding a motorcycle? Harleys are notoriously high in vibration… will this be a risk?
3. After bilateral SI implants, how is ROM affected?
4. My right leg is 3/4″ shorter than my left. I’m assuming this is due to the pelvic, lumbar, and sacral ligament complex having to compensate for numerous lumbar fusions. During the iFuse surgery, does the surgeon adjust for this? If the sacrum is subluxed or otherwise out of position, is there a process for realigning those joints prior to fusing them into place? If the sacrum or pelvis is torsed or out of position, will that be corrected in the O.R.?
5. After a bilateral iFuse on a patient with lumbar instrumentation to S-1, what kind of PT, if any, could be recommended to prevent atrophy of the muscle and ligament structures in the lumbosacral and pelvic regions?
The initial recovery protocol is my main concern… I’ve read next-day partial weight-bearing, to partial weight-bearing for 3-6 weeks, and I’ve read non weight-bearing for up to 12 weeks. What’s the truth on this? Will I need someone with me constantly for the first few days, or weeks, or not at all?
Thanks for your help, and time…
S.W., NC
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