Forum Replies Created
-
AuthorPosts
-
in reply to: back pain for 18 months #7396
Severe lower back pain for 18 months with a leave of absence from work is significant and i am glad you underwent a workup. Do you have any buttocks or leg pain or is the pain squarely located in your lower back?
I am unclear as to the results of your discogram. DIscograms are rated by pain, pressure and morphology (the appearance of the disc on the X-ray and the post-discogram CT scan). The discs are named for the vertebra they are sandwiched in-between. For example the L3-4 disc is the disc in-between the L3 vertebra and the L4 vertebra.
Discogram pain is rated on two different parameters; type of pain and intensity of pain. If you report the same pain during the pressure run up as you normally experience, this is called concordant pain (also known as P2). Pain that is not familiar with pressure run up is called discordant pain (also known as P1). The intensity of pain is rated by a 0-10 visual analog scale (VAS).
Pressure is recorded during the run-up and noted as opening pressure (the pressure needed to start the dye flowing into the disc) and the maximum pressure obtained.
Finally, the disc internal architecture is noted. Is there a full tear in the disc wall with dye flowing into the epidural space, minimum discal disruption or a normal disc appearance?
See if you can get a copy of the discogram report and note these parameters on the forum.
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: Direct Pars Repair #7395You can look at the pars fracture section in the website as well as the isthmic spondylolisthesis section to gain a better ideas regarding pars fractures and pain generation. The experience of surgeons varies greatly regarding the understanding of these fractures so it is not a shock to find different opinions from different surgeons.
If the diagnosis is unclear, pars blocks (lidocaine injection of the region of the pars), nerve root blocks and a discogram at the level of the fractures can give a much clearer picture of the pain generators. Since the pars fractures most likely occurred between the ages of 8 and 15, it would be unlikely that the disc would be fully intact without a tear 30 years later but stranger things have happened.
A pars repair in my practice in an older population requires a significantly symptomatic patient, an intact, non-painful disc (possibly diagnosed with the use of a discogram) without a significant slip on flexion-extension X-rays, proven pain generation from the pars (positive pars blocks) and no significant bone erosion between the fractured ends of the pars.
Unstable segments, painful discs or significant erosion between the fractured ends of the pars normally requires a fusion. Don’t fret if you need a fusion as there is about a 90% satisfaction rate for fusion in that case.
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: Can I Avoid Surgery? #7394I am confused by the surgeon’s recommendation. Your worst level in the cervical spine seems to be the C6-7 level by report. I am unclear as to why the surgeon suggests an ACDF of the C4-5 and C5-6 levels. Maybe the physical examination honed in on the levels above or the radiologist’s interpretation of the images is different than the surgeon’s interpretation.
Did you undergo a complete physical examination with testing of all the upper extremity muscle groups? The biceps, triceps, deltoid, wrist and hand muscles as well as arm internal rotation (tennis forehand) and external rotation (tennis backhand) muscles? Was sensation tested as well as reflexes?
When you say the surgeon wants to do perform fusion “on both sides”, do you mean both a front incision for the ACDF and an incision on the back of the neck too?
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. #7393Thank you for writing to the forum after your surgery. I am sure that this is a Herculean effort with all the medications and discomfort you are currently experiencing. I appreciate this effort.
You underwent a MITLIF which is a “minimally invasive transforaminal lumbar interbody fusion”. The lack of motion of your right leg after surgery is distinctly unusual and I am glad the surgeon performed a post-operative MRI to look for potential causes. WIthout a cause (screw impingement, bone fragments or cage stenosis), the leg pain could have been generated from the retraction of the nerve during surgery.
If this is the case, the nerve should recover over time. Sometimes, corticosteroids can be effective to help heal a nerve, wither orally, through an IV line or sometimes delivered as an epidural steroid injection.
Please continue to keep us posted.
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 grade II+ spondylolisthesis does not respond well to a posterior only fusion with instrumentation but at the time of your surgery, the posterior fusion was the procedure of choice for many surgeons. The first suspicion I have is that the surgery did not create a solid fusion. Most patients who had undergone fusion with good relief for only a short period of time (in your case four months to two years) have a potential for a non-fusion (pseudoarthrosis). I am suspicious of the imaging a year down the road that indicates solid fusion.
You indicate “mild spondylolisthesis” of L5. I am unclear if you mean the L4-5 level or residual slip of the L5-S1 level. If the L4-5 level is slipped, this most likely is a degenerative spondylolisthesis (see website), a common problem for females and a common spinal pain generator.
Has the disc at L5-S1, the prior fusion level changed in appearance since your initial fusion so many years ago? Normally, a posterior fusion at L5-S1 will “freeze in time” the appearance of this disc as the fusion “unloads” the disc. A change in the disc appearance leads to suspicion of motion and loading of this disc space regardless of the fusion status.
You need a complete work-up including a CT scan and MRI (on good scanners) and a diagnostic work-up from a meticulous and experienced spine surgeon.
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: Chronic Pain from L5 S1 surgery #7391The first question I have is why did the surgery not go well? There are many potential possibilities for this. Where is your pain now and where was it prior to the surgery? Was it mainly back pain or leg pain? Is the predominant pain now back pain or leg pain. Leg pain would include one sided buttocks pain and maybe one sided pelvis pain (sacroiliac pain). Is the pain made worse by standing or by sitting?
After surgery, how did your pain change? Did you never have an interval of pain relief or did you have some relief for some months? Did you have a post-operative MRI or CT scan? Did some physician look to see if your attempted fusion became solid?
There are many question that need to be answered for what is called “failed spine surgery 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. -
AuthorPosts
