Forum Replies Created
-
AuthorPosts
-
in reply to: Lower Back Pain #4933
You identify an L5-S1 isthmic spondylolisthesis with a grade one slip (0-25% slip of the vertebra on the sacrum). You also have wedging of the T11 and T12 vertebra.
The upper vertebral wedging is from Scheuermann’s disease when you were younger. The vertebral endplates were soft and you had some fracturing which deformed the vertebra slightly. I assume this is not painful to you and you can ignore this upper problem.
The pain you experience is most likely from the isthmic spondy at L5-S1. It would be unusual for this spondylolisthesis to slip further down the sacrum at this point as I assume you are at least 30 years of age. Depending upon the length of time of pain and the intensity of pain, there are various options form treatment.
Physical therapy to strengthen in surrounding core muscles can be very helpful. An epidural steroid injection or a “pars block” at the site of the old fracture can reduce the sensitivity of the nociceptors (pain nerves).
If you have failed conservative measures or you have weakness of the muscles of the foot (tibialis anterior) from compression of the L5 nerve root, you would be a candidate for fusion surgery of this level. The most typical surgery would be a TLIF (see website).
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 annulus just tears but the ends retract and the annulus becomes incompetent.
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.I would disagree with your PM&R doctor regarding injections. Epidural injections are the best single treatment for thoracic disc hernations in my opinion. The steroid can be delivered through a nerve block or through the posterior route depending upon the comfort level of the injectionist.
Don’t pay too much attention to the rib or the rib muscle mass. You will lose some mass and it really won’t matter to your function too much. You still have a complete tear in the annulus of the disc (see website under lumbar disc herniation as some of it applies to the thoracic spine as well). You could develop a recurrent disc herniation but that would be very rare.
You have picked two sports that do put significant G forces on the spine, skiing and diving. You now have to think in terms of risk. I don’t think your risk is very high with either sport but these two do increase the risk of a recurrent hernation.
You are correct that thoracic disc herniations do tend to calcify but lumbar disc herniations do too. It is just that the annulus is so much bigger in the lumbar spine that the calcification does not cover as much area as the thoracic spine does.
Before you consider competing in the Master’s division in diving or hard core skiing, you need to have fluid, strong and controlled movements to the complete end range of motion in your thoracic spine. If you have an impact or fall that can carry you beyond the normal physiological limitations of the thoracic spine, you have a chance of recurrent injury.
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 one of the rarer patients with a thoracic disc hernation. I see about 10 patients a year with a thoracic disc hernations compared to 300 lumbar and 100 cervical hernations.
I try to keep most thoracic disc hernations out of the operating room as the surgery to remove the herniation is extensive. The chest has to be entered and ribs are either stretched or removed which can lead to intercostal neuralgia. The other technique is to do a transpedicular approach which can occasionally lead to incomplete removal. None the less, there are times that a surgery has to be performed due to cord compression. There are some surgeons who use endoscopy to remove thoracic herniations and those results are mixed.
Epidural steroid injections can work well for these herniations. If there is no cord compression and in your case, it sounds like there is none, injection treatment can give relief. If you can be patient, in my opinion, 80% of patients with these herniations can have moderate to significant symptom relief over time.
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 Disc at L4-L5 and L5-S1 #4923OK- you have mostly lower back pain and that pain is increased with any mechanical maneuvers. The CT scan does not give great information on the health of the disc. It may appear that your L5-S1 disc is more degenerative than the L4-5 disc based upon the disc bulge. This may be more advanced than you can ascertain but do any of the endplates have fractures in them?
The weakness of lifting of the leg I will assume is when you are lying on your back and lift your leg up at the hip joint (flexion of the hip). You cannot resist the downward pressure of the doctor’s hand on your thigh. This is a result of weakness of the psoas muscle and would not be related to disc degenerative changes in the lower lumbar spine as the psoas muscle is innervated by much higher up nerve roots.
This back injury at 5 months of age is not improving. I hope you have already gone through a core strengthening program and Pilates. If not- that is your next stop.
The headache does not sound like dural irritation from the injection but from something else.
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.Sorry to hear of your injury, especially in the line of duty. Your report a fusion of L5-S1 and two revisions. I assume the two revisions were because of pseudoarthrosis- the lack of solid fusion the first time and the second timed around.
Your apparently have chronic pain as you need injections and narcotic medication. Please let me know if you have chronic back of leg pain or both.
You have unfortunately found out that narcotics do not work well for chronic pain. The body “adapts” to narcotics and these drugs eventually become less and less effective.
Chronic pain after surgery can occur because of a previously undiagnosed but possibly surgically fixable disorder or chronic neuropathy/ chronic radiculopathy. These two last disorders have to do with injury to the nerves themselves. An injured pain nerve will continue to send pain signals without a pain stimulus. This is like a short circuit in an electrical wire.
A new MRI might help to discern what the pain generator is but most likely is just the beginning of the workup. You can call my office at 970 476-1100 and ask for Diana or Sarah if you wish to send your MRI.
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
