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Dr. Corenman
I thought it best to continue to use my original thread for this concern. I have still been dealing with this intense low back pain. Due to this i cannot put complete weight on my left side. The pain does keep me from doing certain activities and my regular work (I have desk position as a mortgage originator) My meetings with clients can sometimes be 2 hours or longer. So i feel odd standing up while they are sitting in front of me. I know the MD worked as i had a little while of no pain and feeling quite normal through the holidays. To keep it short here is the timeline and where i am now.
Jan 2020-Dr.appt.- explained low back pain and shifting feeling/ was given steroid shot in the office.
Feb 2020- contacted dr.to see if chiropractor could help me with the low back pain. No was the answer and PT was ordered as well as oral steroids. (aquatic PT)
Feb 2020- Dr. appt. went over the extreme low back pain again… received oral steroid pack and 800mg Ibuprofen.
March 2020- Dr. Appt. Still suffering with this low back pain and feeling of movement. Received 2 steroid shots (one on each side) He said it sounded like Facet joint inflammation. I felt fantastic for the rest of that day! but pain was back the next afternoon. (still doing PT)
May 2020- Dr. Appt- i am fed up with this pain.. so they took Xrays in the office. He said i have options..1 being a fusion as there is movement, something about no cushion?? or continue to treat with steroids ( I hate the oral pills!!) New MRI has been ordered and waiting for appt. I do not have any significant leg pain.. my left is still weaker and there is a pulling feeling down the inside of it, but it is secondary to this low back ache. I cannot do much of anything and i want it gone. Could a fusion resolve this pain? Its another surgery i really do not want but willing to if it will take care of it for good. Now what I am scared to mention is something new and i have not even told my husband in case it is just my nerves (anxious nerves, not literal ) For the past 4 to 5 weeks my left arm has been aching extremely bad. i have never felt this pain before, i can take the 800mg ibuprofen and the Robaxin( I take the Robaxin 750mg at night) and it will let up.but.. what scared me is earlier today the ache was accompanied with the loss of the use of my arm (lifting it) and my index finger and thumb were numb. I got the feeling back, arm is still weak?? Can what i am experiencing in my low back have an affect on my arm on the same side? I have no idea what that could be? I hate to call with another ailment! or if it could just be the stress and lack of rest i am getting with my back. I am tired! Time is just flying by, although at least i am not missing out on too much right now with the virus.. otherwise i would be missing bowling, ziplining.. all of the things me and my family love to do during the summer months! one being in your area (rafting Royal Gorge) which is a blast!! Not sure if i can ever do those things again the way i feel now. I hope all is well for you and thank you for your time that you give each one that writes to you.

Hello Dr. Corenman,

I was finally able to get a 2nd opinion within my HMO. Though not the ideal situation, my consult was a telemedicine appointment (so no physical exam). The new surgeon ordered a SNRB on C7 (Yay and thank you for recommending it back in the Fall!). I had that two weeks ago. The pre-procedure pain was a 5. With the Spurling Maneuver, it went up to a 7 before the procedure. Afterwards, pain was a 2 and Spurling maneuver did not increase my pain. I forgot how nice it was to have little pain. Unfortunately, the pain started coming back at about 2.5 to 3 hours post-procedure and was totally back around 4 hours post-procedure. I was hoping that the steroid would help, but they have not made a difference.

After my fall at the end of January, I started having low back problems (pain and left leg weakness). At L3/L4 level, the thecal space is less than 6 mm (apparently there is a herniated disc compressing from front, a bone spur, thickened flaval ligament and a gas-filled synovial cyst). I just had a nerve study and it shows that I have L4 compression, which explains the left leg weakness.

Unfortunately, I have to wait until late July to have a face-to-face appointment with new surgeon. He mentioned surgery in my telemed visit. He said low back was an easy surgical fix and felt that waiting until August for surgery would not have a detrimental effect on nerve recovery. He also said that neck was more complicated and we needed to have a pro/con discussion. Furthermore, he agreed with neuroradiologist and said that January CT showed a little more fusion at C6/7 but I was not fully fused and there was still movement across spinous processes (> 4mm). Finally, this surgeon said that since my symptoms have been going on since August, my tricep and hand weaknesses might not fully recover and I might have permanent nerve damage from waiting.

My question for you is this:
It is now 20 months post-op from ACDF. There is a small bone spur that was seen on the left C7 level in the left oblique image of the CT myelogram done at 11-months post op, but CT report denotes it as only “mild bony foramenal encroachment”. CT at 16-months post-op showed a little more fusion than CT at 12-months post op, but still mostly not fused. 18-months post-op flex/extension xray showed same amount of movement at spinous process at C6/7 as flex/extension xray taken at 11-months post op. EMG in October showed “chronic inactive C7 Radiculopathy”. SNRB test indicated that left C7 was pain generator. Pain was a 0 and there was no noticeable weakness from 6-months post op to 11-months post op. Given that info, would you recommend more testing (and if so, what)? Would you recommend waiting it out until the 2-year mark to see if I might achieve full fusion? Or would you recommend surgery (and if so, what surgery)?

Hello again Doctor! I would like to paste below the MRI results of my Dec 2019 that led to my ACDF Jan 2020 as your mentioned something about the curvature of my spine. My question is if you often see where a cervical curve could also be part of a thoracic curve?
There is stable reversal of the normal cervical lordosis. There is stepwise anterolisthesis of C3 on C4 and C4 on C5. There is slight retrolisthesis of C5 on C6 and C6 on C7. There are degenerative marrow changes in the endplates at the C5-6 and C6-7
levels. No suspicious osseous lesions are present. The facet joints are normally aligned.

The cervical spinal cord is of normal caliber and signal intensity. The visualized aspects of the posterior fossa are normal.

On the axial images, at C2-C3, there are right-sided facet degenerative changes. There is no spinal canal stenosis. There is moderate severity right foraminal stenosis.

At C3-C4, there is a posterior discussed effect complex. There are bilateral facet degenerative changes. There is mild spinal canal stenosis. There is severe left and moderate severity right foraminal stenosis.

At C4-C5, there are right-sided facet and uncovertebral joint degenerative changes. There is mild spinal canal stenosis. There is severe right foraminal stenosis.

At C5-C6, there is a posterior disc osteophyte complex. There are bilateral uncovertebral joint and facet degenerative changes. There is moderate severity spinal canal and bilateral foraminal stenosis.

At C6-C7, there is moderate severity spinal canal stenosis. There are mild bilateral uncovertebral joint degenerative changes. There is moderate severity bilateral foraminal stenosis.

At C7-T1, there is no spinal canal or foraminal stenosis.

There are no suspicious findings in the cervical soft tissues