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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    I would hope that the first surgical plan did not include also operating on L4-5 only because it would be highly unusual to plan to operate at that level and cancel the plan intraoperatively.

    Some of the questions I have would be what was done with the diagnostics? Did your exam note only the S1 nerve involved with your symptoms and not the L5 nerve (sometimes hard to differentiate without motor weakness). Did you undergo any diagnostic selective nerve root blocks to “root out” the nerve or nerves involved?

    Your MRI reading notes L4-5 nerve compression according to the radiologist; “The L4-L5 disc level demonstrates a shallow right posterior and proximal foraminal disc herniation is present causing focally severe right subarticular recess encroachment … with presumed impingement upon the traversing right L5 nerve root”. I am unclear why the L4-5 level would not also be addressed surgically unless there was clear evidence that the L5 nerve root was not involved.

    Sometimes, “the proof is in the pudding”. How much better do you feel after only having the L5-S1 level addressed surgically?

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    Please call my office and I will set you up with a thoracic spine surgeon. I do thoracic fracture and deformity work but not this mid-thoracic foraminal work.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    Your above assessment is correct. If there is no neurological danger at that level, then facet blocks and RFA are the way to go. You have “mild” central stenosis. I assume you do not engage in impact or contact sports.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    Unfortunately, a minority of surgeons don’t like follow-up care.

    “Pins and needles in my hands, forearms, hips or feet. Not all at the same time but it varies” sounds like a metabolic problem, not generated by the surgery itself. This could be an electrolyte imbalance. Talk with your family doc and see if they are interested in a metabolic workup.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523
    in reply to: Direct pars repair #32706

    Any slip generally means there is some incompetence in the disc which is a problem. There are some strikes against you for pars repair. Your age is one. Younger patients tend to heal better and faster although I have repaired some pars fractures in twenty-something patients with not-unreasonable results but the success rate is lower and healing slower. Disc degeneration is another problem. Disc degeneration can lead to progressive disc thinning and incompetence.

    The type of each pars fracture is important. Displacement is a negative factor. Non-displaced does better. 3mm displacement is a real issue. Atrophy at the end of the fracture is another negative factor. Of course, if the fracture end is hypertrophic and non-displaced, that would be a positive for repair.

    Don’t be too worried if you are not a candidate for repair but are for fusion as many of these patients are very happy with fusion results.

    Normally, most insurance companies welcome a second opinion.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    Minor incision pain can linger for 3-6 months in some individuals so nothing at this point to be concerned about. Some patients feel 100% right after surgery but most do take about 4-6 months to feel that way.

    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.
Viewing 6 posts - 1 through 6 (of 7,522 total)