Forum Replies Created
-
AuthorPosts
-
in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7542
Generally, I am not too concerned about “advancing” numbness. Numbness could have been present but the patient may not have been aware of the lack of sensation in that general region. Even if the skin region has previously been mapped with normal sensation and is now asensate, generally, this area can recover. Even if the sensory nerve has been permanently damaged, the surrounding intact sensory nerves will grow into the asensate region and the patch of numbness will reduce over time.
The big concerns I have are motor weakness and pain. If those are controlled and acceptable, conservative care can continue.
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. #7539Back pain is not uncommon from the initial recovery stages of a TLIF but continuing leg pain is. The source could be from nerve inflammation that will resolve but the other potential causes should be ruled out. These include hematoma, screw stenosis, cage stenosis and remaining bone fragments that can compress the nerve. A medrol dose pack is a good first move.
An MRI will help to differentiate between those potential disorders.
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. #7537Note the last response. I can educate you on the types of nerve injury and how nerves heal from each injury but I cannot tell you what type or types of injury a specific nerve root has suffered. This is the major drawback in predicting if the nerve will come back and if so, how quickly it will come back. Only time will tell what type of injury the nerve root has suffered.
In my opinion, it is important to create the best environment for nerve recovery. My policy therefore is to surgically decompress any lumbar nerve relatively quickly if there is significant motor weakness present. I will also not wait if there is a long cervical nerve that demonstrates weakness such as C8 and T1 (the shorter nerves of the cervical spine have a better ability to recover and I might be more patient with injury to those nerves).
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. #7534Thanks for the reply.
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.Your surgeon notes that the slip has slightly increased and “there is no obvious consolidation in the lateral gutters” which probably means that the fusion is not progressing as intended. The lack of fusion and the increased slip might indicate foraminal stenosis which would explain the significant leg pain.
With the intensity of your current symptoms, you might ask this physician if she might order a CT scan or an MRI. The CT scan will determine what the current state of your fusion is along with denoting foraminal stenosis. The MRI would not help with fusion status but would delineate the state of compression of the nerve root.
If that plan does not work, you could consider 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.in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7531Two questions here. The first is what happens to the nerve root when injured by a disc herniation? The answer is that we can come to the conclusion based upon the final clinical outcome after surgical decompression. That is, we can look back and surmise what happened to the root based upon the time and extent of recovery. Obviously, we surgeons don’t sacrifice the nerve root during surgery and analyze it under the microscope to understand what has occurred to the root.
There seems to be a certain percentage of patients that will not recover strength, even with a timely surgical decompression. It may well be that the initial impact or blow to the nerve from the herniation crushing the root will have caused irreparable damage. That however is not the rule and most nerves will recover. The problem is there is no way to tell how much recovery the nerve is capable of.
I have just written a new section regarding nerve injuries and this should be up on the website in a couple of weeks. You can refer to that for more information.
Increased pain that occurs six weeks after a microdiscectomy is typically produced from inflammation. There are other sources including a recurrent herniation, hematoma in the canal, mechanical collapse of the vertebra (lateral recess or foraminal stenosis- see website) or even infection. Careful follow-up can help to differentiate those problems.
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. -
AuthorPosts
