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#5396 In reply to: Chiropractor's x-rays cervical spine |
Thank you for responding so quickly. It is hard to believe that a busy doctor with a full schedule of patients can care enough to be interested in those who are limited to being online. We are grateful. And I will try to be concise.
Yes, I am a bit lopsided due to a frenetic experiment with “swivel hips” on the trampoline about 25 years ago. The temperature scan was all in the red on the left side and my shoulder, ear etc. are higher on one side than the other. That said, it has never bothered me much and I didn’t think it was so important to mention in conjunction with my head/neck problems. Maybe I was wrong. As for the neck x-ray (I asked for another today), apparently my lordoctic curve is so extreme that my neck never straightens out completely even when my chin is firmly on my chest. Is that so rare or important? (If you are curious to see a cut/paste of the straight head and bent head x-ray, I’d be glad to send them in a document attachment.)
The neurosurgeon whom I am working with has decided to experiment with least invasive procedures first, starting with deep tissue massage. (Previously, he had ordered several nerve blocks, none of which made any difference and prescribed Xanax…ditto). I am sure he will return to the C2/C3 facet joints unless something simpler works. The insurance won’t pay for the massage unless it is done by a physician (gives me cold chills to see another physician), a physical therapist (I’ve been so many times) or a chiropractor. I chose the chiropractor and now he doesn’t want to do the massage. I’m not totally comfortable, but will continue for the moment.
I wish you were closer.#5391 In reply to: Mixed recommendations: Fusion vs. mDisc….HELP PLEASE |Spinal instability originates from wear of the disc and facets and then “looseness” of the connecting tissues (capsule, annulus, ligaments). Instability is best recognized by abnormal motion or alignment on standing X-rays including flexion and extension X-rays. Some surgeons would also consider potential instability after surgical intervention like the case of an angular collapse causing nerve compression in the foramen (what I call foraminal collapse). In that case, the surgical decompression of the nerve would lead to instability.
By your description, it sounds like most of the pain you have is in your left leg. If that is the case and there is a compression of the left nerve root (without confounding factors like the foraminal collapse noted above), then the most likely effective surgery would be a micro-decompression (probably microdiscectomy). However, without a thorough evaluation (history, physical examination, evaluation of all images and tests), this is just theoretical.
The reason for the need for the fusion should be explained to you. Revisit with the surgeon and ask why he or she feels the fusion is necessary. If the explanation doesn’t make sense to you, get a second opinion.
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.#5366Topic: Whats the cause of my backpain??? in forum BACK PAIN |Hello,
I have trouble understanding why my back hurts and how to stop the pain.
I am 22, female and I’ve been having this back pain for 3 weeks now and it’s not getting any better.The diagnosis of one doctor was thoracic syndrome. She said two of my rips were dislocated. Another doctor said that I have mysclerosis in the big trapezius muscle. My whole musculature in the right back and neck is EXTREMELY tense.
Today I was at physiotherapy. The massage to relax the tense muscles hurt so much that I could hardly bear it. There are two points that hurt the most, I think next to the TH2 vertebrae. One on the right side and one on the left.
I also have a constant pressure on what I would identify as my gullet. It literally feels like someones poking against my gullet from the inside (right). It’s extremely irritating.Yeah, I don’t know what to do about all of that. I feel like nothing is helping in any way. I tried many different things now and I don’t want this backpain to become chronic.
So is there any way that I can get my muscle to relax?, should I ask for a radiograph or mri?
I’m thankful for any advice on how to deal with this.
#5335 In reply to: ADR C6-7 level |According to your complaints, with triceps weakness and paresthesias of the index finger, it sound like you have compression of the C7 nerve root. Compression of the C7 nerve root appears to be caused by spur formation from degenerative disc disease (see website under the section “cervical radiculopathy” for further explanation).
You also have some degenerative changes at the C5-6 level but apparently no symptoms at that level. I assume a thorough physical examination revealed no weakness of the biceps or wrist extensors.
If your main complaint is weakness and paresthesias with no significant neck pain, then an artificial disc replacement could be a good solution for your C6-7 level. This surgery allows decompression of the uncovertebral joint spur (see website) and still maintains motion of the segment to reduce the stress on the degenerative segment above.
I don’t know how long these artificial discs will last. They may last your lifetime or only 10 years. The research is still being compiled. The other question is whether the allowance of motion at a degenerative segment will allow recurrent spurs to form but I think that is unlikely.
The good news is that if these artificial discs fail- in general, it is not surgically hard to revise them into a fusion. I have revised quite a few (they were surgically implanted elsewhere for the wrong reasons) with very good results.
Getting back to your problem, the main question is if you should undergo surgery? That is quite a discussion by itself. In my opinion, any patient that has undergone conservative care and continues with upper extremity weakness that interferes with occupation or lifestyle should consider surgery. There is no guarantee that you will regain good useful motor strength even with surgery but surgery gives the nerve the best chance to recover.
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.Hello Doctor,
I am a healthy 57 year old male with no prior history of surgery or spinal injuries. I am a computer programmer who does spend hours at the computer though, although I also walk briskly daily and exercise. I did suffer from an left shoulder bursitis injury about ten years ago which occasionally flares up but does not give me any significant pain or restriction in use or motion.
In August of this past year I developed severe pain in my left shoulder and tingling with numbness extending down to my left thumb and forefinger. There was minimal cervical spine pain, the most intense was just radiating pain across my left shoulder and down my left arm to my hand. Cold compresses helped as long as they were applied to my cervical spine as I sat at a 45 degree angle. After about a week of compresses the pain diminished but did not go away. I could not sleep on my left side. I had an MRI done and then went to physical therapy. After three+ months of physical therapy I thought I was cured — no more numbness or soreness or pain.
A week later I awoke to a severe pain this time in my spine but without the radiating pain to my left arm or shoulder. This was definitely centered on my upper or middle cervical spine. I applied cold compresses but cannot sleep on my left side again, nor my right side without pain developing at the base of my neck and left shoulder. Here is what the MRI indicated from the August incident (I am writing this in January) — that would be immediately after the first incident (I have not had a recent MRI done for this msot recent incident):
August findings:
Findings: The visualized vertebrae demonstrates normal alignment and marrow signal characteristics. At the C3-C4 level, disk bulge minimally effaces the anterior sub-arachnoid space but does not indent the cord.
At the C4-C5 level, left para central disk protrusion minimally effaces the anterior sub-arachnoid space but does not indent the cord. In addition, right para central disk bulge and right-sided facet joint arthropathic changes are seen to cause mild right foraminal compromise.
At the C5-C6 level, disk bulge with a prominent left paracentral disk protrusion is seen which effaces the anterior subarachnoid space but does not indent the cord.At the C6-C7 level, left para central disk protrusion effaces the anterior sub arachnoid space and causes trace indentation on the left ventral aspect of the cord. In addition, this disk protrusion extends into the region of the proximal left neural foramen resulting in mild to moderate left foraminal compromise.
There is no signal abnormality seen within the cord.
Normal flow-voids are seen through the visualized vertebral arteries.
The visualized posterior fossa grossly appears unremarkable.
IMPRESSION: Multilevel degenerative changes, most significant at the C6-C7 level as outlined in the body of the report.
Okay, I need English please. This most recent flare up appears more severe in depth of pain. On a scale from 1 – 10 at it’s height the pain was certainly a 15! After four days it has subsided and the cold compresses help.
Would physical therapy help at this acute stage (pain) or should I seriously consider other therapies and would surgery be necessary at this point?
I can provide snapshots of the MRI as I have the disk and am fascinated when I run it and see the inside of my spine.
Thank you kindly,
Lester
#5288 In reply to: 40year old with 80 year old back |If you end up with a fusion at L5-S1, the TLIF procedure is the one that is most likely to be used. A normal hemangioma is not a factor in a fusion. These are quite common and typically ignored with treatment.
You are correct that no extension of the back should be employed with rehabilitation. Extension will tear or at least aggravate the pars fracture pannus.
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. -
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