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in reply to: Thoracic Spine MRI #5207
Mid thoracic back pain can originate from many structures. The discs, facets, ribs, nerves and muscles can cause pain. An increase of the thoracic cure called the kyphosis can cause pain as well as cervical disc herniations can refer pain to this area.
The “normal” MRI may in fact not be so normal. There are times that radiologists might not recognize a degenerative disc or an abnormal curve but let us assume that the MRI is truly normal. Facet inflammation causing pain will typically not show up on an MRI. Rib subluxations will not show up. Of course, if a cervical disc is herniated, this won’t show up on a thoracic MRI.
These conditions can be diagnosed by an interventional spine specialist or in the case of a rib subluxation, by a chiropractor.
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: Revision Surgery #5206If you have a fusion from T11-S1, there are two areas that need to be watched- the sacroiliac joints and the T10-11 level. You can mitigate the wear by doing just what you stated- low impact activities. The spine fusion should not affect your hips, knees and ankles.
Swimming, cycling including mountain biking, hiking (without a heavy pack), rowing, reasonable gym workouts, cross-country skiing and snowshoeing are all activities that in general, would not harm your back.
Intermediate activities that could cause increased wear are skiing groomed slopes, hiking with a heavy pack, heavy weight lifting and water skiing.
Acivities to avoid are all impact activities such as running, tennis, volleyball, basketball, soccer as well as others that increase the load on the back.
Normally, both a CT scan on a 64 slice scanner and an MRI on at least a 1.5 tesla machine are necessary for the workup. In-office standing x-rays with flexion and extension view are 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.in reply to: Burning feet #5200The complaint of “burning feet” immediately makes me think of peripheral neuropathy but let me clarify. Peripheral neuropathy is a disease of the nerve itself. This disorder is fiber length dependent. That means that the disease normally affects the longest nerves in the body first. The S1 and L5 nerves are the longest nerves and these supply the feet.
The nerve itself becomes “sick”- possibly from losing its blood supply (the vasonervorum) and starts to deliver ectopic messages. That is- the nerves produces signals for no reason. These signals typically are of a “burning” nature and are symmetrical (both feet equally). The symptoms typically increase at night and some patients complain of hyperalgesia (pain with just the covers touching the feet). Yes- diabetes is associated with this disorder but many patients have no apparent associated diseases that can cause peripheral neuropathy.
A disc herniation at L5-S1 can cause these symptoms but this is highly unlikely. Both S1 nerves would have to have equal compression for symmetrical symptoms and it is extremely unusual for the symptoms not to start in the buttocks and radiate to the feet.
Seek out a good neurologist as these specialists can diagnose this disorder with an electrical test and there are medications that can treat the 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: Revision Surgery #5198Your problem is very typical of long term results of this type of surgery. It has been well known that a long fusion down to L4 will eventually wear out the L4-5 level in approximately 10 years. That is exactly what happened. You had a fusion of L4-5 and continued your active lifestyle.
Unfortunately, the L5-S1 level will then eventually wear out and again, that is most likely what happened. The condition is called isolated disc resorption (see website). The pain that occurs is bone pain from lack of shock absorption. Symptoms initially develop with impact activity and after some months to years, delayed deep boring pain occurs some hours after the impact event. Patients will say they “pay” for the activity later. Eventually, night pain can occur that wakes the patient up.
If isolated disc resorption is the problem, the surgery is relatively standard. You may already have hardware in your back which can make the surgery easier. The procedure is called a TLIF and you can view a video of this on the website. If you have a flat back syndrome from surgery, this is a different matter and an osteotomy may need to be performed along with the TLIF. Yes I perform this type of surgery.
You can send your films to the office or you can call for an appointment at (970) 476-1100.
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.By your husband’s complaints, it appears that your husband has compression of the S1 nerve root at the L5-S1 disc. It is a possibility that the compression could be the L5 nerve root if the spur or herniation is in the foramen but that should not matter to you.
He already has had 3 epidural injections with only temporary relief and has had pain for over three months. He is in extremis (severe pain that prevents him from walking).
Based upon what you have told me, he should be a candidate for a surgical decompression of this level. Find a competent spine surgeon and get a consultation. Surgery should have at least a 90% chance of relieving a good portion of his 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: pain after surgery #5194Pain that improves with standing and walking is most likely not from foraminal stenosis or lateral recess stenosis. Burning/cramping pain is associated with chronic radiculopathy, more so if night pain is part of the symptom complex.
A selective nerve root block (lidocaine with steroid) can be helpful for symptom relief and diagnosis. If there are no compressive elements and the root is swollen or surrounded by inflammation, there may not be any surgery that can help. It may be worthwhile to get another pair of neuroradiologist eyes on the MRI.
If this turns out to be chronic radiculopathy, you may be a candidate for a spinal cord stimulator. You can have a trial (it is an outpatient experience) and if you like it, have the device implanted. There are occasions that if this is chronic radiculopathy, time with be helpful to reduce pain but that is not a guarantee.
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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