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in reply to: Post ACDF pain #7727
The question is where is the origin of the left neck pain. If the pain radiates into the shoulder or down the arm, the origin could be from the foraminal narrowing of the left C5-6 level that compresses the nerve root here. I would also be suspicious of a pseudoarthrosis (lack of fusion) at one of the two levels of your prior surgery. This can be revealed by X-rays including flexion/extension views.
If there is no pseudoarthrosis present, a selective nerve root block (see website) of the C6 nerve with good temporary relief (see pain diary) would indicate that compression of the C6 nerve is the most likely cause of your pain. If this is the case, a posterior foraminotomy can be performed (see website) to decompress the nerve. This is of course assuming that you have failed conservative therapy.
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.in reply to: L4-L5 Herniated Disk #7726You were on a flexion/distraction table. This table, in the right hands can help to relieve pain in some cases of herniated disc/nerve pain. If used incorrectly however (as you found out) this treatment can cause increased nerve pain. This chiropractor you visited did not understand the biomechanics of the disc herniation and caused you more pain. This is not the case with all chiropractors but unfortunately is more common than I would like.
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.in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7724Sorry for the delay but I was out of town.
Nerve recovery has two separate modes. One is quick and one is very slow. If you review the section under “Nerve Injuries and Recovery”, you will understand this information more thoroughly.
The quick response is noted in the first couple of days after a surgical decompression. Taking pressure off the nerve root can allow almost immediate recovery of some muscle strength.
The delayed recovery response is from healing of the myelin sheath, nerve budding or nerve regrowth and healing. This can take from 6 weeks to one year.
Since nerve budding takes from three to four months to occur, electrical muscle stimulation can be used after six months as this is beyond the period that electrical treatment would retard the budding process.
You would be better off in my opinion by exercising the muscle as best you can. There has never been a study to my knowledge that indicates the muscle can be preserved by electrical stimulation in the face of denervation (loss of nerve supply) until the regrowing nerve can reconnect with the target muscle. Plus, there is no way to know if the nerve is actually regrowing down the preserved myelin sheath or is forming a neuroma at the point of injury.
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.in reply to: Discectomy even without leg pain? #7723Your pain is not related to stenosis but more likely than not related to the tears in your disc walls (annular tears). If you are a candidate for surgery, there are two choices for surgery. A microdiscectomy has about a 50% chance of reasonable relief of your lower back pain. A 50% success rate is not high. This lower success rate however is balanced by the minimal nature of the microdisc surgery. It is a small surgery and generally easy to recover from.
The typical surgery for lower back pain relief is a fusion. This is a much bigger surgery than the microdiscectomy surgery and takes about four times as long to recover from. Nonetheless, this surgery is the gold standard for relief of lower back pain. You would need a work-up to determine if you are a candidate for this surgery.
If you choose the microdiscectomy and do not get the relief that you expect, you have not burned any bridges and can still be a candidate for a fusion procedure.
Both neurosurgeons and spine surgeons can perform either procedure. With that long wait, you might look for another surgeon to get a quicker 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.You have two separate problems. Your lower back pain is generated from your lumbar spine and your neck pain (and possibly headaches) are generated from your neck.
You have degenerative changes of your discs and facets in your neck. The anterolisthesis (forward slip) of C3 on C4 occurs from facet wear and retrolisthesis at C4-5 is generated from degenerative disc disease. You probably do not have significant ligamentous instability unless there is significant shifting of one vertebra on the other with flexion/extension views.
Most of the time, neck pain is generated by degeneration of the discs and facets. If you have failed chiropractic treatment and a good course of physical therapy, you should seek out a well experienced interventional PM&R doctor or interventional anesthesiologist for potential injection therapy as the next step.
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.in reply to: Lumbar Herniated Disc or Spine Cancer? #7716The chance of cancer causing your friends symptoms is very remote. I see about 1100 new patients a year and only two to three have cancer so you can see the odds of cancer are very low.
Pain and numbness in the legs is generally not related to cancer but to nerve compression. The MRI will answer a lot of your questions.
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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