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in reply to: Can I Avoid Surgery? #7586
In my opinion, surgery should generally only be performed for the levels that are symptomatic. There are rare times that a non-symptomatic level should be included. This would be suggested when the level can be predicted to break down in the future or is a clear threat to the cord or roots (severe cervical stenosis for example).
I just had a patient yesterday that had incapacitating lower back pain and had failed all treatments. The patient had severe isolated disc resorption of L5-S1, severe DDD at L4-5 with minimal endplate fractures and a normal disc at L3-4. A discogram workup revealed that L5-S1 was the pain generator, the L4-5 disc was severely degenerative but caused no pain and the L3-4 disc was normal.
Here is a case where we don’t know what will happen to the L4-5 disc in the future. There may be as much as a 50/50 chance that this disc will become a pain generator but there are no studies at this point to clarify this (I am currently gathering data but will not have an answer for some years). This is where I explain the pros and cons to the patient and let them make their own decision to involve L4-5 in the surgical process or leave it alone.
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.A spinal cyst can have many origins and the origin and symptoms produced dictate the treatment. Is this a synovial (ganglion) cyst, an arachnoid cyst or ???? What are the symptoms that this cyst produces?
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: Cervical Instability C1 C2 #7579The C1-2 fusion is not a common surgery as this level is normally stable. Unfortunately, fusion of this level will reduce the ability of head rotation (looking over your shoulder) by at least 50%.That is the price to be paid for preventing a potential devastating cord injury in your case.
Small C2 pedicles do not preclude a successful fusion surgery. Fusion down to C3 can help if necessary and wiring of the C2 arch can help. Also lamina screws of C2 (every C2 vertebra has thick lamina) are very successful and create a great stabilization base.
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: opinion about discogel? #7578I at this point do not perform the discogel surgery. I am uncertain of the long term outcome and this product has not been out long enough to confirm safely or longevity. The substance used may be inert or may cause some long term reaction. Only time and appropriate studies will tell.
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: Numbness and motor weakness post-op #7577There has never been a study that indicates how time or the amount of compression of a nerve affects recovery. It makes logical sense that the longer the period the nerve is compressed, the poorer the recovery and I have a policy to decompress a lumbar nerve with associated motor weakness as soon as reasonably possible.
I would try and push the MRI imaging as soon as possible.
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: Effects of a poor posture #7576I would love this to be fully true but unfortunately, it is partially true. The effects of gravity do create a toll on the human frame. The main problem is the thoracic kyphosis (the forward curve of the middle back or chest) advances with age. This does create greater strain on the neck and lower back. Extension exercises which most of us do not do would be helpful.
The problem with this theory is that spines deteriorate with exercise too. SInce the discs are essentially avascular, injuries to the discs are permanent. The effects of occupation, daily living, trauma and genetics produce wear in the spine. Many patients who come into the office suffer from antalgia- the abnormal posturing of the body to prevent pain.
If you had lumbar stenosis (see website), you would bend forward at the waist to prevent your lumbar nerves from being crushed. If you had significant symptomatic lumbar degenerative disc disease, you would bend backwards at the waist to unload the painful discs.
I agree that individuals need exercise to stay healthy and posture is one of the more important items to focus on but it is not the only one that needs to be addressed.
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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