Archives

Pain in the teres minor and levator scapulae muscles is most commonly referral point from facets, discs or from nerve irritation. The EMG which confirms triceps denervation indicates a C7 nerve compression. The teres minor weakness is unusual by itself as this muscle is innervated by the axillary nerve from C5 and/or C6. This might indicate the higher nerve roots being compressed but you should also notice weakness in wrist extension and biceps if C6 was involved and deltoid weakness if C5 were involved (holding your shoulder up against resistance).

The MRI reading is appreciated but remember that modifiers are in the eye of the beholder. “Moderate canal stenosis” to one radiologist might be “severe” or even “mild” to another.

Let’s talk about central stenosis. If the cord is compressed significantly, you do have a somewhat greater chance of central cord syndrome with an injury (see website for that description). This injury occurs when you fall and hyperextend your head (impact to the forehead forcing your head backwards). If you do not participate in activities that put you at risk for neck extension (snow skiing, mountain biking, water skiing, horseback riding, contact sports, etc…) then the stenosis is not that important for injury risk.

If however you do participate in sports that put your neck at risk, the danger of injury has to be factored into the need for surgery to remove the stenosis.

Your arm pain and weakness is from foraminal stenosis causing compression of the various nerve roots. Unfortunately, you have multiple levels of foraminal stenosis and at least C5-6 and C6-7 seem to be symptomatic.

So- to a conclusion without a history or physical examination (a far leap of faith), if you had the C5-7 levels fixed, you would be left with C3-4 central stenosis and C4-5 central and foraminal stenosis. You might be able to consider an artificial disc for one level (much depends upon exam and x-rays) or even a combination procedure involving and ACDF, an artificial disc and even a possible posterior decompression (laminectomy, laminoplasty or foraminotomy). Your X-rays including flexion and extension will help. Much depends upon your activity level, your expectations and your physical examination along with personal review of your MRI images.

Dr. Corenman

Most likely, you have foraminal stenosis. The foramen is the location where the nerve exits the spinal canal. Stenosis is a narrowing of this opening. The foramen narrows with spinal extension (extension occurs with standing and walking) and widens with flexion (bending forward or sitting). What most likely happened is that the herniation or bone spur that was compressing the nerve enlarged slightly and the nerve root became momentarily severely compressed. This will cause the nerve to swell and have a tighter fit within the foramen. Now, when you stand and walk, the nerve root becomes more irritated and pain results.

The treatment is a physical therapy program to start and a selective nerve root block to medicate the nerve. If that treatment is ineffective, surgery might be warranted if your pain or impairment is significant enough. Surgery might be as little as a foraminotomy or as much as a TLIF (see website).

Ozone is oxygen gas that instead of the state O2- has an extra molecule of oxygen and is O3. Ozone is highly corrosive. The extra oxygen molecule will attach to many tissues and oxidize that tissue. It is also found in a gas state. Injecting this into the body is fraught with complications and it is hard to think where this injected gas would be necessary. Injection of any gas into the body could cause an embolism which could cut off blood flow to the embolized blood vessel.

Dr. Corenman

You report back and right leg pain that radiates to the heel, onset in 2007 that faded away without treatment in about three months. For the last four years you have had four “attacks” that have lasted about one to two months each.

You apparently have had another “attack” that has lasted more than two months with more intense symptoms.

The MRI was read as significant degenerative changes at L5-S1 which have advanced in the last two to three years. There is either a disc herniation or bone spur protruding into the lateral recess and foramen on the right. (Look up lateral recess stenosis and foraminal stenosis on the web site).

I assume your leg pain is worse with standing and walking and improved with sitting and bending forward. You need to identify whether your back pain or your leg pain is worse and what actions cause increased pain. If you can identify that differentiation, I can give you more information.

Dr. Corenman

Sorry for the delay. You are considering a microdiscectomy for an L4-5 herniation for lower back pain, right leg pain and foot drop. Foot drop is related to an L4 or L5 nerve root compression. In general, any significant motor weakness should be addressed surgically soon. The best chance for useful strength return is with a timely decompression. The right L4-5 herniation is compressing the L5 nerve root and the microsurgery is indicated.

The second question has to do with return to high-level sports. Your spine has three levels of degenerative changes (L3-S1). This to me indicates a genetic predisposition for tears of the annulus. These degenerative discs by themselves do not rule you out for competitive sports but does indicate that you will have problems with your back as you do now.

The recurrence rate for herniations is 10%. A small thin layer of scar tissue does cover the annular hole where the disc extruded from. The volume of the nucleus is reduced from both the herniation and the surgery which most likely prevents further herniations.

Back pain from the degenerative discs can be controlled with core strengthening. I understand you need explosive push-off strength for pole vaulting but dead lifts and squats place high shear forces on the lower two discs. You might consider other methods to gain gluteus, quad and hamstring strength. Hyperextension for the takeoff in pole vaulting places greater stress on the facets and unloads the discs. Without a history of a spondylolisthesis, facet arthrosis or facet fracture- this position should not cause concern.

In regards to flat landings with snowboarding, this maneuver causes significant loading to the lower discs and the thoracolumbar junction. I can’t tell you how many fractures I see from this very mechanism. Great care needs to be taken to assess the landing and how much velocity is needed to reach it safely. If you land flat from a high jump, you do not escape Newton’s laws.

Dr. Corenman