Need a new search?
If you didn't find what you were looking for, try a new search!
-
AuthorSearch Results
-
#5280 In reply to: 40year old with 80 year old back |
Your symptoms are 10 years’ worth of left SI region pain, intensity about 1-5 (0-10 VAS scale) depending upon the day and increasing in consistency over time. You have no leg symptoms. Your trade is that of a mechanic and your back feels fragile. Sitting increases symptoms and walking decreases them.
The diagnosis needs to correlate the MRI findings with your symptoms. X-rays are valuable in your case as with pars fractures and degenerative facet disease noted on the MRI, you could have developed a spondylolisthesis. Standing views with flexion and extension films are needed to look for slip and instability. Now for the MRI.
Your main problem is the pars fractures and slip (isthmic spondylolisthesis) at L5-S1. The reason you have no leg pain or paresthesias is that you have no nerve compression as identified by the MRI. I imagine you have moderate degenerative disc disease of L5-S1 but this is not noted on MRI.
Rehabilitation for isthmic spondylolisthesis involves a flat back posture program. You should not do extension exercises as this will aggravate pars fractures. Any yoga position that causes bending backwards should be avoided and in general, you want your lower back to become stiffer. Manipulation of the L5-S1 level should be avoided.
If rehab and injection therapy does not help, this problem is most likely surgically treatable.
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.I’m a 50 year old male with no prior neck or arm problems, until a July 2010 traumatic injury from a fall from a bicycle onto pavement—no helmet. Cervical CT scans were normal, but two months later I began to notice an annoying discomfort on top of my shoulder just under the clavicle. 60 days later I had agonizing pain down my left shoulder and arm. I was started on Gabapentin for the pain, which helped a lot; seven months after my accident I had an MRI which revealed herniations: At C6-7 There is a large broad-based disk protrusion which effaces CSF anterior to the spinal cord and slightly flattens the left anterior contour of the spinal cord. There is moderate bilateral neural foramen narrowing. At C5-6 there is a central and left paramedian disc protrusion which partially effaces CSF anterior to the spinal cord and which is slightly flattens the left anterior contour of the spinal cord. There is no alteration in cord T2 signal intensity There is moderate neural foramen narrowing on the right, with severe neural foramen narrowing on the left. At C7-T1 there is a mild broad-based disk bulge with axial images suggesting a small far right paramedian disc protrusion. There is a mild bilateral neural foramen narrowing. I tried traction, PT, epidural steroid injections, none of which gave any relief. By April 2011 I was up to 2700 mg daily of Gabapentin, and by May I was taking 3600 mg daily to manage the pain. Clearly, surgery was in order. Exactly one year after my accident, I had two level ACDF surgery from C5-C7. According to the surgeon, everything went well, and he said he removed “two large herniations” from my neck. I woke from surgery with no pain relief, and was in even greater pain for 30 days after surgery. Five weeks after surgery things calmed down so that I was able to reduce my dosage of Gabpentin in half. It’s now been five months post-surgery and although the pain is a little less, I’m still having bothersome shoulder and arm pain, and I can’t figure out why. My post-surgical x-rays show everything is fine and fusion beginning. Why do some people report immediate pain relief after nerve decompression, while others like myself continue to struggle months later? I might mention that I never had tingling, or pins and needles sensations, nor did I ever have motor and strength issues. My symptoms have always been pain. I am tired of being patient and “giving it time.” This pain is getting really discouraging. I wonder if I should have had the decompression surgery sooner, and that maybe I have permanent nerve damage? Your website says this surgery is successful in relieving arm pain 90-95% of the time. How many months after surgery is this assessment of recovery normally made? Thank you for any ideas! .
#5277 In reply to: 40year old with 80 year old back |I should also add some information I note that you mention in a number of other posts. I really can’t say I have leg or foot pain/tingling. It’s mainly left low back/si/QL area. I do have couple lipomas (so I’m told) around this L5 area that feel sometimes bruised from sitting but I’m guessing that’s referral pain. Honestly sitting seems to aggrivate it worse. Walking feels better, and just standing doesn’t seem to aggrivate it as bad. My P/T generally makes it feel less aggrivated but that’s usually short lived.
I actually yesterday purchased your new book, I don’t expect my symptoms go away with your book, but maybe I can get an even better visual as to what is happening when. One of my biggest dilemmas with this problem is knowing how to do the correct excercises to not aggrivate it. My P/T folks gave me a number of things for core work, I’ve worked on that 3 months now. My chiropractor took a couple things out, said he didn’t like em and added a couple other things (superman and back extension raises 30deg only), then I read online superman is the worst thing one can do for foramen problems. It so frustrating to know what to do and not with all the information out there. The neurosurgeon said yoga was great and really only prohibited me from squats and axially loading the spine from above the shoulders.#5274 In reply to: MRI and Xrays done of neck and I have ?'s |Extension is essentially the act of looking upwards. If extension or bending the head backwards causes the hand to go numb- you need a thicker pillow. Some pillows that are “designed” for proper neck position actually can cause problems as these pillows are manufactured for “normal necks”. If there is stenosis or narrowing of the nerve exit foramen (see foraminal stenosis on website), relief is gained by flexing the neck (chin toward chest) and that can occur with a thicker pillow.
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.#5273 In reply to: Disc Replacement vs. Posterior Foraminotomy |Thank you very much for your feedback. The epidural did eliminate all radicular symptoms. What I am left with feels like a mechanical block to extension. As you stated, a foraminal block from the disc herniation. If now all I’m dealing with is a blockage (which causes rather constant pain and discomfort) & I have no radicular symptoms or weakness–where do I go from here?
thank you so very much for this forum and your website.
#5269 In reply to: Disc Replacement vs. Posterior Foraminotomy |Your symptoms fit with foraminal stenosis from the disc herniation or spur formation. Extension of the head will narrow the foramen and compress the nerve root. Pain in the deltoid/biceps area most likely would fit with the C6 root but C7 can occasionally cause this. A thorough physical examination will most likely be able to identify the nerve root.
If you had an epidural injection, I hope you paid attention to the first three hours after the injection. This is when the diagnostic portion of the injection holds value. Numbing the root should have given you 2-3 hours of temporary relief. If not, it is possible the injection did not reach the level of the compression.
Cervical disc replacements work well with herniations and spurs not associated with severe degenerative changes of the disc and no significant axial neck pain. The longevity of the replacement remains to be seen but many have done well 10 years out. I started replacement surgery about three years ago and have done quite a few.
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. -
AuthorSearch Results
