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in reply to: degenerative disc bulge L5/S1 #7131
Coccyx pain from an impact directly on the coccyx can cause ligament injury, fracture or dislocation. If you have had pain for 9 years in the coccyx, I hope you have had some treatment of this disorder. I did indicate treatment earlier but direct injections into the coccyx ligaments can be helpful.
If there are no other potential pathologies that can refer pain here and the local injection yields good temporary relief, a coccygectomy can be performed (removal of the coccyx bone).
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: disc herniation and degeneration , pain in leg . #7128MRI images are very important to understand the “geography” of the back but must be correlated with symptoms and physical examination findings to fully understand the pathology present. Please see the section under “Conditions”- “How to describe symptoms” to fully convey what problems you are experiencing.
I can say that at twenty years of age with two levels of degenerative disc disease, you have a genetic prdisposition for degenerative changes. If you can describe your symptoms in more detail, I can give you more information.
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. #7127Pain with sitting and “jolts” down your leg might signal another disc herniation. There is the chance that there is no new herniation but the nerve root is still so swollen from two compressive injuries in a short period of time.
To check for motor weakness, there is a simple test you can perform yourself. Balance on one foot on the painful leg while steadying yourself on a counter or wall with your hands. Just use your hands for balance and do not support your weight with your hands. Perform ten heel raises on the painful leg. Then do the same on the non-painful leg.
Compare the ability to do these heel raises one side to the other. If you are substantially slower or cannot complete the ten raises with your painful leg, there is most likely motor weakness. Do the same test but this time, raise the ball of your foot off the floor ten time (toe raises). Compare both sides. Again, if one is substantially slower or you cannot complete ten on the painful side, there is motor weakness present.
Either the current intensity of your pain or weakness if present should warrant a new MRI. If the nerve is compressed by another herniation, surgery should be considered. If the nerve is inflamed, an epidural injection or even an oral dose of steroids might be helpful.
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: To fuse or not to fuse #7122By your report, you have significant degenerative disc disease at C5-6 (“it is a grade 1 spondylolisthesis”). I assume cord compression (“C5/6 is abutting the spine”) as well as foraminal stenosis (“2 EMG reports that neck,shoulder, arm, hand pain all coming from cervical C5/6 and irritating from C7”).
Make sure that the C7 nerve is not involved as surgery at C5-6 will only help the C6 nerve and not decompress the C7 nerve.
Addison’s disease does make the recovery from surgery more difficult. You will need significantly more steroids for the immediate postoperative period and then taper back to your normal doses over time. Make sure your surgeon understands the significance of these steroids to your health and recovery. You should not have to be placed in the position of demanding therapeutic doses of these medications.
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: Herniated disk #7121MRI findings are only a portion of the diagnosis. I have seen patients with incredibly large herniations and no symptoms! I can discuss what symptoms an MRI can generate but without knowing what the symptoms a patient is suffering from, this is a guessing game.
You have two potential leg pain generators, the L5-S1 extruded left disc herniation compressing the left S1 root and a foraminal herniation on the right compressing the L5 nerve root. The L1-2 disc disorder is more likely than not, not causing symptoms.
The S1 nerve compression causes left buttocks pain that can radiate down to the bottom of the foot. This pain would increase with sitting and bending forward and be relieved by standing and walking. Weakness of the gastroc/soleus group of muscles could cause difficulty with pushing off on the left foot.
The right foraminal herniation at L4-5 does not make much sense. If this herniation is in the foramen, it should compress the L4 nerve root and not the L5 nerve root. If this herniation is in the posterolateral position, it could compress the L5 root but the radiological report is confusing regarding this detail.
If this right foraminal hernation is causing L4 root compression, you should have pain that radiates to your ankle that would be worse with standing and walking and improve with sitting and bending forward. However, if this herniation truly causes L5 and not L4 compression at this level, the pain would radiate to the top of your foot and be worse with sitting and bending forward. Watch out for foot drop, the slapping of the foot with walking and the feeling of an unstable foot that can easily sprain the ankle.
I cannot begin to tell you about epidurals without you first describing your symptoms. See the section under “Conditions”; “How to describe your symptoms” to explain your pain.
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: Procedural Questions for iFuse SI Joint Implant #7120SIJD is not typically associated with severe muscle spasms. If you have significant spasms in bed, the diagnosis of SIJD goes down in the differential list in my opinion. The sacroiliac joint should not be painful when not loaded and spasms typically are associated with other diagnoses (spinal instability and radiculopathy). Of course, your SIJ blocks yielded great relief so I have to assume that this is a real disorder of these joints.
If there is no other pathology that is also present, the fusion of these joints should give you some relief. I see this disorder about one to two times a year (many patients enter my office with this diagnosis but most of them do not have this disorder). SInce my experience with SIJ fusion is more limited, I called a colleague who has performed 70 of these fusions. He reports that he has about a 70% satisfaction rate for this surgery.
If the disorder you suffer from is only that of sacroiliac joint dysfunction, you have a 70% chance to be satisfied with your results. If you have other underlying disorders, the satisfaction rate will be less.
PT is always valuable prior to surgery to increase conditioning and flexibility. Manipulation of the sacroiliac joints should be avoided as these joints deliver painful movements. You do not want to mobilize a painful joint. After all, you are going to consider having these joints fused due to pain.
You really cannot sublux the sacrum as this joint is interlocked by bony ridges and depressions. The sacroiliac joint is also fitted with very tough fibrous attachments.
The IFuse technique is new and many insurance companies are loathe to pay for new procedures. It will depend upon your insurance policy. There are many other techniques but these techniques are probably not as good as the IFuse technology.
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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