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I can help with interpretation but a diagnosis requires much more that x-ray results. Loss of lordosis could be from degenerative disc changes or simply positioning when the x-ray was taken. It may not mean much.
Spondylosis simply means degeneration of discs or facets. It may or may not mean much. Disc spaces significantly narrowed means degenerative disc disease and would fit with loss of lordosis from degenerative discs.
Calcificantion of the posterior longitudinal ligament at C5 may mean an old injury, ossification of the PLL (a disorder more commonly seen in Asians) or a calcified disc herniation.
Again- x-rays are used in conjunction with a history, physical examination and other tests (MRI etc.) to come up with a diagnosis.
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: Still in pain after surgery #4687AP, lateral, flexion/ extension views are x-ray views to determine spine stability. Check the website for ALIF procedure and for foraminal stenosis. All the information you need is on the 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.in reply to: Still in pain after surgery #4685Lying prone on the floor (on your belly) causes extension of the back (backwards bending). Leg numbness in that position fits with the diagnosis of foraminal stenosis.
Again, to diagnose foraminal stenosis, AP, lateral, flexion/ extension standing x-rays, an MRI (with gadolinium if surgery was within a year period). If foraminal stenosis is identified, a SNRB (see website) with good relief will indicate that foraminal stenosis is present.
The three procedures that relieve formaninal stenosis are a foraminotomy, ALIF or a TLIF, depending upon the amount of collapse and how many prior surgeries have been performed.
Consult your surgeon to see what he thinks.
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: Still in pain after surgery #4682By your symptoms of pain with standing that becomes worse with bending back, you may have foraminal stenosis. Again- this problem is discussed at length in the website. The way to accurately diagnose this is with a highly selective nerve root block (see SNRB on website).
If the disc has collapsed and the foramen is narrowed, you could try to have a foramenotomy procedure as one of your surgeons suggests but the success rate for that procedure with a discal collapse is not as high as some others.
The TLIF procedure involving a fusion of this level uses the “cage” that some other physician has recommended. This procedure increase the height of the collapsed disc space to make more room for the nerve and is the best procedure for opening the foramen and increasing the space for the nerve.
If you did have a foramenotomy and the procedure was unsuccessful, you could always then have a TLIF procedure but that does possibly increase the chances of chronic radiculopathy (see website for this) from multiple surgeries and continuing compression of the nerve root.
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: Still in pain after surgery #4680According to your history, you had a laminotomy/ microdiscectomy at left L5-S1 14 years previously most likely for a herniated disc. You then re-herniated the same disc presumably on the same side 3 months ago. This is not uncommon as the recurrent herniation rate is about 10% in an active population.
You underwent a redo microdiscetomy at L5-S1 left and had no improvement after surgery and even developed symptoms in the opposite leg. A new MRI reportedly demonstrated no further nerve compression but inflammation only.
Some questions. Did you have any relief in the intensity of the left leg pain after surgery or did the pain change in quality or location? Does the pain increase when you sit and bend to tie your shoes or does it improve with those positions? Does the pain become worse with standing and walking or does it improve? Is the pain constant and does not change with any position and does it have a burning quality?
The reasons for those questions is that there are three potential sources of pain. One is that the pain source might have been not fully diagnosed. If you have foraminal stenosis (see website), you will have pain with standing that improves with sitting (the opposite of herniated disc nerve pain). The MRI will reveal foraminal stenosis if closely observed. This can be diagnosed with a selective nerve root block.
If there is a residual fragment of disc material that is still compressing the nerve, the MRI may also reveal it. Ask to review the MRI report from the radiologist. This report may be complicated, but it still can be interpreted.
Finally, you may have chronic radiculopathy. If the nerve has been injured by these recurrent herniations, after surgical decompression, the nerve needs time to heal. This occurs 90% of the time and heals by Mother Nature. Full healing is not always guaranteed and residual pain can continue. It may take 6 months to know if the nerve will heal. Epidural steroid injections are a good treatment as nerve inflammation is significantly reduced with these. Membrane stabilizers like Neurontin are also beneficial medications if there are minimal side effects.
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: c5-c6 c6-c7 bulges #4678By your description, you have herniations at C5-6 and C6-7 on the left with C6-7 being a larger herniation. These herniations would compress the C6 nerve (C5-6 herniation) and the C7 nerve (C6-7 herniation). Symptoms of a C7 herniation would be shoulder pain that radiates into the middle of the hand, weakness of the triceps, MCP extensors (straightening of bent fingers) and wrist flexion (bending the wrist down). C6 compression symptoms would be shoulder pain radiating into the thumb side of the hand, weakness of the biceps and wrist extension (bending the wrist up and important for grip strength). Neck may or may not be present- it depends upon the tear of the disc itself.
You have already had a very good conservative treatment program with chiropractic, physical therapy, traction and epidural injections.
There are new complaints of paresthesias (pins and needles) down the arm which concern you. Paresthesias are generated from the proprioception portion of the nervous system. This is the system that tells your subconscious brain where your body parts are in space.
Symptoms of paresthesias generally are an indication of nerve root compression and new onset symptoms are slightly concerning. The most concerning symptoms to me however are the generalized weaknesses of the muscles of the arm. This requires some explanation.
There are four nervous system functions carried by one nerve root. These are sensory (compression would cause numbness), noceceptive (compression causes pain), proprioception (compression causes paresthesias) and motor (compression causes weakness). All except the motor are pure sensation type transmitters. The sensory roots can cause these symptoms with only mild compression but the motor portion of the nerve root is much tougher and more compression is required to make it dysfunction.
When weakness develops from motor nerve compression, this means the compression is significant. The motor nerve root does not recover easily after compression and some patients even after decompressive surgery may not recover full motor strength. The nerves that are the most to least sensitive are T1, C8, C5, C7 then C6.
There are four indications for neck surgery, significant motor weakness, spinal cord compression, instability of the vertebra and intolerable pain. You have at least one of the indications.
In my experience, PRP will do nothing for symptoms of nerve compression. Epidural steroid injections are the single most effective treatment for pain but will do nothing for motor weakness. PT is very important for function but will not help motor weakness.
My opinion is that surgery for motor weakness is the best option. In the face of a disc herniation without neck pain, surgical options include ACDF or artificial disc (see website for discussions). Motor weakness with neck pain most likely requires ACDF only. There are no studies regarding how quickly the surgery needs to be performed but in my opinion, the quicker the nerve is decompressed, the better the chance of recovery.
Hope this helps.
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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