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#4950 In reply to: Define disc and spine issues |
You report neck pain for many years that has increased in intensity. You then report an injury fall after your “left side went numb and I fell”. Your report significant pain and paresthesias (pins and needles) in your left arm and you cannot bend your head backwards or to the left.
You have an older MRI that notes cervical kyphosis at C4-6 with degenerative disc disease at those levels. You have “minimal” foraminal stenosis at C4-5 bilaterally and a broad based bulge at C5-6 with minimal right and no left foraminal stenosis.
To let you know, kyphosis normally goes hand in hand with degenerative changes. Your symptoms can be generated by your neck. Some individuals have very sensitive pain component nervous systems and these tears in the disc wall can cause local neck pain. The left arm symptoms are harder to understand as the old MRI report does not note significant nerve compression (foraminal compression) but if the arm symptoms are of more recent vintage, a new MRI might reveal newer anatomic changes. I am also reluctant to read an MRI report and accept the conclusions at face value.
The fall from left sided numbness does not fit well with a neck origin unless the numbness was only in your arm and your arm gave out when you grabbed something to prevent the fall. Numbness in your leg would not fit with your neck disorder.
You need a good spine specialist to look you over and figure this out.
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.#4933 In reply to: Lower Back Pain |You identify an L5-S1 isthmic spondylolisthesis with a grade one slip (0-25% slip of the vertebra on the sacrum). You also have wedging of the T11 and T12 vertebra.
The upper vertebral wedging is from Scheuermann’s disease when you were younger. The vertebral endplates were soft and you had some fracturing which deformed the vertebra slightly. I assume this is not painful to you and you can ignore this upper problem.
The pain you experience is most likely from the isthmic spondy at L5-S1. It would be unusual for this spondylolisthesis to slip further down the sacrum at this point as I assume you are at least 30 years of age. Depending upon the length of time of pain and the intensity of pain, there are various options form treatment.
Physical therapy to strengthen in surrounding core muscles can be very helpful. An epidural steroid injection or a “pars block” at the site of the old fracture can reduce the sensitivity of the nociceptors (pain nerves).
If you have failed conservative measures or you have weakness of the muscles of the foot (tibialis anterior) from compression of the L5 nerve root, you would be a candidate for fusion surgery of this level. The most typical surgery would be a TLIF (see 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.#4925 In reply to: One in a Million? T9-T10 Symptomatic Disc Herniation |You are one of the rarer patients with a thoracic disc hernation. I see about 10 patients a year with a thoracic disc hernations compared to 300 lumbar and 100 cervical hernations.
I try to keep most thoracic disc hernations out of the operating room as the surgery to remove the herniation is extensive. The chest has to be entered and ribs are either stretched or removed which can lead to intercostal neuralgia. The other technique is to do a transpedicular approach which can occasionally lead to incomplete removal. None the less, there are times that a surgery has to be performed due to cord compression. There are some surgeons who use endoscopy to remove thoracic herniations and those results are mixed.
Epidural steroid injections can work well for these herniations. If there is no cord compression and in your case, it sounds like there is none, injection treatment can give relief. If you can be patient, in my opinion, 80% of patients with these herniations can have moderate to significant symptom relief over time.
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.#4915 In reply to: Lower back pain due to hernaited disc? |You have lower back pain that radiates into your left buttocks and occasionally radiates below your left knee. You do not mention when the onset of pain occurred. Was it gradual or immediate as the result of an action like lifting? Did you have long standing intermittent lower back pain that increased recently? Is the buttocks and leg pain newer onset or just increased in intensity?
Is the lower back pain or the leg pain worse and by what amount? Example- 60% low back pain and 40% buttocks and leg pain or 70/30 or 30/70? What makes the low back and leg pain worse? Standing vs. sitting vs. lifting vs. walking vs.???????????
Your MRI notes degenerative disc disease at L3-4, L4-5 and L5-S1. You have a rather large herniated disc at L4-5 which fills up about a third of the canal and is compressing the L5 nerve root on the left. That explains your leg pain. Your lower back pain could be from the three degenerative discs, the herniation itself, stenosis from the herniation (see web site) or even the facets.
I don’t know what facilities you have there but an epidural steroid injection and physical therapy are the initial tools I use for this disorder in the beginning. You may eventually need surgery but if you have no motor weakness, the conservative route is the one to take in the beginning. To test for motor weakness, simply heel walk (duck walk) around the room. If your left forefoot stays off the ground with prolonged walking, you have no significant motor weakness. If you have weakness, surgery should be considered.
By the way- using flicker to show your images worked very well. That was a great idea.
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.#4913Topic: Lower back pain due to hernaited disc? in forum BACK PAIN |Dr. Corenman,
I have lower back pain that goes to my left buttock and when agitated the pain goes down past knee. I like to lift heavy and I’m a Soldier so I must do PT. The doctor is telling me to stop all lifting and PT. My question is will it heal? Will I ever be able to lift again? Will surgery allow me to lift again and at same strength levels? The less I work out the better it feels, but it never goes away. It even limits the range of motion that my left leg can move and somewhat my right leg also but not as much.
Below I have posted what the doctor put on my MRI CD.1. Mild disc bulging and central protrusion at L3-4.
2. Disc bulging with central extrusion and narrowing of central/lateral canals at L4-5.
3. Disc bulging and central protrusion at L5-S1.
4. No abnormal signal intensity in bone marrow or spinal cord.Thanks you.
#4912 In reply to: Disagreement on Degree of Surgery Needed |Though you have limited access to the test results, your diagnosis is not only appreciated but affirming of the feedback I received today.
The second neuro-surgeon’s opinion came in more conservatively than either of the first two doctors. He said that this is a C7 radiculopathy and needed ACDF on only one segment (C6 – C7). He acknowledged that bone spurs and stenoses were evident elsewhere, but he saw no need for further surgery beyond the one fusion point, considering the limits of my symptoms.
His assessment of what the MRI termed “severe” was moderate. Adjectives are subjective, as you cautioned above. He added that the space between my other C vertebrae was fine, and that I was in no unusual danger of injury. I asked him about my present neck ROM, and he said that too was fine.
The trade-off of so much ROM for my limited symptoms was not worth it at this time. I am going with the one-level fusion.
The initial surgeon characterized himself “as conservative as they come.” And yet, of two other diagnoses conducted with all results and office visits, and two more with only anecdotal or limited access (including yours), all four prescribed more conservatively, from one half to one quarter of the work the original doctor recommended.
Wrist extension and bicep strength are sound. I alternate curl fifty pound dumbbells for eight reps with good form. I will see what becomes of the teres minor issue.
I don’t participate in any sports. I only weight train. I’m soon to be fifty-five, and the gym is a place of refuge. I appear athletic, but I am not very coordinated, agile, or competitive. I only lift.
My bench press has never been strong as a long-limbed individual. But I noted a precipitous drop from 225 to 165 for reps. Overhead military press remains compromised. That lack of strength would come and go in seasons. Now it’s all making sense with this C7 thing. I imagine it was alternately flaring and quieting over the years, and other muscles were compensating whenever possible.
I have pillaged the internet’s ACDF resources, and there are many good sites out there, but this website is a gem among them. Your personal responses have been helpful and alarmingly prompt.
I may start other threads if more questions occur, to keep the forum coherent and searchable. Cheers and thanks to you.
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