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By your history, it appears that you have had a discectomy at L5-S1 two years ago and surgery was a success as the pain disappeared initially. I am unclear when the pain returned, but apparently it did at some time. The pain now is intermittant in your right buttocks. The pain is aggrevated by bending and sitting. You do not report any back pain.
This is speculation but by the sounds of your symptoms, you may have a recurrent disc herniation at the same location as your first herniation. The chance of that occurance is 10% in the active population.
Without significant back pain, you don’t need to think of a disc replacement or a fusion. What you need is a diagnosis. Either go back to your original surgeon or find a spine surgeon with a good reputation and ask to be looked at. You most likely need a new MRI with gadolinium (the dye that lights up scar tissue) to determine what the next step is.
Good Luck
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: Treatment for L5-S1 Spondylolisthesis #4617By your complaints, you have evidence of radiculopathy from foraminal stenosis which is a common sequela of an isthmic spondylolysthesis (see web site). However, you also complain of lower back pain which may be a sign of instability from the pars fractures. The fact that the lower back pain is only one sided may possibly be an indication of nerve irritability and not instability. The pain in the outside of the foot normally belongs to the S1 nerve root but would be unusual with an L5 isthmic spondylolysthesis, as this normally affects the L5 root. None-the-less, I have seen the L5 root occasionally cause this symptom.
The foraminotomy on the left at L5-S1 in the face of an isthmic spondylolysthesis can be problematic. The cause of the collapse and bone spur formation that leads to the nerve compression stems from the pars fractures and instability/ degenerative changes. Performing a foraminotomy can create further destabilization of the level.
In addition, if some of the pain is originating from your spondylolysthesis, foraminotomy surgery will not eliminate that pain. You can get an idea if most of the pain is originating only from the nerve by using a selective nerve root block (SNRB- see website). With great temporary relief- there is a reasonable chance that the pain is nerve only.
So to get to the point- foraminotomy can work to relieve leg pain but the chance of developing instability after the surgery is high and therefore, I personally don’t recommend it except in very special cases. The TLIF procedure for decompression of the root and permanent stabilization of the isthmic segment is most likely the procedure that has the best results for nerve pain from an isthmic spondylolysthesis. This procedure reconstructs the missing disc height and makes more room for the nerve. Yes- it is a fusion but this segment most likely has a degenerative disc along with root compression and pars fractures with possible instability.
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 ?????????? #4615You need a good spine surgeon or neurosurgeon to go over your options with you.
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 ?????????? #4613The MRI report gives an idea of the cause of the symptoms, but does not specifically identify what is causing pain. I can let you know what potential symptoms you can have from the MRI report, but without a good history and physical examination, this is conjecture.
Do you have central upper neck pain? This can occur from the C3-4 disc space. Do you have right sided neck and shoulder pain? This can occur from compression of the C4 nerve which is compressed at the foramen. The C4-5 and C5-6 levels do not sound too problematic but you have to remember that we are reading this report through the eyes of a radiologist and personal opinion can flavor the report.
The C6-7 level has foraminal stenosis on the right. This can cause arm pain and paresthesias (pins and needles) into the middle of the hand and weakness of the triceps muscle.
The way I confirm the diagnosis of a patient with this type of MRI is to have a selective nerve root block performed at the suspected level. Good temporary relief would confirm the suspicion of the diagnosis.
Treatment could range from physical therapy and injections through surgery.
Hope this helps.
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 are now coming across the great dilemma of chiropractic but at an early phase. Chiropractic has so much to offer but is also taught with much dogma. To take on the mantle of “primary health care practitioner” but not use the knowledge of physiology, immunology and medicine is doing a disservice to patients. The core philosophy of subluxations causing dis-ease is simply not supported by any research or literature.
Chiropractic is a wonderful treatment for many disorders but if your patient comes in with pelvic inflammatory disease from an infection and you are going to “take on everything that comes in your door”- to be called a primary health care practitioner, you must diagnose and treat this individual. Do you adjust this patient when they really need antibiotics? Do you adjust the patient with severe back pain from an undiagnosed osteomyelitis and cause further damage? As a chiropractor, I needed more knowledge. I thought the medical route would give me a better understanding of the disorders my patients had.
If you want to become a great healer, open you mind to the achievements made by all the specialities. Look into the philosophy of Osteopathy and you will find that Stills was very close to DD Palmer in thought as well as location. Find out about the history of Homeopathy and why in the 1900s, it was the most respected profession in the USA. Yes- above medicine. Look into acupuncture and you will find similarities to chiropractic.
Use the knowledge gained from so many great individuals such as Lister and Osler. DD and BJ Palmer made great discoveries and brought together a wonderful treatment method but it is not the only discovery that has had great outcomes.
Then look into medicine. The profession has downfalls (the egos are difficult to deal with and the politics) but if you really look with a practiced eye, you will find the most scientific but caring profession. The amount of knowledge to gain blows the mind and takes years to master. If you however, start with a chiropractic background and then learn medicine, you have a base point to make much more sense of it all. I think that chiropractors that go into medicine make great doctors. You already know how to listen to patients and take care of them on a personal level. If you just add current medical knowledge to that mix- you will give spectacular care.
I’ll compose and send you another email regarding the trials and tribulation of going from D.C. to M.D. There are some challenges!
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: bulging disc #4607The fact that standing and walking do not aggravate your symptoms is helpful. Central spine pain with standing normally stems from instability or discogenic pain so absence of this pain makes the prognosis much better. The “central bulge” at L4-5 does not really describe how large the herniation is or if it lateralizes to one side or the other. Please send in your films.
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
