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#6381 In reply to: MRI report |
Hi again, Dr. Corenman,
Pain history: gradual onset, but most prominent over the last 3 years. Constant headaches, the best description would be the sensation of a hot knife, sometimes dull and throbbing, sometimes sharp and steady, at the base of my neck radiating upwards into the base of my skull. Trapezius muscles are usually rock-hard, limited mobility. Crackling or popping sound when I turn my head or lower my chin to my chest. No skin changes or hypersensitivity. Pain is 95% neck, 5% arm (which is more of a numbness, not pain). Neck pain intensity usually 6-8 range. Moderate weakness in right arm is most problematic upon waking. No problems with gait or coordination. Pain is usually mild to moderate upon waking, increasing in intensity throughout the workday; evenings are usually the worst. It wasn’t until I recently took my first hydrocodon that I experienced what it feels like to *not* be in pain.
Activity/occupational restrictions: sitting through a movie is challenging, had to give up swimming laps (rotating head side to side is a problem), used to run 4 miles per week but running seems to aggravate the pain. Part of my job requires lifting/pushing very heavy objects or vehicles, but I have been excused from that lately
I have been a graphic designer/illustrator for the past 28 years, sometimes spending many hours at a drafting table or computer, so my condition is not surprising.Consultations/treatment:
Chiropractor for three months: not effective
Orthopedist: during a visit for lower back pain 3 years ago, I asked the doctor to also check my neck. He stated that I did indeed have a partially “blown” lumbar disc, but that my neck was “far worse.” Prescription: PT, anti-inflammatories, pain medication. PT was mildy effective but temporary. Second doctor, last month: x-ray revealed “collapsed” disc at C6-7, prescribed Celebrex and ordered MRI (impression listed above). MRI also indicates numerous osteophytes but most significant at C6-7. Moderately severe disc desiccation at C6-7, minor desiccation at C4-5 and C5-6. Minor facet arthrosis C2 through C7, moderate at C4-5.And that brings me to today, waiting for my consultation with the orthopedist to discuss this recent MRI.
Again, thank you for your generosity.
Regards,
John#6377 In reply to: Discectomy Risks |Let us discuss what causes facet or pars fractures. If there was a decompression that thinned the pars or facet down beyond the point of structural integrity, the pars or the facet can be broken, especially with an extension moment. As I noted earlier that I have only seen this 3 or 4 times in the higher levels but today was very different.
This very day I took care of a patient that had two “minimally invasive” prior decompressions at the L4-5 level at another institution. She was undergoing a TLIF fusion of L4-5 by me. At the level of the prior decompression, she had an L4 inferior facet fracture due to the thinned pars, the first facet fracture that I have seen at this level.
I would assume that most surgeons measure the width of the pars when doing surgery to determine how “thin” the pars can be made while performing the appropriate surgery. I also assume there are some surgeons who find circumstances that dictate the thinning to the pars to a point that it might be structurally unsound. I do not think the original surgeon knew that the pars was thinned too much and most likely, the fracture did not occur on the operating room table.
Your friend’s experience was obviously not good. He underwent a microdiscectomy and was discharged from the surgical center in severe pain with no increase in medications from prior to surgery. The question to ask is why his pain was greater than prior to surgery as with a microdiscectomy, normally the pain improves substantially postoperatively. The lack of ability to communicate with the surgeon is something I also cannot explain.
The second surgeon reports an iatrogenic pars fracture (fracture caused by physician intervention) and fused the segments involved. I assume the fusion was for instability of the segment secondary to the pars fracture.
Two months after the second surgery, your friend bent down, felt a “pop” and developed pain greater than necessitated the first surgery. He now has had back and right leg pain for three years and his life is substantially changed.
I would hope he had a new work-up after that episode to determine the origin of the new pain and had it addressed.
I can understand your reluctance to have back surgery after the experience of your friend but I assure you that his experience is not universal. We have some of the best spine surgeons in the world here in the USA.
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.#6372 In reply to: Discectomy Risks |The patient, a close friend was 52 year old male in excellent physical condition and muscular build that exercised regularly and with no genetic dispositions. He had completed a 3 year circumnavigation, on a large sailboat, is a master diver and otherwise a very healthy and active individual before lifting a 25 pound tool back while in a closed confined space that caused the ruptured disk.
An X-Ray and two MRI before the discecotomy showed no pars fracture and an MRI two weeks after the surgery showed the pars fracture. The patient had not performed any extension activity or stress that would cause the fracture, as his pain post-op prevented and physical activity and physio did not start until 1 month post-op.
When admitted for the surgery the insurance had authorized and expected to pay for a 2 day hospital stay, but the patient was told to leave the hospital only 2 hours after awaking from the procedure at the orders of the performing surgeon. The patient was in unbearable pain when he was discharged and against his request to stay the night was told that it was not necessary. The patient, then check into a hotel 1 mile from the hospital, with the same pain meds that he had been taking before the surgery. He did not see the surgeon for 2 weeks after the surgery and when he did the doctor said that the nurse had stated that he had got up after the procedure and ran out off the hospital feeling great. The patient replied that he had been run out of the hospital at which time the surgeon replied with anger and defended the actions. It had appeared that the discharge was a setup, to make it appear that the surgery was a success.
A second surgery with different doctor, fused the L4 L5 with hardware to stabilize and reported that the pars fracture was indeed caused by the previous surgeon. There is no thinning of the pars or any sign of degeneration that would lead to the pars fraction without intervention.
Two months after the fusion the patient reported bending over to pick up an onion skin off the floor when he felt a pop in the lower back and has sustained constant pain, worse than the pain that lead to the first surgery.
The pain in his lower back and right leg has been ongoing now for 3 years and his life is un-recognizable.
So the big question is; if it is it is extremely rare to break a pars during a disectomy, what happened and why did the surgeon attempt to cover his tracks if he had not known of the fracture. Is this indeed a rare event? If so are there any actual statics.
After witnessing this I am reluctant to have any back surgery what so ever.Respected SIR,
Recently i have intense lower back pain which continously efecting my routine work and get worsed, I have concerned neurophysician who adivice to go for another MRI and refer me to surgeon possibly for another surgery ,Should I go for another surgeon opinion? THANKS#6357 In reply to: Discectomy Risks |I can say that I don’t remember ever seeing a pars fracture at L5 or L4 from a microdiscectomy but I assume it can happen. The higher levels have a much more narrow pars and I do believe I have seen three or four. That is however out of thousands (or tens of thousands) that I have seen in my office. If there is a foraminotomy however, this does thin down the pars to try and clear the foramen and there is a small percentage that pars fractures can occasionally occur.
A one level fusion normally does not cause significant stress to the levels around but there is some additional stress. Most of the problems are due to genetics and not the fusion.
The surgeon might not have noticed the pars fracture as it might not have been present at the time of surgery. This fracture would most likely happen later with the patient undergoing some extension activity and the additional stress causing the fracture.
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.#6356 In reply to: L5S2 Back Pain |What is the quality of the pain?
–> I have nerv pains in the buttocks and pain in the left leg. I feel a prickling in left calf and shinebone. I also have pain which goes to the left side of the groin.
Sometime I also have buttlocks pain on the right side but this is very irregular.Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?
–> Pain in groin is like stabbing or pins, buttlock pains are aching especially when I do special movements such as streching myl legs while lying on my back.
Does the quality of pain change with activity?
–> yes, sometime when I stand, sometimes when I sit, sometime when I lie in bed. pain increases if I sit too much at my office desk or stand too much.
Is the skin hypersensitive to touch? No
Are there associated skin changes like thickening, color change or nail changes? not to foot or lower leg
Percentage of Pain by Location:
8 to buttlocks
6 groin
4 backHow did the pain start?
I complained because of back pain last year before that I had intermittent pain at my back
Was it a gradual onset over years or was there one specific activity or injury that caused it? No really.
When did that injury occur? May 2011
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?How long have the symptoms been present and have they changed in quality or intensity? For nearly one year. They are always present but sometimes I can not stand the pain or can not sit on my desk.
I hope this helps you. I am planning to create new pictures with the MRI. As soon as I have them I will post new ones.
Best,
Saad -
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