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in reply to: Abdominal distension after spinal fusion surgery #7273
You had an anterior approach to the spine. An incision on the left requires cutting some abdominal muscles and these muscles will not heal and function as before the surgery. This abdominal wall weakness has two separate consequences.
One is that the opposite side muscle will continue to pull with regular strength and the surgical side muscles will have less “pull” (strength is diminished by the incision). This imbalance will pull the midline off center (as marked by the umbilicus or navel).
The second consequence is that the abdominal wall on that side will bulge somewhat with the complaint of “bloating”.
“Core” therapy work to try and rebalance the abdominal wall may yield some symptom relief. Make sure you have a consult with the original general surgeon who made the initial incision and approach to make sure there is nothing wrong (abdominal wall hernia).
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.Post laminectomy syndrome is a catch-all term for failure of surgery to relieve pain. An open laminectomy with a large incision does not necessarily mean that the surgery was done improperly but that the surgeon is probably from the “old school” where the philosophy was “incisions heal side by side” and it did not matter how long the incision was.
A full laminectomy does not generally create instability of the spine. The spinous process is removed but the facets are generally left intact which are the main stabilizing processes (other than the disc). A microdiscectomy is a much “smaller” surgery with only a very small portion of the lamina removed (laminotomy) and the approach is from only one side. The laminectomy is performed from both sides.
Your spine could be unstable but that term is used for a number of different pathologies. True instability is the inability of the spine to maintain normal anatomical relationships with forces that cause shear, torsion and flexion/extension.
Pain generation could be from instability, foraminal stenosis, lateral recess stenosis, degenerative disc disease, isolated disc resorption, or chronic radiculopathy. See the website for description of each.
Spinal fusion- if needed, might be your answer but a thorough workup needs to be performed to determine the cause of your pain. As to complications of fusion, look to the website for “complications” for a good description.
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.If your mother has significant pain from a deteriorating disc and has failed typical initial care (medications, therapy and activity alterations), she might be a candidate for spine surgery. Neurostimulators and pain pumps are only for patients that have failed surgery or are not surgical candidates. I am not sure if Medicare covers implantable stimulators. She needs a good looking over by a 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.This is a very good reply. The general guidelines are very appropriate. Try to avoid surgery unless there is a clear compression of the spinal cord with myelopathy (very rare).
The Santa Barbara chiropractor is spot on with “posterior chain muscle” strengthening. The thoracic spine has a built in forward curve (the kyphosis) which loads the discs. Herniations in the thoracic spine will actually increase this curve which obviously increases the load on the discs. Increased disc load increases the pain.
The antagonists to this kyphosis or forward curve are the posterior thoracic muscles (the extensor muscles or posterior chain muscles). Strengthening of these muscles will reduce the load on the disc. Extensor training is as simple as using a rowing machine and extension “sit-ups” while lying on an exercise ball.
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 general, a second herniation at the same level requires only a repeat microdisectomy, not a fusion. If however, the level is associated with a spondylolisthesis, isthmic or degenerative, there may be an indication for fusion. Nonetheless, if your only symptom is leg pain and not back pain, the surgical plan should lean toward decompression.
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 history leads me to believe that you might have developed herniated a disc at L4-5 or L5-S1 compressing the nerve root and causing leg pain. A positive EMG report indicates that you probably have motor weakness. Rarely, a positive EMG report may just indicate nerve irritation but most of the time will pick up muscle involvement.
Walking pain as compared to sitting and bending pain may indicate a disc hernation in the “far lateral” or lateral recess position but may also indicate foraminal stenosis from degenerative disc disease (see website).
You need a spine surgeon to examine you and an MRI of the lower back will be necessary.
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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