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in reply to: Sacral pain, ongoing. #7528
Tenderness on the skin in the lower back and pelvis region normally does not have a direct relationship with a spinal disorder. Your increased pain with load that is not related to skin pressure makes me think of a mechanical disorder (disc, sacroiliac or facet origin pain). Your pain distribution does not fit with only a unilateral root being compressed. There are patients that have magnification of pain distribution probably from a nervous system anomaly.
I think a new set of eyes would be a good first place to start to resolve your disorder. Find a spine surgeon in your area that is patient and has lots of experience.
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: Sacral pain, ongoing. #7525So that I can understand, there only is pain produced with pressure on the sacrum? You can stand or sit on a stool without a chair back and not have pain? You can exercise and not have pain? You have no more pain at the end of the day than the beginning?
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: Dura Deficeincy #7523If you have symptoms in your upper extremities as well as lower extremities, this could not have been caused by your pseudoarthrosis and “dural deficiency”. If however, your symptoms are only in your lower extremities, the severe arachnoiditis you noted can cause some of the symptoms to mimic MS.
You need another very experienced neurologist for a second opinion to help you understand what disorder you have and the appropriate treatment necessary for this.
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 asked the “million dollar” question. There is really noting in the literature that can answer this question and I am now gathering statistics on this subject to come up with some answers.
Generally, in my opinion, surgery should be performed sooner than later in the presence of lower extremity motor weakness. There are no guidelines that are helpful. I have never stratified motor weakness patients into making some wait one week, some wait two weeks and some wait six weeks. I try to get all of them into surgery within ten days of diagnosis and even sooner.
Now in the study I am currently undertaking, there are patients who have initially seen me from three days to three months after onset of motor weakness so I do have some variation of presentation to time of surgery. Hopefully, I will be able to use this data to determine some type of findings regarding time of injury to time of surgery.
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. #7521I think most likely that your canal has been decompressed and you are on the road to recovery. You now must wait for nature to take it’s course and allow the nerve to heal. I am just writing up a new section for the website regarding nerve healing and I will attach some of it here.
“The nerve was injured by the large disc herniation and even though the herniation was surgically removed, the nerve has yet to recover. The burning sensation is typical for a nerve injury. The reason the leg becomes weaker with activity is that only a small portion of the muscle cells are firing in that muscle group. Most of the muscle cells are not getting the signal from the brain to contract and the ones that are still connected are too few to give a normal contraction.
These working muscle cells fatigue easily as they are overloaded with work and cannot “keep up” with the load. This is why with continued exercise, the leg feels weaker.
Muscle cells that are not connected to the brain are called “deinnervated”. These cells have a number of ways to recover but this takes time. Some of the recovery methods are functional recovery, nerve budding or sprouting, myelin sheath repair, nerve regeneration and muscle hypertrophy.
The first recovery method is functional recovery. You have experienced this yourself in the past. When you rest your elbow on a hard counter and your “hand goes to sleep”, you have actually temporarily blocked the ulnar nerve by this compression. This causes a temporary physiological block. When the pressure is removed, the nerve recovers relatively quickly.
Budding is a phenomenon where the deinnervated muscle cells puts out a neurochemotactic factor. This is a chemical “cry for help” and any close functioning nerve will bud or sprout a branch to connect with this muscle cell. This can take 12-16 weeks.
Myelin sheath injury. This is the condition where the insulation of the nerve itself that was damaged. These myelin cells will regenerate which allows the signal to continue down the nerve. Myelin sheath repair takes anywhere from 2 weeks to 16 weeks.
The third recovery method is by axonal regeneration. If the nerve was severed but the insulation sheath (myelin) was left intact, the nerve can grow down this pathway. The nerve grows at about one inch per month. The problem with the S1 nerve is that it is the longest nerve in the body with some examples at 22 inches long. It could take many months for the nerve to grow down to the muscle in the leg (this is assuming the insulation sheath is still intact). If it takes longer than 12-18 months to reconnect with the muscle cells, these muscle cells will atrophy and fibrose. This means that even if the nerve grows and reconnects, the muscle cells will be useless and not be able to contract.
The last possibility for recovery is muscle hypertrophy. Arnold Schwarzenegger is what many individuals think of for muscle hypertrophy and that thought is not far off. The residual muscles can be conditioned to become stronger and last longer. Training is the key for this and this result may take three of more months of hard work to achieve success.”
The reason that I don’t recommend electrical stimulation is that there is some literature that notes the budding or sprouting phase of nerve repair is stunted by stimulation. It appears that the neurochemotatic factor might not be released by the muscle cells if electrical stimulation is used.
I think you have a good chance of useful muscle strength recovery with your surgery. It might take some time, but don’t be frustrated.
Please keep the forum informed regarding the course of your recovery.
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: Tarlov Cysts & Hemangiomas in the Sacral Canal #7520Tarlov cysts are not uncommon in the sacrum. Yes, they can cause pain but that is the exception and not the rule. Even some of these cysts that erode the sacral bone can be painless. Before you condemn these cysts as the cause of your pain, you need to have a complete workup for pain generation.
I will assure you that if these are true Tarlov cysts, they contain CSF and communicate with the dural sac. If for some reason you need to prove that, you can have a myelogram performed and a post-myelogram CT scan. You will see that these cysts contain myelographic dye which will confirm that they communicate with the main dural sac.
If you find they do not communicate with the CSF, these could be arachnoid cysts.
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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