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#35324 In reply to: I’m accepting this surgery at neurosurgery |
I had an add on extension to the S1-T10 taking it up to T4 18 months ago. No I have not had diagnostic testing for pain such as ablation but I did have short term success with trigger point injections at T4 but would wear off quickly. The loose screws at C7 were a bonus find on tspine imaging. Surgeon said if it’s not causing me trouble swallowing we will watch and wait. This is the first time I heard non union at that C level. I believe the compression fracture which wedged within 6 weeks of the extension will never heal on its own without surgery. Then the kyphosis issue.
#35320Topic: I’m accepting this surgery at neurosurgery in forum BACK PAIN |Hello Doctor. This is the plan I agreed to as 18 months of constant pain is ruining my quality of life. I sure hope it ends the pain at T4 both back and front of my chest. Do you see alot of cases like mine?
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CHIEF COMPLAINT:
Mid back and neck pain.HISTORY OF PRESENT ILLNESS:
Patient is a 68-year-old female who has undergone multiple surgeries in
the past. She underwent ACDF as well as a thoracolumbar fusion at an
outside institution. She was found to have some adjacent level disease
and kyphosis and underwent extension into her midthoracic spine with me
approximately a year and a half ago. She did well but suffered a
compression fracture at her upper instrumented vertebrae with some
midthoracic back pain. She has also a backed out screw at C7 with
pseudoarthrosis at C6-7. She has failed conservative management with
physical therapy and trigger point injections. She is not interested in
ablation at this time.REVIEW OF SYSTEMS:
See HPI and prior notes, otherwise negative.PHYSICAL EXAM:
Unable to perform.RESULTS REVIEWED:
Patient’s CT was again reviewed that shows loosening of her T4 screws,
as well as the backed out C7 ACDF screw.ASSESSMENT AND PLAN:
Patient is a 68-year-old female with a T4 fracture with loosening of her
screws as well as a pseudoarthrosis at C6-7. We again discussed
surgical and nonsurgical options. Not sure if surgery will fix all of
her pain issues but I think she would be a candidate for an extension of
her fusion to her mid cervical spine. This would likely be a C5-T4
instrumentation and fusion. We discussed risks, benefits, and
alternatives of surgery. She will need anesthesia clearance prior to
surgery.This was a telephone encounter. I spent over 15 minutes with the patient, more that half was spent counseling and coordinating care.
#35300 In reply to: Lumbar spine mri report |To determine the type of surgery would require my evaluating the lumbar X-rays including flexion/extension and the MRI. The procedure could be as simple as a 2 level decompression to a lumbar decompression and fusion (TLIF). What level and side was the attempted injection?
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.#35284 In reply to: ligamentum buckling or hypertrophy in cervical spine |CSM, such as increased signal intensity of the spinal cord on T2-weighted imaging, typically occur late in the course of the disease and are predictive of poor neurological outcome even with decompression surgery.
so it is important to know you needed to know before myelopathy appears to do early surgery.
you don’t think this ?.Meni
Thank you, Dr. Corenman, your expertise has helped me better understand. I have pain centralized in my lower area of lumbar with pains across top of both legs, Focus has been more on the sciatica pain. Injections that I had received did help for the traveling pain down the legs. Heel to toe walk can not do, I still work at balance and did get a massage table to excercise at home. I do feel that therapy aggravated with the tilts, but the leg stretches helped reduce the leg spasms with less tension on my spine. Are there good excercises at this level that would be better? I do know now that when you go to physical therapy, all seems to be the same therapy for lumbar. When it came to neck therapy and discussion of vertigo, seemed hesitant and gave me excercises I could do at home to help. Would I be safe for neck therapy are would it be possible to cause harm? This is a natural process and I had already come to terms of not having surgery, but taking better care of myself by eating right and focusing more on posture and working with levels of how far I can walk. The only true regret I have was being given the choice of which one was to be addressed first. When a person has painful areas of concern, both were not accessed to determine what the best approach would be first. This is 8 months in now, not including time before the realization break down. I again thank you.
Thank you, seemed somewhat manageable over the years, I had previously had chiropractic adjustments a few years back for spurs in neck and did get an adjustment late last year. I had bought tens and even got a cervical collar to wear at times. (not at work). I work at correcting my head position due to tilting upward and out abit to bring it back to some alignment. I sleep with a heating wrap for shoulders neck and arms and legs propped up. I wanted to step down latter part of the year and was asked to hang in there and some changes would be made at work for me, made it thru, no help but at a cost. Employees kept telling me I could’nt keep doing what I was doing. always fast paced. Last time I had to leave I hurt so bad and bent over that one of the ladies called home to let my son know I was not doing well. Got in the door and literally got sick on top the pain. 2nd worst flair up stayed in bed and went back to Dr. 3 days later. From 1st go around knew I would have to get thru it anyway. They are kind enough to hold my position open, appears no one wants it. I am thankful to you for taking the time. I had left out the on/off pelvic pain, crease of legs and the inner thigh pain, he did say that was from my back. I can not lift, push and shove no more, I pay for it when I do. looking up, bending down and laying back always thankful not having the full blown vertigo. I expected to go back to work and now in process of possibly getting disability. My family Dr. had already said that a while back. Would a back brace help? I did wear one for 6 months years ago after surgery. Personally I feel a neck brace from shoulders up would be beneficial. Thank you so much and wish you continued success. we need more Dr’s like yourself, I have visited your site many times, but never reached out. I appreciate you very much. Take care.
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