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Sir,
continue with prevoius comments, sir i have consult orthopaedic spine
surgeon upon examination and investigation he arrived at conclusions
that there is spinal instability in lumbar region in lateral radiograph in flexion and
extension there is upward and downward movement of L5 L5 vertebrae,
now he put me on lumbar built for three months and certain lower back
exersices, moreover the surgeon says if this therapy fails then we have to
go for surgery in order to fix the spine by rods and screws. sir plz let me know
about ur valuable suggestions? thanks alot.#6722 In reply to: Is this a serious issue? |Cord flattening is the same as canal stenosis or narrowing of the canal. This condition deforms the normal “bean shaped” cord and flattens the rounded corners of the spinal cord. The symptoms are under myelopathy 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.#6717 In reply to: My Condition and Recommendation |Dear Dr. Croenman,
please find below as requested.
Location and Quality of Pain
What is the quality of the pain?
The pain is in the lower back into buttocksto wiastline and radiating to thigh and leg left, right or both sides with burning, dull and sometimes aching.Does the quality of pain change with activity?
Yes, Increases while sitting radiates to thigh and leg. Also increases when standing, less while sleeping, but have to change position or will have difficulty in getting up.Is the skin hypersensitive to touch?
No hypersensitive, but sometimes yse.Are there associated skin changes like thickening, color change or nail changes? This is important in the foot and lower leg?
No.Percentage of Pain by Location
What is the percentage of pain in the back vs. buttock and leg?
It 50% back vs. 35% buttocks 15% thigh and leg.Intensity of Pain
The current pain back & buttocks is 4-6 VAS.
Leg now is now 0-2 VAS.
Thigh now is 0 VAS.
The worst befoer 7 years 9-10 VAS. Radiating from back to thigh to leg right side.Weakness
Is there weakness associated with the pain?
sometimes, not always.Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)?
Don’t know.Is there now a limp due to pain or to weakness?
Sometimes.Are certain activities more problematic like climbing stairs (due to weakness and not pain- such as a weak anterior thigh muscle) or walking due to a foot drop (you catch your toe on the ground when you walk) or even push-off (your foot will not push you forward while you are walking)?
No.Onset and Length of Time Symptoms Have Been Present
How did the pain start?
Was it a gradual onset over years or was there one specific activity or injury that caused it?
Always present over years, but increases sometimes.When did that injury occur?
7 years ago.Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?
lifting some heavy.How long have the symptoms been present and have they changed in quality or intensity?
The pain is present since 7 years on and off.Activities
What activities increase or reduce the pain?
Increases is Joging, otherwhise pain is always present but in lower level and increases for no reason known to me.Think carefully about this question as the information produced is very valuable: Is it sitting that increases the pain where standing reduces the pain or visa versa?
Both.Can you sit for 15 minutes or one hour before you have to get up?
yes, but painful.How far can you walk?
maybe 2 miles.Does prolonged exposure to the activity cause more pain?
depending on the activity.What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain?
Sitting, standing and jumping in general make pain worse. Walking is less but when I stop it pains.Does the activity cause different symptoms?
Not sure.Does the lower back hurt with sitting and bending but the leg hurt with standing and walking?
Back and leg hurt with sitting and standing.Does the neck pain become worse with bending forward vs. backwards?
Yes, sometimes.Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague?
There IS mild pain with activities that becomes excruciating with a certain movement that I avoid.Does daily function go relatively smoothly unless you bend over to pick something up?
Yes, but I avoid certain movements.Pain Intervals
•Are you pain free for certain times of the day or with certain activities?
sometime, but have pain with sitting, standing. Maybe the pain is mild with walking but severe with sitting. Possibly there is moderate constant pain that becomes severe with, jumping or some other activity like running.Are there flair-ups that occur? Are you pain free for most of the day but by the end of the day, pain onset occurs? Do you get pain crises? Are you free of pain for a week, month or even year but one event will cause severe, incapacitating pain?
Pain is always present but on a lower level, but flair-up for no reason or any activity.When the pain crisis occurs, how long does it last?
Depending when I visit the hospital, generaly 3-4 days.Activity and Occupational Restrictions
How has the pain changed your life?
Walk and move very carefully.Have you adapted to the pain by limiting your activities? If so, what activities do you now avoid?
Yes, running suden movements.Do you no longer participate in recreational activities that you once did? Which activities have you eliminated?
Yes, running .What activities have you modified?
Now walking & swim vs. running for 45 minute a previous.What do you now do to prevent pain from occurring?
Don Know what flairs up the pain to avoid reoccurring.What type of work are you involved with?
Expediting company work in other companies and gernment departments. involves driving, standing and office work.Describe your work by its physical demands. Do you have to repeatedly lift, bend and twist?
No lifting or twisting.Do you have to sit without position change for long periods of time?
Yes, Sometimes.Are you off of work due to the pain or did you have to change your job position secondary to pain?
Same job, but I try to avoid sick leave as much as I can.How long have you been off work or have changed your position?
In general Sick leave is for 3-4 days.Liability
•Is there liability from another party (motor vehicle accident or workman’s compensation involved)?
Both motor vehicle accident or workman’s compensation involvedHave you been injured by another’s fault?
Recently I was involved in an accident on 3/June/2012 no direct hit to me but bad damage to my car. Pians have increased and symptoms have changes. Prevously only pain in back radiating to right side.Liability is too complex to be dealt with by a simple Internet site. Your consultant will need to obtain specific details regarding the injury to help with any decisions on settlement or causality and apportionment.
Previous Consultations or Treatment
What previous treatment have you had?
Yes.Have you seen a chiropractor?
yes.Have you seen a therapist?
Yes.How successful or non-successful has that treatment been?
On and off.Have you seen a surgeon and if so, what did they say?
Some said surgery others said you can wait.Did you have previous spine surgery and if so, what procedure?
No.What happened to your symptoms with the prior surgery?
No Surgery.Again I thank you for your time and effort.
#6712Topic: Is this a serious issue? in forum GENERAL |Hello,
I had an MRI that I’ve literally been begging for since January of 2011. My symptoms started as facial numbness on the left side of my face. I thought I was having a stroke, but my blood pressure and heart rate was fine. This continued to happen and has been more consistent over the last 18 months. I also had visual disturbances in my right eye, where my eye would suddenly go blurry for hours or for days at a time. i had an eye exam by an optho who said that there was blood vessel restriction in the back of my eye. I have had increase in pain midline back of the neck below my skull radiating to the top of my head. This pain has been excrutiating at times. I’ve had pain to the left and right side of the back of my neck, and between the shoulder blades. I have restriction of my range of motion with my head on both the right and left, that was noticed upon exam by a Rheumatologist who ordered an x-ray. These findings indicated that I had an degenerative issues at C5-6 and C6-7. I have had pain in my legs on and off for many years that felt like a constant burning pain, but would come and go. I have fibromyalgia and it was blown off as that. The last year, I have had new pain in this area that is much more severe: Going from my lower back through my hips (aching/lightning like pain in right hip), through my buttocks and down my legs to my heels. It is painful when standing, or sitting. I have noticed the last two months that I have heaviness in my legs, as well as a deep pain from the top of my legs all the way down to my feet, making it feel as if I am carrying concrete pillars. walking for long stretches, which i use to enjoy doing now brings on excrutiating pain for anything longer than ten minutes and standing in check out lines is nearly intolerable. This is inconsistennt with the pain, but the heaviness AND weakness, is scary. This happens inconsistently as well. The last several months, I have felt off balance. I’ve nearly fallen several times. I feel like I’m going around the world to my left. I have trouble grasping small items. I at times experience vertigo as well. These symptoms are totally frightening and also come and go. I feel like this is all in my head as it all started so subtly for me. I have become greatly limited the last year and a half, but yet keep pushing anyway and get through with pain medications and trying to move slower while I wait for my insurance company to get me to a neurosurgeon.
My MRI read as the following. I also need oral surgery to remove all of my lower teeth, i wonder if having this done is dangerous with the conditions I am currently dealing with related to C spine.
Anyway, MRI results. I won’t get into them all, but am wondering if this could be contributing to these wild, wacky and increasingly obvious symptoms this last year and a half. What is interesting to note is that on the x ray taken in February C 4-5 showed no involvement, but by June, when I had the MRI done, it was now involved. How rapidly can these things progress? I am really scared but thinking no one takes it seriously.MRI:
C4-5-There is a mild central disc osteophyte complex which normally effaces the ventral thecal sac but causes no significant canal stenosis or cord flattening. There is no significant formaninal narrowing.
C5-6-There is a central disc osteophyte complex which effaces the ventral thecal sac and flattens the cord with moderate canal stenosis. Uncovertebral hypertrophy results in mild right foraminal narrowing. The left foramen is patent.
C6-7- There is a central/right paracentral broad-based disc protrusion which effaces the ventral thecal sac and results in moderately-severe canal stanosis. Uncovertebral hypertrophy causes mild to moderate right foraminal narrowing. The left foramen is patent.Lower lumbar
L3-4 there is minimal circumferential disc bulging and mild facet degenerative changes.
L4-5-there is mild circumferential disc bulging and mild facet degenerative changes.
L5-S1- There is a small central disc protrusion with an associated annular tear. This results in no significant canal stenosis, formanial narrowing or definitive root impingement. There is mild facet degenerative changes bilaterally.Then why are my legs this way? Why am I feeling such pain? why am I so off balance? I also have lighthing like sensations and my arm goes numb on my left side. I have numbness and tingling in both hands. sometimes, my right hand toward the pinky up to where my wrist begins will go completely numb. My legs also fall asleep easily, as when I’m driving. I have literally gotten up in the middle of the night to use the bathroom and fallen directly to the floor because I could not feel my legs at all. I’m clumsy and stumble alot, having bruised myself up quite a lot this last year.
Is this dangerous? The condition of my C spine and could these symptoms be contributing? Currently, i am awaiting a referral to a neurosurgeon. thank you.
#6707Topic: My Condition and Recommendation in forum NECK PAIN |Straightening of cervical spine curvature noted.
C5-C6 disc shows early loss of normal T2 bright signal intensity and diffuse circumferential disc bulge causing mild indentation ventral thecal sac.
C6-C7 disc shows reduce disc height with posterior and bilateral posterolateral disc osteophyte complex causing mild indentation of ventral thecal sac and encroaching bilateral respective C6-C7 neural foramina causing mild foraminal narrowing.
C2-C3 disc also shows mild bulge with posterior annular tear.
C3-C4 and C4-C5 disc shows minor disc bulge.
Posterior marginal osteophyte formation noted at C6-C7 disc level.
Cervical vertebral bodies otherwise are preserved in vertical height, alignment and marrow signal intensity.
No definite marrow edema noted.
Cervical cord is normal shape and parenchymal signal intensity.
Thecal sac elsewhere appears normal.
Anteroposterior spinal canal diameter is within normal limits.
Visualized posterior elements including facet joints are intact.
Mild narrowing of bilateral C5-C6 neural foramina also noted.
Rest of the visualized neural foramina and exiting nerve roots appear normal.
Pre and paravertebral soft tissue appear normal.
IMPRESSION:
C5-C6disc degeneration with diffuse disc bulge.
C6-C7 disc desiccated with posterior and bilateral posterolateral disc ostophyte complex causing mild ventral thecal sac indentation and encroaching bilateral C6-C7 neural foramina causing mild respective forminal stenosis.
C5-C6 mild neural foraminal stenosis.Thank you
#6705Topic: My Condition and Recommendation in forum BACK PAIN |Straightening of lumber spine curvature noted.
There is mild anterior subluxation of L5 over S1 vertebral body with bilateral L5 pars interarticularis defect noted (grade 1 L5-S1 spondylolisthesis).
L2-L3 disc shows mild posterior annular bulge with preserved signal intensity causing flattening of ventral dural sac.
L3-L4 disc shows mild disc bulge with preserved singal intensity and minor central protrusion causing mild indentation on ventral thecal sac.
L4-L5 disc shows loss of normal T2 bright signal intensity and diffuse circumferential disc bulge with right posterolateral right osteophyte complex encroaching right lateral recess causing left L5 lateralstenosis.
L5-S1 disc shows earlyloss of normal T2 bright signal intensity, diffuse disc bulge with annular tear and small broad based left posterolateral disc protrusion encroaching left L5-S1 neural foramina lying in close proximity to left L5 exiting nerve root.
Rest of the visualized intervertebral discs are preserved.
Rest of the visualized neural foramina and exiting nerve roots appear normal.
Modic type 2 endplate degenerative changes noted at L4-L5 disc level and T12 superior endplate.
Small Schmorl node is also noted at L3 and L4 vertebral body.
Rest of the visualized vertebral bodies appear normal in vertical height, alignment and marrow signal intensity.
Rest of the visualized posterior elements including facet joints and ligamentum flavumare intact.
Conus and caude equina roots appear normal.
Thecal sac elsewhere appear normal.
Pre and paravertebral soft tissue appear normal.
IMPRESSION
Mild L5-S1 spondylolisthesis (grade 1).
L5-S1 disc desiccation with diffuse disc bulge, annular tear and small left posterolateral disc protrusion encroaching left L5-S1 neural foramina lying in close proximity to left L5 exiting nerve root.
L4-L5disc degeneration with diffuse disc bulge and right posterolateral disc osteophyte complex encroaching and compromising L5 lateral recess.
L3-L4 diffuse disc bulge with minor central protrusion.thanks you.
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