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in reply to: Maxillary/Mandibular vs Skeletal Osseointegration #12084
Thanks for the quick reply, Dr. Corenman..
Is there a series of tests or labs that could identify or perhaps suggest a metabolic disorder of the bone? If so, I’d appreciate any suggestions … Might be worth it to investigate this, just for my peace of mind. These surgeries are getting a little old, especially without an explanation to precede them. I have a hard time believing that all 28 orthopedic / joint / spine-related procedures have been completely coincidental, or just the result of being a little rough on my body years ago.
The majority of the non-spine surgeries have been related to tears in the rotator cuffs of both shoulders (including a Type IIa acromion and SLAP II, which was just repaired this past Weds); tears and separations of the lateral epicondyles of both elbows; deteriorated cartilage and tears in the knee; and / or separated bone fragments & osteophytes that eventually needed removal. Many of these anomalies resulted from NO identifiable trauma or accident beyond age 35 … I just wake up (literally) in the morning with a torn tendon somewhere. And, to my knowledge, I’m not sleepwalking and scouring the woods near our home like Rambo.
You may be able to lend an opinion based on this: I was adopted as an infant (4 months of age) from a foster home. During my first 4 months of life, I was mostly fed whole milk … no supplements or other nutritional / dietary augmentation. Once adopted, my pediatrician identified me as a “milk baby” (a term that I’m not sure is still used in pediatric parlance) … To this day, my mom believes this may’ve had something to do with this bone mystery. Your thoughts?
Again, thank you.
SW, N.C.
in reply to: What does this mean? #10245EW,
I happened to see your post regarding your current situation, and wanted to offer my two cents’ worth as a spine patient. I completely “get” your frustration, and have been at exactly the same juncture as you’re experiencing presently.
From 15 years of age until age 25, I powerlifted, did some non-professional bodybuilding, ran, played sports, and was in excellent physical condition. Although I’m female, I lifted considerable amounts of weight (405 deadlift, 195 bench), which in hindsight, likely contributed in part to my situation now.
At age 18, I ruptured a disk in my lumbar spine (L4-5) after sneezing one morning. I wish the whole thing could’ve occurred while saving kittens from a burning building, or from fending off an entire battalion of enemies in combat with my bare hands, but in the end, it was a simple sneeze, and hurt like h***. I waited 7 months to see a neurosurgeon, who yelled at me for 30 minutes because of the time lapse. I was 18, however, and had no clue as to why this guy was so angry with me. He had me in the operating room within a few days, and I underwent a laminectomy and diskectomy with no complications. He warned me, though, that 18 year old teenagers don’t usually rupture disks, and that I should prepare for this to happen again.
While serving in law enforcement, I engaged in a fight with a suspect whose entire 300lbs of bodyweight landed on top of me. When the adrenaline finally wore off the next morning, I felt the same tell-tale symptoms of ruptured disk #1. I had yet another surgery on two more ruptures (age 23), then finally had to undergo an L-3 to S1 fusion with plates in 1991 (age 26). That ended my law enforcement career, which affected me on 100 different levels that I won’t bore you with here. Suffice it to say I was mad at the world.
Since 1991, I’ve had 10 additional spine surgeries, including 5 on my cervical spine (C2 – T2), and a complete reconstruction of L-2 to S1. I just underwent bilateral fusions of my SI Joints in 2012 and 2013, which were needed after years of displaced kinetic energy affecting my pelvic/sacral joint spaces, and was diagnosed with severe bilateral sacroiliac joint dysfunction (SIJD&D). Although I never consult forums (such as this one) for advice on my health (or anything else), Dr. Corenman provided me with some great pre-operative information, including results of research studies on SI joint procedures and causes of the condition, possible complications from surgery, benefits, and so forth.
I can honestly tell you that while some would see my situation (and yours) as a “no brainer”, it’s never easy when it’s YOUR spine, and YOUR life. Yet, I can attest to the fact that had I not had these procedures, I’d likely be wheelchair-bound…. or, worse, I suspect. For me, it simply filtered itself down to this: quality of life. In your current physical condition, every sudden move or surge of kinetic energy (like that rogue sneeze in 1982) is placing strain on your disk spaces, your L5-S1 region, and the neural foramina that are impinging on nerve roots. Your comment that, “I don’t hurt while I’m active, but I feel pain afterward” is COMPLETELY understandable. This happened (and still does) with me as well… cleaning house, shoveling snow, riding my Harley-Davidson… I’m somewhat OK while I’m in motion, but as soon as I stop, I’m beyond miserable. My lower spine simply can’t take the movement and loading required to accomplish those otherwise simple, everyday tasks. Your spine can be equated to an Army… when the weak parts start to give out, the ones above and below try to pick up the slack to keep going… this constant redistribution puts a ton of strain on the surrounding disk spaces, bony structure, and peripheral nerve outlets. Thus, you end up like me… with everything wearing out simply by process of elimination. Hence, the “degenerative” nature of many spine conditions.
Finally, my ego has likely taken the biggest hit of all. If you could X-ray a person’s self-image, mine would have dents and scars all over it… It’s a pride thing, especially with Type-A personalities that hate to admit weakness, failure, and a loss of autonomy. I’m also coming to the realization (ever so slowly) that I’ll be under pain management care for the rest of my life, and will occasionally have to choke out the question, “Can you help me do….?” to my friends and family. Your alternative, however, is what you should spend time thinking about right now. There are pros and cons to every situation, and when it comes to one’s health, those are extremely important to consider.
Just keep a positive attitude, and view your current situation (and your body’s current condition) as a temporary setback that can, and will be corrected by a competent surgeon and post-operative care team. Grab the bull by the horns now (as I had to do 13 times) and try to stay in front of it. Your body will respond according to your mental state, and you’ll be just fine if you keep your head in the right place. Just don’t make the mistake I did and assume you’re ready to lift the family car off the ground a week after surgery… give your back time to heal, and follow the surgeon’s directives to the letter. A fusion / bone graft in the spine takes at LEAST 6-8 months to firmly set (just like concrete around rebar). Don’t compromise the integrity of the fusion by being stubborn. Easier said than done.
Good luck. I hope you don’t mind that I tossed out my experiences as they directly relate to your current situation. Again, it’s temporary, and can be managed (and corrected). Go get ’em.
Take care.
in reply to: Dr. Corenman… Please Help #9914Hi Suzanne,
I saw your post to Dr. Corenman regarding the ER diagnosis of SI Joint Dysfunction, and wanted to briefly offer my personal experience with this disorder.
The Sacroiliac Joints themselves aren’t what we typically understand to be garden variety synovial / hinged joints. It’s simply the junction at which the upper pelvic crest (Ilium) meets the Sacrum (the large plate at the end of the lumbar spine). At most, and simply due to design, our SI joints will only shift or move about 4 degrees as opposed to something like an elbow — 130 degrees or more.
I was diagnosed in October 2012 with Severe Bilateral SI Joint Dysfunction, but as Dr. Corenman indicated, this isn’t a disorder that’s common, nor is it an easily diagnosed condition. Bulges, large “knots” or masses, and severe leg pain aren’t the usual warning signs and symptoms of SIJD. In fact, the SI joints aren’t “capable” of producing any kind of large lump under the skin, or knots within the overlying muscle tissue.
A confident, definitive, accurate diagnosis of SIJD is typically made by process of elimination, and by performing two series of diagnostic tests. The first tests require a physical examination conducted by an alert orthopedic surgeon who has more than just a basic knowledge base of SI Joint disorders.
First, there are 5 very specific manipulative maneuvers of the patient’s pelvic region that will indicate a somewhat conclusive diagnosis. Limited tolerance or outright intolerance of these 5 manipulative maneuvers will tell the physician that he or she is on the right track. Second, the orthopedic specialist will order an anesthetic injection (Lidocaine or similar solution) to be introduced directly into the joint(s)… if the patient experiences 90% or more relief within 10 minutes, that’s usually the diagnostic indicator.
The etiology of SIJD is still under study, however a few causative variables are its manifestation in women more so than men, age (over 40), with an extensive history of severe spine problems. The most significant origin of this condition lies in the patient’s history of spine surgeries.. individuals who’ve undergone several bi-level lumbar fusions are particularly at risk (at the time of my diagnosis, I had undergone 10 spine surgeries). When the spine has been rendered completely (more or less) immovable or static, the load we experience from walking, sneezing, straining, and lifting has to be dispersed somewhere — so, that kinetic energy and load is transferred downward and outward through the SI region. The SI junction is an extremely solid and durable region, however it can wear out just as any traditional joint space.
The pain “pattern” experienced with SI issues is different than that from discogenic or nerve compression pain. Mine began as severe spasm-like shocks across the upper buttock area (below the waist of my jeans, but above the glutes). I also had severe neurogenic claudication, meaning that walking and taking normal strides were extremely painful. Another tell-tale symptom is the patient’s inability to roll over in bed… I felt “locked up” and unable to roll onto my sides from a supine position. In standard x-ray films, my SI joints exhibited gas formation and significant deterioration. I had both SI joints fused between Oct. 2012 and Feb. 2013, yet this procedure is only undertaken as a last resort to preserve the patient’s quality of life. My surgeon was incredible, and had a high success rate in treating this condition through the iFuse MIS procedure.
I hope this information helps. Good luck to you.
S.W., NC
Since you’re asking no one in particular to address your question, I’ll add an observation. You’ve had an MRI scan, yet don’t have a dictated report of the radiologist’s impressions and primary interpretation of your images. You also haven’t had a follow-up appointment with your orthopedist to discuss the results, which may or may not coincide with your symptoms upon initial presentation to his office. It’s unlikely anyone here, or elsewhere, can begin to offer any explanation for why you’re experiencing intermittent back discomfort and leg pain. Here’s why…
The primary reason for the lack of responses to your question is that you’ve only provided your subjective, personal description of the pain (which could be muscle spasms, a herniated disk, nerve root compression, minor arthritis, a misguided rocket, a cyst impinging on a nerve, inflammation, or any number of countless possibilities). You mentioned your physician’s suggestion that this is possibly related to something “swallowing your disks” and causing episodes of irritation to the nerves. It’s unclear what you mean with regard to “swallowing”, but perhaps you misheard what he was referring to. To my knowledge, there’s not a back condition involving the swallowing of anything, so this is a case of mistranslation during your conversation with the doctor. Next, you stated that at first, “you didn’t realize it was something serious.” There’s no way of concluding this is anything serious, because you have no test results to confirm that. Back pain has been deemed the #1 chief complaint by patients seeking initial treatment by orthopedic specialists, and the #1 pain-related reason people use when they “call in sick” to work. In fact, recent research indicates that back pain costs our healthcare system billions each year, and is unfortunately one of the most commonly “faked” injuries in order to obtain narcotic pain medication. The causes of back pain are still not completely understood within the medical community, so many patients never know the exact cause of why their back hurts.
The majority of back pain cases do not result in paralysis, disability, life-long bouts with severe pain, the need to take drugs forever, or even significant future flare-ups. Plus, back pain doesn’t always equate with “serious.” Believe me, a stubborn or awkwardly located muscle strain, spasms, and inflammation from excessive or strenuous activity can hurt worse than back pain from a disk issue or nerve compression. A good example is a nasty high ankle sprain, which is probably a somewhat common injury seen in emergency rooms close in proximity to Dr. Corenman’s location (Vail). Beginners will set the boot binding too tightly, then when they fall, the boot doesn’t separate from the ski. These ankle injuries can hurt 500 times worse than a fracture, and most people will tell you they would’ve preferred their foot to break off. So again, pain doesn’t translate to serious.
You begin to conclude your post by indicating you have no idea why your back hurts, but that you’re sure you did nothing to cause this pain. Again, it’s not uncommon to experience back pain, and many times, there’s no memorable event that you can connect to it. In other words, back pain isn’t always the result of a fall down a mountain, a car wreck, being hit by an asteroid, or being smashed into the ground while playing football. Pain anywhere in your body can occur from the most subtle, unnoticeable reasons — every year, people strain their backs and suffer from inflammation due to an exceptionally powerful sneeze or cough, two of the most kinetically-violent forces produced in the body. Seven years ago, I woke up one morning to severe elbow pain — imaging revealed a 60% complete tear of the tendon from the epicondyle. To this day, I have no clue how I managed to do that, and my surgeon who repaired it had no answer either.
There’s no possible way anyone here can tell you, “what you’re facing”, “what the problem is”, whether it’s “serious”, whether it’ll “go away”, or if your “daily routine” will return to normal. And, while Dr. Corenman’s videos rank right up there with those action-packed Dirty Harry classics, simply watching these videos won’t lead to the reason behind why your back and leg hurt. Nor can you watch these brief videos and exclude every possible cause for your back problem just because your pain doesn’t match the pattern of pain associated with back problem “X” in Video #4.
Again, it’s impossible for anyone to answer what you’re asking unless you have something to actually interpret.
in reply to: SI Joint "iFuse" Update #8278Dr. Corenman,
If you’d like, I’d be happy to draft a letter / summary of what exactly happened in my situation, and include the radiograph copy I mentioned in my previous post above. I’ll address it to you directly if you’d please indicate what mailing address I should use. Feel free to share the letter and radiograph with your colleagues as you see fit. In short, I’m more than happy to share my experience with this mode of MIS for SIJD if it has the potential to help you, your surgical colleagues, and future patients.
And listen here… If your new “idea” includes a new patent and millions in royalties, don’t forget me …
I’ll send you my summary, etc., as soon as you reply with a mailing address.
Take care,
S.W., NC
in reply to: SI Joint "iFuse" Update #8270Dr. Corenman,
Yeah, cautionary is right. When I landed, I heard the pops. I briefly thought it could be internal stitches, but the pain was far too acute and severe for that. I told my friends that when it happened, I couldn’t think of an expletive adequate enough to scream out (which is unusual for my prior military and law enforcement mouth), so I just stood still for about a minute, hyperventilating and grunting like some scary character from the Hobbit.
I wonder if this is something iFuse might benefit from hearing about. And, I’m picturing in my head those wall screw anchors, the white plastic things with barbs on them, that hold screws in the wall when you’re hanging a picture. Although the iFuse implants aren’t screws, I’m thinking the device could be revised to include some kind of 3-sided “anchor jacket” (very thin) that would be emplaced first, then the actual implant inserted within and held securely in the port.
This is a rough idea, obviously. But, what about also considering some kind of small pins implanted down the side of the drilled port, then redesigning the implant to contain small divots or holes to which the pins would “catch” upon implantation?
As a current patient having just undergone 2 of these rather new procedures, I can promise you that it HURTS when those implants are displaced. And, mine was shoved directly into the S-2 nerve outlet, completely trapping the nerve exiting the hole. I told my surgeon that with all the ruptured disks I’ve had throughout my life, and with all of the foraminal obliterations I’ve experienced, the nerve pain from THIS incident was something beyond description. No patient should ever have to experience that — and, I think the biomedical design team at iFuse might entertain a letter describing my incident. It could only help them, and future patients.
If you’d like, I can send you a photo of the post-displacement incident, which shows the bolt “shoved” into the S-2 nerve outlet. You could share with colleagues, especially the one you’re friends with who’s performed many of these procedures. To what address could I send it so you could just see it? My surgeon prints off X-ray images for his patients, so this is literally an 8×10 piece of paper with the image on it.
Thanks for taking time to read my post, as always.
We’re thinking of you today here in the mountains of NC… Heavy snow and 50 mph winds. An awesome day to go outside on the walker and create a new sport for the X-Games… Freestyle Fuse ‘n Luge.
S.W., NC
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