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#31817 In reply to: Microdiscectomy L3-L4 |
Everything you replied is exactly what I am experiencing. The original surgeon has blatantly refused to even communicate with me on ANYTHING. I do believe in some fashion there may be surgical error & this could be potentially why he has refused to give me any advice or answers.
MRI—-
I am pending a new one from the new surgeon.EMG —
Muscle bulk is reduced in the left leg with mild quadriceps, tibialis anterior and gastrocnemius atrophy. Fasciculations and abnormal movements are absent. There is no pronator drift. Tone is normal. Neck extensors were 5/5 and flexors were 5/5. Upper extremity power, when graded out of 5, revealed:Lower extremity strength, when reported the same way, showed:
Right
Lefthip flexion
5
4hip extension
5
4hip abduction
5
4-knee flexion
5
4-knee extension
5
3-ankle dorsiflexion
5
0plantar flexion
5
2foot inversion
5
0foot eversion
5
0toe extension
5
0toe flexion
5
1MUSCLE STRETCH REFLEXES:
Comparing right to left and utilizing the NINDS scale (0 = absent; 1+ = less than normal, including a trace response or a response brought out only by reinforcement; 2+ = lower half of normal range, +3 upper half of normal range; 4+ = enhanced, more than normal, includes clonus if present) reflexes are:Biceps brachii
2+/2+Brachioradialis
2+/2+Triceps
2+/2+Long finger flexors
present/presentQuadriceps
3+/2+Semitendinosus/
Semimembranosus
present/absentGastrocnemius/ soleus
2+/2+
slightly lower on the leftMild spread in synergistic muscle groups. Vendorovich signs are present, bilaterally. Mild crossed adduction in the lower extremities. Plantar responses are mute, bilaterally. Clonus is absent.
SENSORY: Left L5 >> L4/3 sensory loss. Otherwise normal and symmetric perception of pinprick, vibration. Romberg’s sign absent.
COORDINATION/GAIT: Unable to rise from a chair without using arms.
#31797 In reply to: Post L5,S1 discectomy back and left leg pain |You had a seroma, a fluid collection that occasionally occurs after surgery. This collection can compress the nerve and act like a recurrent disc herniation. You were followed with serial MRIs which is appropriate and indicated reduction of the size of the seroma over time which is to be expected.
Unfortunately, you then had return of pain of the same type and intensity as before surgery. This could indicate return of the seroma (less likely) but could also indicate a recurrent herniation. It would be OK to consider an oral steroid for now but consideration of a new MRI with gadolinium to look for a recurrent herniation is also something to think about. If you have new motor weakness or worsening of previous existing motor weakness (found on examination), the MRI is imperative.
Dr. Corenman
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.#31769 In reply to: 12 Week post-op meeting for C5-6 ACDF |To me the double crush wrist-neck hypothesis made sense because I was first symptomatic 3 years ago in my wrists, I assumed from intensive computer use on job and at home. That then migrated up into my arms while working a farm job (and also sustained computer use.) And finally settled in neck as well.
When I said “pain going from my neck down into my hands” I didn’t mean it always goes in that direction. It can also start in my hands/wrist/forearms and travel up. It seems to go both ways.
I’m a bit daunted by the number of tests possible for something like this. The nerve conductivity tests seem only to check one nerve pathway (median nerve at wrist is what I have ordered, I believe.) What about ulnar at wrist, cubital, orbital, etc?
If this is an issue of double crush/multiple nerve impingements, I want to catch that before going into another surgery (partially because if I do need carpal tunnel release, I could have done that at the same time as my ACDF instead of now looking at waiting for another 2-3 surgeries to happen [both hands separately and possibly 2nd ACDF on adjacent level] before getting relief and being able to work/function.) Any advice on best route of diagnostic testing for nerve impingements? My surgeon says he trusts EMG for wrists but doesnt put much stock in it for neck because the muscles are so dense and so much is going on there.
#31758 In reply to: physiotherapy that works? |Thanks very much for your reply! Two pieces of information I’ve not heard before that I find extremely useful, are that there are flare ups (so if you have a bad day, not the end of the world, necessarily) and that flexion and extension might help or hurt depending on your specific case. This is reassuring, and also now I know to pay close attention to effects of flexion vs extension movements.
Much appreciated, thanks again! And have a great holiday season.
AL
#31741 In reply to: physiotherapy that works? |The keys for rehabilitation with pain generated from an HNP would be to reduce or avoid BLT (bend load twist), (generally) work on extension exercises and Pilates work. You can use non-steroidals if they work and you can tolerate them. Expect some mild flair-ups on occasion. Include cardiovascular exercise as a major part of your rehabilitation.
There is no established exercise pattern as it depends upon where the herniation is located in the spinal canal to design a program. Some herniations aggravate the root with flexion and some with extension.
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.#31734 In reply to: Comparative Studies of Decompression with/without Fusion |If your spondylolisthesis does not demonstrate instability as found on flexion/extension X-rays and has not advanced in slip (let’s say from 3mm slip in 2012 to 5mm slip now), you could consider another decompression of that level. The caveat is that these cysts tend to be adhesive and stick to the nerve roots and dura making a second decompression more difficult. There are plenty of papers in the literature that discuss this but the insurance company should follow the lead of the surgeon and allow leeway for you and the surgeon to make that decision.
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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