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in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7502
You had an MRI on 9/28 that demonstrated a large left herniation at L4-5 left. Less than two weeks later, you had significant increasing left thigh pain. The evaluation from the neurologist noted an S1 nerve involvement and you were referred to a neurosurgeon. Two days prior to the surgery, you lost the strength of the left calf muscle.
Your complaints are related to the left S1 nerve. It is unusual for a disc hernation at L4-5 to cause an S1 radiculopathy as a hernation here would typically compress the L4 or L5 nerves. Your presentation would make me uncomfortable with the diagnosis and I would want another MRI. You did however have an urgent situation with motor weakness.
This does present a problem because the insurance company just paid for an MRI one month previously and your symptoms were still in the same leg. There are many of these companies that would put up a fight to pay for another one. I would have to be on the phone for long periods of time to get approval and would be shuffled from one agent to another and finally to a “physician specialist” to hopefully gain approval.
The nerve was eventually decompressed and you are now in the recovery phase. It will take six months to fully know how much strength will return. I have my patients use a recumbent bicycle for early rehabilitation. Do not let physical therapy use an electrical stimulator for rehabilitation.
Please let the forum know about the process of your recovery in the next six months.
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.TP fractures of L2-3 are somewhat common. They are typically a result of blunt impact to the back of the lumbar spine but these fractures can also result from avulsion (pulling off) from contraction of the psoas muscle. TP fractures typically do not heal with bone to bone union but with fibrous union. Normally, after 6-8 weeks, these fractures are not painful.
There is most likely another source of pain from your lumbar spine if you have chronic pain in your lower back.
These fractures are not related to carpel tunnel syndrome. If however you fell onto your hands in the course of the impact, this could cause carpel tunnel syndrome.
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: New MRI and X-Rays #7487He is using up to date procedures with (most likely) Medtronic LT cages and BMP. The L5-S1 anterior approach is one of the more “safe” approaches and if you know he has had good results in a prior patient, that is one of the better recommendations.
Please keep us posted regarding your surgery for our own education.
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: New MRI and X-Rays #7485Every surgeon has their own personal experience regarding the success rate of fusion; from the front (ALIF), from the back (PLF) or TLIF (really a 360 fusion from the back) and a true 360 (from the front and then from the back).
My experience is that an ALIF has to go through the abdominal wall and disrupt some muscles. The chance for an abdominal wall “bulge” as well as dysfunction from this incision is not so small. The success rate is for fusion good for an ALIF, probably almost as high as for a TLIF. Will the surgeon be using BMP?
“Muscular disruption” from a small posterior incision is minimal for a TLIF and you must remember that these small muscles (multifidi, transversalis and rotators) are unisegmental muscles. The fused levels will not need these muscles to function after fusion.
You should go with what the surgeon is comfortable with as you do not want to push him or her out of their normal comfort zone and perform a surgery they are unfamiliar with. An ALIF is a tried and true procedure. As long as you know the potential complications, it is an acceptable procedure.
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 simple laminectomy is generally not advised unless there is signficant central stenosis without anterior cord compression. There is a technique called a costotranseverectomy that can get into the canal by resecting the rib head and transverse process but that is a difficult approach and has limitations too. I have used that technique with some success but the disc herniation has to be in the posterolateral position and not under the center of the cord. Most patients with pain and without cord compression signs (myelopathy), I recommend to use epidural steroid injections and therapy. Generally, over time the symptoms abate.
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: SI Joint "iFuse" Update #7482Thanks for notifing us about your recovery. Please keep us up to date every four weeks to let us know how you are doing.
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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