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Thank 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.Failed back surgery syndrome (FBSS) is a syndrome of many different disorders. The disorders can be separated into failure of fusion (pseudoarthrosis), failure of decompression of the neural elements, instability of a segment or segments, surgery for the wrong diagnosis and finally chronic nerve injury which includes chronic radiculopathy (injury to one nerve root) and arachnoiditis (see website for explanation).
Sacroiliac disorders do exist and do have more association with a prior lumbar fusion (normally of more than three motion segments or four vertebra). However pain in the region of the sacroiliac joint is typically not associated with sacroiliac syndrome. This area is the most common referral location for radiculopathy (nerve root disorders) and L4-S1 disc disorders.
A typical work-up for FBSS starts with an MRI with gadolinium, a CT scan, X-rays including flexion and extension and a thorough physical examination. After that, a differential diagnosis is formulated. Provocative tests (discograms) or anesthetic tests are then performed (SNRB, epidural steroid injections, facet blocks, SI blocks). An EMG might be required if there is thought of nerve injury or peripheral neuropathy is suspected.
All the results are correlated and a diagnosis is formulated. The problem is surgically fixed if this disorder is a decompression problem or a failure of fusion. A spinal cord or peripheral nerve stimulator is used if there is arachnoiditis or chronic neuropathy.
By the way, I like that you still have your sense of humor. Believe it or not, that is a very good sign for the chances of recovery.
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: degenerative disc bulge L5/S1 #6995Your pain seems to be focused in your lower back with some radiation to the legs. Your MRI notes degenerative disc disease at L5-S1 with a bulge at that level. You do not describle the severity of the bulge nor the quality of the degeneration of the disc at L5-S1.
Your pain could very likely originate from this degenerative level. With years of symptoms now confining you to bed, you would do well to obtain a workup by a spine surgeon. This might include discograms and even selective nerve root blocks (see website for explanation of these). You might be a candidate for a fusion.
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: doc please help with CT findings #6994The term pseudoarthrosis means “false joint”. This term should really be non-union or failure of attempted fusion but “pseudoarthrosis” is the accepted moniker for lack of fusion.
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.The SPECT scan is an older test (bone scan) that involves an injected radiographic tracer and a scan like a CT scan (SPECT= single photon emission computed tomography). The technetium 99 radioisotope injected accumulates in bone with high turnover rate. This would be bone under stress (osteoarthritis or tumor).
Yes, the SPECT scan will help to diagnose sacroiliac disorders to some extent but in my opinion, this test has been supplanted by the MRI of this joint with STIR sequences. There is no radiation exposure with an MRI and the sequences yield more information than the SPECT scan will.
Be careful with the sacroiliac disorder diagnosis. This syndrome does occur but it is relatively rare and over-diagnosed in my opinion. I would rule out other potential pain generators, scan the SI joint with MRI, X-ray and CT and then have a positive SI block before this joint is implicated as the cause of your symptoms.
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 Surgery 4 years ago MicroDisc #6992You have a large herniation at L4-5 that causes canal compression (stenosis) as well as nerve root compression. Your neurosurgeon has recommended a left sided microdisectomy at L4-5. Obviously, without a physical examination or reviewing the films, my information is conjecture.
If this is a standard large central disc herniation, the left sided microdiscetomy is a good choice for surgery. There are two variations of this herniation; sub-ligamentous and extruded/sequestered. The sub ligamentous variety is typical. The herniation fragments are located under the posterior longitudinal ligament. During surgery, the ligament is opened and most if not all of the herniation fragment can be removed from both sides from the left sided approach.
If the fragments are in the canal (extruded/sequestered), I still think this surgery is a good choice but there are some potential problems. Most of the time, there are two to three large fragments in the canal and these are generally visible or reachable by the left sided approach. There are rare times that these fragments are multiple and small and cannot be fully reached from the left side. Nonetheless, removing most of the fragments will debulk the nerve root compression and any small fragments “left over” are generally not symptomatic.
You can send your MRI to my office. Please call the 888 number and talk to my nurse Margaret.
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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