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#31958 In reply to: too young for fusion, need an alternative |
You note that “Oct of 2019 I started to experience debilitating sciatica of my right leg with numb toes and leg weakness, but zero back pain. An xray showed less than grade 1 spondylolisthesis of L4 over L5 and a herniated disc was suspected”.
You then note “MRI the 1st week of Jan 2020 my discs look great, but I have a large synovial cyst on the ligamentum flavum that is impinging my L5 nerve root”.
Then finally you note “The neuro said the cyst has to be surgically removed and in doing so he will have to remove a piece of bone that will weaken my otherwise healthy spine. He is recommending a fusion to stabilize the spondy and says if we do not stop that abnormal movement the cyst will likely return and the spondy will progress”.
One of the important factors is how stable (or unstable) this degenerative spondylolithesis really is. Stability is judged by flexion/extension X-rays and you don’t mention those. There are many degenerative spondylolitheses that produce ganglion (or synovial) cysts that are compressive to the nerve root. If your disc looks good and the spondylo level is stable on flexion/extension X-rays, you could have a simple cyst excision with the understanding that this level can go on eventually to need a fusion.
I do not endorse the Coflex device as this device will eventually fail and does not address the problem of cyst compression of the nerve root.
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.#31950 In reply to: C5/c6 neck fusion surgery |A CT scan is better to look for the fusion status of your ACDF. An MRI is not as good for fusion status but is much better for nerve root compression disorders. For a failed surgery, both tests combined are more helpful along 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.#31932 In reply to: Cervical MRI Result – PT for Severe Foraminal Stenosis? |Your complaints are “Neck pain is 60% and right shoulder blade pain is 40%….weakness in the right shoulder and forearm along with a new general feeling of clumsiness in both arms”. You hobby is to “ride and race mountain bikes as a hobby, and have been training hard this off-season”. You obviously want to avoid surgery.
Your MRI report notes “C5-C6…small right paracentral disc protrusion/herniation with minor cord flattening without spinal canal stenosis…moderate to severe right foraminal stenosis…C6-C7… moderate to severe right and mild to moderate left foraminal stenosis from uncinate hypertrophy and facet arthropathy…C7-T1…severe right foraminal stenosis from uncinate hypertrophy and facet arthropathy”.
So your “general feeling of clumsiness in both arms” apparently is not from cord compression due to spinal stenosis so that is a major plus as mountain biking does put your neck at risk. You do have severe right foraminal compression at C5-T1 on the right which would correlate with your neck and arm pain along with the feeling of shoulder and arm weakness. See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/.
The already congested (narrowed) right foramen become more narrowed with extension (backwards bending). Unfortunately, mountain biking causes neck extension due to the need to bend your torso forward to reach the handlebars. You can modify the stem making it shorter and taller to reduce the need to extend your head but this will make your balance especially for climbing altered.
You could try selective nerve root blocks (SNRB-see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/) to reduce the inflammation and pain but these won’t reduce the compression pressure of the nerve roots. There is some risk living with these compressions as if you do have motor weakness from root compression, sometimes even after surgical decompression, the root won’t 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.#31928 In reply to: New back/leg pain |Hello Dr.Corenman,
I reviewed my MRI from January 2 with my surgeon’s PA. He said he has never seen deterioration as bad as in my spine at the L4-5 level. He said the fusion from 2 years ago looks wonderful but that the other vertebrae have deteriorated greatly. He said for the upcoming appointment for the injection, I will be receiving 2 instead of just 1. He then proceeded to tell me that I cannot go 4-6 longer without another fusion. We will be scheduling that second surgery at the end of this month.
I have my medical chart and found notes from a previous CT (dated April 2017 and my fusion was in Sept 2017) that states….. Intervertebral discs are mildly narrowed and desiccated throughout the lumbar spine. The conus ends normally at the L2 level. The conus medullaris is of normal morphology and signal intensity. Cauda equina are also of normal signal intensity and morphology with the exception of crowding due to canal stenosis as described in further detail below. T12-L1: Mild facet arthropathy, without significant narrowing. L1-L2: Mild facet arthropathy, without significant narrowing. L2-L3: Moderate facet arthropathy, without significant narrowing. L3-L4: Moderate facet arthropathy, without significant narrowing. L4-L5: Bulging annulus eccentric towards the left with moderate facet arthropathy/ligamentum flava thickening, which creates mild canal stenosis, mild right foraminal narrowing, and moderate left foraminal narrowing. L5-S1: Bulging annulus with superimposed central extrusion which migrates 1 cm below the level of the disc, and moderate facet arthropathy/ligamentum flava thickening. Constellation of findings together with above described retrolisthesis creates severe canal stenosis with pronounced crowding of the cauda equina, posterior displacement of both descending S1 nerve roots, and moderate foraminal narrowing. So now, my question…. Reading this regarding the L4-L5 and hearing how badly my back has deteriorated regarding L4-L5, would there be a significant reason why that area would not have been taken care of at the same time as the fusion of my L5-S1? I’m quite confused. It sounds to me as if that whole section needed to be fused.#31925Topic: Cervical MRI Result – PT for Severe Foraminal Stenosis? in forum NECK PAIN |Dr. Corenman,
I found your website while researching my latest MRI results and I’m amazed at the time and effort you take to respond to questions in this forum. I first noticed neck pain between the shoulder blades that would run down my right shoulder blade accompanied by right arm numbness in 2008. I recall my first MRI showing mild stenosis and a round of PT gave me acceptable improvement. Symptoms gradually returned and I completed another round of PT in 2014 which didn’t provide much relief.
Neck and shoulder pain has increased in both frequency and intensity in the last 4-6 months. Neck pain is 60% and right shoulder blade pain is 40%. Also experiencing weakness in the right shoulder and forearm along with a new general feeling of clumsiness in both arms. My GP sent me off for a new MRI and EMG consult. MRI results below and I’m hopeful that another round of PT will provide additional relief? Trying to avoid surgery if possible because I ride and race mountain bikes as a hobby, and have been training hard this off-season and really looking forward to a strong 2020.
General: There is minor rotatory levoconvex scoliosis and straightening of cervical lordosis with slight retrolisthesis of C3 over C4. Vertebral body height is adequately maintained. There is mild height loss to the C5-6 intervertebral disc and little height loss to the C6-7, C7-T1 and T1-2 intervertebral discs.
Bone marrow signal/fracture: No evidence of pathologic marrow infiltration. No evidence of prior fracture.Craniocervical junction: Craniocervical junction is normal.Cord: The visualized cord is within normal limits of signal intensity but is compressed as outlined below.
The paraspinal soft tissues are within normal limits.
C2-C3: Unremarkable.
C3-C4: There is minor pseudo disc bulging and small left paracentral disc protrusion/herniation with minor cord flattening and borderline spinal canal stenosis. There is mild left foraminal stenosis from uncinate hypertrophy and facet arthropathy. The right neural foramen is adequately maintained.
C4-C5: There is subtle disc bulging without sniffing spinal canal or foraminal stenosis.
C5-C6: There is a small right paracentral disc protrusion/herniation with minor cord flattening without spinal canal stenosis. There is moderate to severe right foraminal stenosis from uncinate hypertrophy and facet arthropathy. The left neural foramen is adequately maintained.
C6-C7: There is mild disc bulging without spinal canal stenosis. There is moderate to severe right and mild to moderate left foraminal stenosis from uncinate hypertrophy and facet arthropathy.
C7-T1: There is mild disc bulging narrowing the ventral epidural space without significant spinal canal stenosis. There is severe right foraminal stenosis from uncinate hypertrophy and facet arthropathy and there is mild left foraminal stenosis from uncinate hypertrophy.Sagittal imaging demonstrates mild disc bulging and small central disc protrusion/herniation at T1-2 with mild spinal canal stenosis.
IMPRESSION: Minor dextroconvex scoliosis, nonspecific straightening of cervical lordosis and slight retrolisthesis of C3 over over C4 associated multilevel spondylosis most significantly at C3-4, C5-6 and T1-2.C3-4 level, disc protrusion/herniation with minor cord impingement and borderline spinal canal stenosis.C5-6 level, right-sided disc protrusion/herniation with minor cord impingement.T1-2 level, disc protrusion/herniation with mild spinal canal stenosis.
Multilevel acquired foraminal stenosis most significantly moderate to severe right foraminal stenosis at C5-6 and C6-7.
#31909 In reply to: 8 Months Post Op Micordisectomy L5/S1 |Dr. Corenman,
Thank you for your reply. My surgeon has prescribed a round (12 days) of oral steroids (30mg/20/10/5, 3 day ea). The first few doses completely eliminated the symptoms. Now on the mild dose (10 mg) the symptoms have returned with much less intensity. Will wait to see the results when completed but I intend to ask about an epi-injection to stamp out the inflammation.
Thank you again,
Doug
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