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in reply to: L4 vert break and bottom plate splintering #4877
The X-rays do not demonstrate a back fracture but a limbus vertebra. If you look carefully at the top of the L4 vertebra, you see a bone that looks like it split off of the top of L4 but it is a perfect triangle piece that would fit into the missing corner of the vertebra. You will also see that the L4 vertebra is wider than the L5 vertebra underneath it. These all have an explanation.
When you were younger, like all children, you had open growth plate rings at the top and the bottom of the vertebra. This is how your spine grew in height. One ring had a weak spot between the body of the vertebra and the ring. With a bend, a lift or a fall, you herniated a disc into one of the growth rings and split off a piece of the ring. Since this split piece was designed to grow, it did indeed continue to grow and that is what you see as the split off piece in the top corner of the vertebra.
The width or diameter of the vertebra normally gets larger with each lower vertebra being larger than the one above. If you look carefully, you will see that the diameter of L4 (the one with the limbus) is larger than L5 below it. The reason L4 is larger than L5 is that when you injured the L4 vertebra so many years ago, this injury stimulated more blood flow to L4 and it consequently grew larger than it’s lower neighbor, L5.
You state that you have significant lower back pain and right hip pain (I assume you mean the buttocks region and not the groin region). Most likely, you tore the annulus and possibly herniated a disc at the L4-5 level or the L3-4 level (both discs exhibit degenerative change on the X-ray).
If you have either one of these disorders, the typical treatment in my practice is an MRI, epidural injections and physical therapy or chiropractic treatment (see web site for descriptions of each). If there is pronounced muscle weakness, surgery should be considered.
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: cervical spine diagnosis #4874Please let me know where you primary pain is, your secondary pain and even the location of other associated pain. Do you have central neck pain that radiates into the shoulders or primary shoulder pain? Is your pain worse in the morning or at the end of a work day? What activities make your pain worse and better?
The trapezius muscle is the most common place for referral pain originating from the neck. This muscle rarely causes pain by itself.
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: cervical spine diagnosis #4872Thank you for sending your MRI reading for my perusal. MRIs are used as imaging to understand the physical changes in the neck but do not diagnose a disorder. Your symptoms need to be discussed, how the symptoms occurred and how they interfere with your life to help understand what your MRI notes about your neck.
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: Return to sports after microdiscetomy #4870Sorry for the delay. You are considering a microdiscectomy for an L4-5 herniation for lower back pain, right leg pain and foot drop. Foot drop is related to an L4 or L5 nerve root compression. In general, any significant motor weakness should be addressed surgically soon. The best chance for useful strength return is with a timely decompression. The right L4-5 herniation is compressing the L5 nerve root and the microsurgery is indicated.
The second question has to do with return to high-level sports. Your spine has three levels of degenerative changes (L3-S1). This to me indicates a genetic predisposition for tears of the annulus. These degenerative discs by themselves do not rule you out for competitive sports but does indicate that you will have problems with your back as you do now.
The recurrence rate for herniations is 10%. A small thin layer of scar tissue does cover the annular hole where the disc extruded from. The volume of the nucleus is reduced from both the herniation and the surgery which most likely prevents further herniations.
Back pain from the degenerative discs can be controlled with core strengthening. I understand you need explosive push-off strength for pole vaulting but dead lifts and squats place high shear forces on the lower two discs. You might consider other methods to gain gluteus, quad and hamstring strength. Hyperextension for the takeoff in pole vaulting places greater stress on the facets and unloads the discs. Without a history of a spondylolisthesis, facet arthrosis or facet fracture- this position should not cause concern.
In regards to flat landings with snowboarding, this maneuver causes significant loading to the lower discs and the thoracolumbar junction. I can’t tell you how many fractures I see from this very mechanism. Great care needs to be taken to assess the landing and how much velocity is needed to reach it safely. If you land flat from a high jump, you do not escape Newton’s laws.
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: severe back pain at l5/S1… No Surgery? #4869When you note “hip” pain- where exactly is this hip pain. Is it where your back pocket would be when wearing jeans, where a holster would hang if you wore a gunbelt or in the groin area in front of the thigh? There are occasions that hip disorders can refer pain into these regions. Did you also have a hip work-up?
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: HAVE PAIN IN NECK NOM #4867You now have both increased left and new onset right leg pain after a decompression surgery of the lumbar spine. The differential includes recurrent herniation, lateral recess or foraminal stenosis, instability, infection, chronic radiculopathy, aggravation of arachnoiditis or iatrogenic injury. (see website for explanation of all diagnoses)
Have your surgeon go through the various possibilities. There is an answer and with careful workup, the answer can be found.
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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