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#33068 In reply to: S/p TLIF 8 weeks ago-new sx |
There was no obvious comment about degenerative facet changes at L4-5 but sometimes, radiologists might not pick up on that. The best way to determine if that slip is significant is with flexion/extension X-rays.
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.#33066 In reply to: S/p TLIF 8 weeks ago-new sx |Your new MRI notes no compression of any root above the L5 level (“There is no significant canal or foraminal narrowing inferiorly through L4-L5”). There is some displacement of the L5 nerve root due to a seroma-a collection of post-surgical fluid; (“L5-S1: There is postsurgical fluid along the surgical tract into the disc space, which superiorly displaces the right L5 nerve root within the foramen, for example series 3 image 11. There is persistent T1 hypointense material in the epidural space extending along the right S1 descending nerve root, likely reflecting scar tissue”).
If your symptoms are improving to your satisfaction, you can elect to “wait and see”. If however, you have problematic symptoms, you can ask for a needle aspiration of the seroma and an epidural steroid injection to decompress the root and allow some anti-inflammatory consideration.
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.#33063 In reply to: S/p TLIF 8 weeks ago-new sx |The new symptoms are what concern me as well. I did have a phone conversation with the surgeon and shared with him how i am feeling;he thought the MRI at the higher lumbar levels looked great. He thinks these symptoms are related to the tlif and nerves being irritated. I guess this could be possible but im not completely convinced. He did share that i had terrible scar tissue around L5 and he really had to dig in to dissect it. I do respect his opinion. he is the chief nsurg at a top orthopedic hospital, but unfortunately i have had some poor outcomes from people being wrong in the past, so i may be a bit jaded.
As far as the back pain-its inconsistently better in the past couple of days. The surgical pain is better but i find that changing positions (especially from laying down-sitting-standing) is very painful in the lower back area. Also, i become very stiff when laying down and trying to change positions in bed is very painful and challenging-this is how things were pre surgery, as well. And depending on which side of by body i am laying on, my leg symptoms change-if that makes any sense
I do find with more activity i am getting more nerve pain both in L5-S1 (which i expect) but also in this new distribution. For example, last night after sitting/standing at my son’s hockey game my leg felt more tired and heavy to pick up from the floor when walking, my knee felt very weak and on the drive home i had nerve pain all the way down to the inside of my ankle. Below are the most recent reports for standing xrays and MRI. Thanks for your help!
***Final Report***
EXAM#: 2511655
PROCEDURE: MR 0109 MRI SPINE-LUMBAR Aug 21 2020 3:10PM
CLINICAL INDICATION: post op pain
CLINICAL INDICATION: post op pain
TECHNIQUE: MR imaging of the lumbar spine was performed without contrast
in multiple planes with multiple sequences according to department
protocol.
COMPARISON: MRI from July 28, 2020
FINDINGS:
There are postsurgical changes related to anterior and posterior fusion
at L5-S1, with right-sided laminectomy and facetectomy changes.
Alignment and Curvature: Normal.
Conus and Cauda Equina: The conus terminates at the L1-L2 level and
demonstrates no signal abnormality. Cauda equina appears unremarkable.
Vertebral Body Heights: Normal.
Marrow Signal: There is persistent mild marrow edema at the L5-S1
endplates, likely reflecting Modic 1 changes..
Discs: Interbody spacer at L5-S1. Remaining discs are well preserved..
There is no significant canal or foraminal narrowing inferiorly through
L4-L5.
L5-S1: There is postsurgical fluid along the surgical tract into the disc
space, which superiorly displaces the right L5 nerve root within the
foramen, for example series 3 image 11. There is persistent T1
hypointense material in the epidural space extending along the right S1
descending nerve root, likely reflecting scar tissue. The is no
significant bony narrowing of the foramina. The canal is patent.
There are postsurgical changes in the paraspinal soft tissues. There is
small amount of postsurgical fluid in the surgical bed.
The imaged upper sacrum and upper iliac bones appear unremarkable.
Miscellaneous Findings: None.
IMPRESSION:
Lumbar postoperative changes at L5-S1 as described, with postoperative
fluid within the surgical bed and along the tract on the right side.***Final Report***
EXAM#: 2507247
PROCEDURE: RAD 0137 XR LUMBAR SPINE 2-3 VIEWS Aug 7 2020 11:55AM
CLINICAL INDICATION: CHECK HARDWARE
EXAM: XR LUMBAR SPINE 2-3 VIEWS
COMPARISON: 02/17/2020. Correlation with MRI 7/28/2020 –
INDICATION: CHECK HARDWARE
FINDINGS: Upright AP and lateral views of the lumbar spine show
transitional anatomy at the thoracolumbar junction, with a lumbar-type
left transverse process and rudimentary right rib at what is considered
L1. There is a mild rightward curvature at L4-5. There is minor stepwise
grade 1 retrolisthesis from L1 to L4, and slight anterolisthesis of L4 on
L5. There are bilateral pedicle screws, posterior paraspinal rods, and an
interbody cage at L5-S1, and right-sided laminectomy defects.
IMPRESSION:
Laminectomy and interbody fusion L5-S1 with fixation hardware in place.
NUMBER OF IMAGES: 2#33058Topic: Cervical pseudoarthrosis in forum NECK PAIN |Hi Dr Corenman,
In 2017, I started having headaches and was diagnosed with occipital neuralgia. I then began having pretty severe muscle spasms in my neck and shoulder. I was treated with muscle relaxers without relief. I was sent to pain management for occipital nerve blocks and trigger point injections. I started having trouble raising my arms and noticed pain in my axillary area and on top of my shoulder on the right side. An X-ray showed DDD. I was unable to have an MRI as I have a Medical device for my bladder. I was sent to physical therapy. PT and dry needling did not help and I progressed to numbness and tingling into my fingers. I had an epidural injection that did not help. I also had an RFA that seemed to have made things worse.I noticed at work that I was having trouble with fine dexterity of my hands. I began dropping ink pens. I was finally sent to a neurosurgeon for an opinion at my pcp advice. I was found to have cervical kyphosis at C5 that appeared to cause cervical cord compression according to a flexion/extension x-ray. A CT myelogram was ordered but I was scheduled for surgery as well. CT myelogram showed cord compression at C5. I had an ACDF surgery on C4-C6 in Sept of 2018 (just 2 weeks after my appointment with the surgeon).
Right after surgery, I was in a lot of pain and I had a right foot drop. My legs were weak and I had to use a walker. The surgeon could not find a cause for this and actually told me to get rid of the walker and start walking. I was readmitted 3 weeks post op for pain control as well. Since then, I have undergone physical therapy totaling about 8 months, epidural injections, pain management, and about 4 opinions. Because I could not get an mri, I had been diagnosed with anything from functional neurological disorder to now progressive cervical myelopathy with pseudoarthrosis. The most recent diagnosis came from the Cleveland clinic. I am 42 years old and in decent health. I am extremely weak if I walk for anything over 15-20 min. I still have weak arms and sharp pain in my shoulder and down my arm. I have trouble picking up small objects. I walk with a cane. I lose my balance at times.
CT myelogram showed pseudoarthrosis, congenital cervical spinal stenosis, and cord compression at C5-C7. 8/31/19
In office X-ray showed a cervical kyphosis on the level below the ACDF. 8/2019.
I underwent a surgery to exchange my medical device to an mri compatible one.
The mri of my neck showed cord compression and foraminal compression at C6-C7. 8/28/20
1. My question is what would you suggest would be the best way to treat my cervical spine? The Cleveland clinic has offered to do a posterior cervical fusion. Another surgeon locally, has offered to do an ACDF on the level below as well as a posterior fusion on C4-C7.
2. Also, I realize that after surgery I will still have symptoms, but what is the likelihood that if I work with PT, I will be able gain strength and mobility back to have a normal life?
3. What is the likelihood that this will keep happening to levels below where I’ve had surgery?Thank you for your patience, it’s been a long road!
#33044Topic: Nerve sensations 11 months after fusion in forum BACK PAIN |I had a tlif surgery last november, prior to the surgery i had terrible left leg pain right before the surgery they gave me cortisone injection. right after that my right leg started feeling different. i made my surgeon aware of this. right after the actual surgery i had 0 leg pain, in either leg. about 2 weeks out from surgery i started to feel a vibrating/tingling, burning, dull/sharp sensation in my right leg, on front and back of my thigh, and bottom of foot, that seemed to never go away and would only subside when i stood still after moving continuously. i made my surgeon aware of this sensation too, he said it was probably nerves healing. now 11 months later i still feel the same feeling maybe a little more defiant now, still only in the right leg, nothing in the left. i went in for just a post op visit yesterday and he took xrays and once again said it’s probably nerves healing. is it possible that my right leg is feeling this way from nerve healing for 11 months straight, everyday. my left leg still has not given any pain or tingling since i got the surgery and that was the leg that made life horrible for me. i’m starting to feel as if the sensation in my right leg is intensifying with time and it’s starting to worry me. can you possibly tell me about how nerves heal? and is it possible i essentially traded one leg pain for another? or is it there a possibility these feelings are actually normal for this long of a period during healing? i should also add that my fusion is fully healed in terms of actual fusion itself. i don’t think i’ve lost any strength and i don’t have numbness in my legs.
#33037 In reply to: Bizarre leg pain after 360 fusion |Your notation “There is also fairly strong postcontrast enhancement and high precontrast T2-weighted signal intensity around the disc space implant at L5-S1“ is most likely from the surgical implantation and nothing else but with continued pain, an unlikely infection should be ruled out by obtaining labs.
This notation “At L5-S1, there is fairly prominent right anterior epidural enhancing scar tissue which extends around the right S1 nerve sleeve and into the new right hemilaminectomy defect. Again, however, there is no epidural fluid collection. The right S1 nerve sleeve is not significantly displaced or effaced” indicates still some inflammation around the right S1 nerve root. The good news it that the root is not displaced (compressed) and you don’t have a seroma so you don’t have to worry about compression.
The root however is aggravated and this might take about 3 months to calm down. Normally, oral steroids are helpful so I don’t understand why you gained no relief. With negative labs (no infection), a TFESI (transforaminal epidural steroid injection) can be helpful.
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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