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in reply to: L4-L5, L5-S1 MICRODISCETOMY SURGERY DONE #4866
You report lower back pain for 14 years. I assume that this is pain in the center of your lower back as if this pain radiates to one side (sacroiliac joint or buttocks), this may have different implications.
6 years ago you underwent a microdiscectomy at left L4-5 for a disc herniation and new onset left leg pain. This procedure relieved a percentage of your leg pain. I assume the surgery did not help your back pain.
Your pain returned. I assume this was return of left leg pain and the lower back pain did not change. You had a new left-sided herniation at the level below (L5-S1). You underwent another microdiscectomy at this new level and the results were not good. Your pain in the left leg is unchanged.
A return visit to the surgeon revealed “no instability” but a significantly narrowed L5-S1 disc space. This surgeon (same one as before?) then placed a titanium spacer in that disc space. This sounds like an attempt at a fusion but I cannot be sure.
You now are left with lower back and left leg pain that is disabling.
The diagnostic possibilities include a new disc herniation at the L4-5 level, a pseudoarthrosis at the “fusion level”, foraminal stenosis, lateral recess stenosis, implant stenosis, chronic radiculopathy, aggravation of degenerative disc disease at L4-5, arachnoiditis and infection. See website for explanations of these disorders.
Before you look for whatever the costs of treatment are, you need to have the correct diagnosis. A new consultation would be required by a different set of eyes.
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? #4864You note a rather large herniation at L5-S1 left causing left lateral recess stenosis and impingment of the left S1 nerve. You have had what sounds to be good rehabilitation care and have failed that care. The fact that you have no leg pain and no neurological symptoms is generally reason not to perform a microdiscectomy but there are some exceptions and you need to supply some missing information.
You note that you had no relief with epidural steroid injections. Was that long term relief only? Many times, patients who undergo epidural injections are not asked to keep a pain diary or pain log for the first three hours. This period is crucial for diagnostic information. The injection contains both a corticosteroid and an anesthetic like Novocain. The injected anesthetic temporarily “numbs” the structures in the canal and if you noted relief for only three hours, that piece of information would be important to know.
You don’t specifically describe your back pain. Is the pain in the center of your back or does the pain radiate to your buttocks or sacroiliac joint on one side? If it is central back pain, what makes the pain worse? Sitting vs standing vs lifting vs????
If your pain is central back pain, the disc herniation may still be causing your pain as it could be tenting the annular fibers which could cause the symptoms (see website). The pain could also be coming from the disc itself and the herniation is a red herring. You may be a candidate for discograms (see website).
Some surgeons do not consider surgery for lower back pain and if there are no neurological signs or symptoms and no leg pain, you would not be a surgical candidate in their eyes. Other surgeons do have surgical solutions for lower back pain. You may need another set of eyes to help 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.in reply to: HAVE PAIN IN NECK NOM #4863Please slow down to describe your history.
14 years ago you had your first laminectomy at L5-S1. You did well until March of this year when you lifted a keg of beer. You developed back, buttocks and left leg pain. You apparently had surgery again- I will assume another decompression laminectomy.
Your symptoms became worse and changed after surgery. By your description, the original symptoms intensified and new symptoms developed. Forgetting your neck symptoms at this point- did any new symptoms occur in your lower back, left leg or right leg? Do your back and leg symptoms become worse with standing or sitting? Do you have new pain in your right leg? What is the ratio of pain in your back to pain in your leg? Is your back pain worse than your leg pain in a 60/40 or 70/30 ratio or is it reversed?
The surgeon stated to you that there might be an infection present. Did he work that up to disprove it or could there still be an infection present?
The clumping of nerves in the spinal canal is from arachnoiditis. The surgeon identified arachnoiditis before your March 2011 surgery and thought that it was not causing problems. Does he now blame the arachnoiditis for your current symptoms?
You developed neck pain and arm paresthesias 3 weeks after your latest lower back surgery. Most likely your neck symptoms are from a problem in your neck and not related to your lower back. These symptoms could have developed from a preexisting problem that just surfaced, an aggravation of a problem from the intubation during surgery (preexisting foraminal stenosis that was aggravated by the extension maneuver necessary to intubate your trachea), or something else. There is an extremely rare possibility that if you did have an infection in your lower back disc, you could have seeded your neck with a new infection.
What does your surgeon propose as the next step?
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 #4859Arachnoiditis in the lower lumbar spine will not cause neck pain and arm symptoms. Why did you have L5-S1 decompression surgery? Did the symptoms get better after surgery or did they get worse? Have the symptoms changed? What did your surgeon say about your symptoms? When did your neck and arm symptoms start?
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 report, your weakness is very mild so I don’t think there is any significant danger in waiting for surgery within a couple of weeks. Again- a full laminectomy may be unnecessary and even in cauda equina syndrome (massive hernations) I have never found it necessary to perform a full laminectomy. Still- there may be situations that a full laminectomy is required so I don’t want to throw stones.
IF you want to Fed Ex your films overnight to the office, please call DIana or Sarah at 970 476-1100 and explain your situation. They will put my face in front of the images that day and I will give you a call.
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: microdiscectomy recovery #4854Most machines are not worth the money paid for them. There are some good one (Med-X and Cybex strengthening machines both come to mind) but most are not worth much for treatment. These machines are generally traction type machines like the DMX 9000, are very expensive and generally not very helpful. The “back2life” machine is an inexpensive traction unit that “rounds” the lower back (reduces lordosis). It would give temporary relief to some patients but with vertebral instability, this maneuver would increase mobility which would increase 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. -
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