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in reply to: Foot Drop due to L5-S1 Herniation #7420
In general, it is my opinion that with substantial motor weakness due to lumbar nerve root compression, a decompressive surgery needs to be performed. What concerns me is that after three months of presence of foot drop (weakness of the tibitalis anterior muscle), the chance of useful return of motor strength is questionable. Nonetheless, I would generally advise a decompression surgery (microdiscectomy or equivalent) to allow the best chance for return of motor function.
There is no chance based upon your MRI findings that you will develop bowel and bladder function loss. The herniated disc or spur is “touching the theca” which simply means that the sack of nerves (thecal sac) is being “touched”- not compressed. It takes significant compression of the entire thecal sack to cause malfunction of your bowel and bladder.
One concern is that the tibialis anterior muscle is normally controlled by the L5 nerve (and less commonly, the L4 nerve). The report notes the S1 nerve is compressed which would not cause foot drop but would cause calf weakness. This weakness would cause difficulty with push-off of the foot- not foot drop. The surgery that is planned is being performed to decompress your left S1 nerve root. Make sure the surgeon has this question worked out before you agree to 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: MRI results with hemangiomas #7419This would be more accurate from one of my oncology colleagues but I’ll give you my limited understanding. Multiple Myeloma is a disorder of the plasma cells of the bone marrow. These cells usually make the antibodies that fend off infection. A chromosomal abnormality causes one cell line to misbehave, over-multiply and overproduce useless proteins (Bence Jones proteins).
Multiple myeloma is diagnosed by the presence of these abnormal proteins, an abnormal bone marrow biopsy and other evidence of the abnormal presence of plasma cells. I don’t believe that just the presence of Bence Jones proteins confirms that diagnosis but has to be associated with a positive bone marrow biopsy.
Your lower back pain more likely than not is related to the significant degenerative changes of the discs, especially at L5-S1 but you do need to rule out the presence of MM.
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: Second Six Weeks after Lumbar Fusion #7414The first 12 weeks is split into two 6 week segments for recovery. The website in quite valuable to explain these steps. See “Pre and Post Op”; “Recovery Information by Surgery”; then “Lumbar Fusion”.
The first 6 weeks in involved with surgery recovery. That is, getting rid of the aches and “tiredness” that comes with surgery of this nature. In the first couple of weeks, you start to take care of yourself by using the training you received in the hospital by the physical and occupational therapists. This includes getting out of bed, how to get into a car, how to take a shower and how to prepare meals. You can start driving when you pass the driving test (“Pre and Post Op”; “Post-Operative Instructions”; then “Driving Test After Back Surgery”). You can start exercising on a stationary bike (with the handlebars up) or even an elliptical (without using the arms which causes rotation). No BLT in this period. No NSAIDS (Motrin, Aleve etc…) Also, the large notebook you are given in the hospital contains all this pertinent information.
The second six weeks is the period you start a formal physical therapy program. The scripts are written in the office and typically, you will attend twice a week. The therapist will work on endurance and conditioning but not range of motion (the bone cells are still growing in this period of time). Still no BLT and no NSAIDs.
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: MRI result should I be worried? #7408Pain in the neck radiating into the left shoulder and arm sounds like radiculopathy. Your head being “forced forward” is also a classic symptom for radiculopathy. The nerve exit holes change in volume with head position. Bending the head backwards decreases the room for the nerves and bending forward opens the holes. If you have significant narrowing of these exit holes, you will want to hold your head forward to prevent compression of the nerve with the resultant pain and numbness.
The MRI report uses some terms that are concerning. “Marked compromise” of both exit foramen sounds to me like severe foraminal compression at C3-4 and especially at C4-5. The left sided foramen at C6-7 is “almost obliterated”. That also sounds like severe foraminal stenosis. “Suggestion” of myelomalacia from central stenosis at C6-7 certainly sounds pretty significant to me.
I would not undergo manipulation by an osteopath for these MRI findings. I think a good spine surgeon should comment on these findings, perform a thorough physical examination and give you his recommendations.
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.I have to stand corrected. It appears that you had a full blown radiculopathy of the T9 nerve and resultant weakness of the intercostal muscles associated with that nerve. The muscle weakness might have allowed the floating rib to be uncontrolled with movement and now protrude out. I can tell you that I have never seen this before. This is why I love this forum as I learn new things every day!
Hopefully, this nerve will recover and the motor strength will return. If this nerve can recover, the nerve will grow down from the site of injury about one inch per month. I assume the length of the nerve was initially about twelve inches. You probably have developed as much recovery at this time as you can hope to.
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: When is it time for surgery? #7397Swallowing difficulties after an ACDF are not uncommon. Thin liquids like water are difficult to swallow in some patients initially. You will find that more viscous liquids like kefir or yoghurt are much more easily swallowed. Milk shakes and smoothies are welcomed by recent surgical patients. In more significant cases, oral steroids can be helpful to reduce swallowing difficulties.
Hoarseness is more concerning. Did you have a right or left sided approach to your ACDF? There is a small filamentous nerve called the recurrent laryngeal nerve that can be stretched especially during a right sided approach. This may take some months to recover function.
I m unclear as to why you are on high doses of Gabapentin after surgery. Were you on high doses prior to surgery?
Please keep the forum informed regarding your recovery.
Thanks
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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