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I think you are on the right track. Flexion/extension X-rays are important to determine the weight bearing component of your disorder. A CT myelogram is a great test to determine both fusion quality and nerve compression. If you were my patient, that would be a test I would endorse.
In addition, as I mentioned before, a SNRB of the L2-3 level bilaterally would be considered if there was a solid fusion of L3-S1. A good temporary result would indicate those nerve roots as the pain generator (see pain diary on the website). This does not necessarily mean that the nerves are mechanically compressed but the likelihood of that is very high.
If the L2-3 level turned out to be the problem, surgery would depend upon the angulation of the deformity. If the endplates of the two vertebra were parallel on standing films but there was instability (spondylolisthesis) present, a simple one level TLIF fusion would be the likely surgery needed. If there was significant angulation (called a kyphosis), adding another level might be necessary to correct the deformity.
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: ACDF cervical surgery #6918Review the section on this website under “Treatments”; “Surgical”; “ACDF” to fully understand what the procedure is all about. Review the video on that ACDF thread as if describes in images why the graft or spacer is utilized.
The “spacer” is probably a PEEK cage made of plastic that might be filled with a “bone substitute” product. I have made many comments regarding this combination on this forum. Please search for those threads to understand my thoughts.
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 protrusion #6916Call my office as this is a fairly common request. My staff is very good and will give you all the necessary details.
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.There is a debate regarding the sacroiliac joint as a pain generator in spine surgery circles. I do believe this joint can cause pain but not to the extent that many others do. You do have a situation that the sacroiliac joint has more stress than normal (three level fusion to the sacrum) but your symptoms do not reflect sacroiliac pain.
Sacroiliac joint pain is local pain right over the joint itself that can radiate to the buttocks and rarely the posterior thigh. This is not your pain. The sacroiliac joint is incapable of generating “stenotic” type pain as there are no movable foramen or nerve exit holes that can change in diameter with motion.
“Butt crack” is a term we spine surgeons should use as it is perfectly descriptive but unfortunately we have to use “gluteal cleft” instead.
Pain that originates in the sacral region, radiates into the anterior thighs and down to the lateral mid-calf is in the referral area of the L2 through the L4 nerves. If you have a fusion from the sacrum to L3, there are two possibilities for pain referral. One is a pseudoarthrosis at L3-4 that is causing nerve compression. The other possibility is a breakdown of L2-3 with nerve compression from this level.
Your symptoms are classic for mechanical compression due to spine position which is very common. The MRI may not demonstrate significant compression but the standing flexion/extension x-rays may reveal this instability. Selective nerve root blocks should yield temporary relief (see SNRB and pain diary on the website for further 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: confused, please help #6914Please- no personal names on the forum. You may send personal names through the private email channel however.
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: ACDF cervical surgery #6913Part of the recovery depends upon the type of graft that is used. Autograft (your own bone) will heal in six weeks. Allograft (cadaver bone) will heal in three months. PEEK cages heal somewhat more slowly.
Your occupation also makes a difference. Heavy lifting, overhead work and impact activities require more healing time than others.
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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