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in reply to: pain after spinal stenosis op. #4663
From my understanding, you have foraminal stenosis at L5-S1 on the right at the previously decompressed level and a ganglion cyst that has reformed on the left side. The right leg pain is significant and the left leg pain is mild.
One surgeon has recommended a right sided foraminotomy (which is really a laminotomy and foraminotomy) and the other has recommended a laminectomy which is a bilateral decompression with removal of the entire lamina.
You state that the x-rays do not note a slip or instability which is good. There probably was no mention of the angulation of L5 on S1 on the front to back (AP) view. This is important as an angulation of greater than 5 degrees can have an adverse affect on outcome with a simple decompression.
Foraminotomy at the L5-S1 level is a reasonable procedure but has a not insignificant recurrence rate. A full laminectomy is probably not necessary but I do agree that this procedure will have a better chance of a more complete foraminotomy.
There are two questions I have. First- how insignificant is your left leg pain? The recurrent cyst on the left is bothersome as if you have current left sided symptoms, you might ask the surgeons if that cyst should be addressed. The cyst has the capability of growing larger again and causing problems which might make you consider doing something about it while under only one anesthetic.
The other is the reason for the foraminal stenosis on the right. Is it from a disc herniation, a spur off the endplate of the vertebra, from a bone spur off the superior facet of S1 or from a collapse of the L5-S1 disc on that side only? The chance of recurrent foraminal stenosis can increase with unilateral collapse or a far lateral disc spur that may be difficult to completely remove.
“Failed back surgery syndrome” (FBSS) is a poor term as it indicates a failure of surgery but without the reason for failure. If you had a foraminotomy and the foramen re-narrowed, this would be failed back surgery syndrome but the problem could be fixed with another surgery. If the surgery successfully decompressed the foramen but you had continued nerve pain, this would be chronic radiculopathy.
If either surgeon is technically very good, you would be in good hands with either surgeon.
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: Spinal x-rays #4660We all need to be aware of x-ray exposure. Certainly, significant exposure can increase the chance of certain types of cancer. Your exposure for this lower back series by itself is probably no need for concern. Certain populations have a greater exposure by location or by occupation.
For example, I live at 8000 feet altitude which increases my exposure of naturally occurring radiation and airplane pilots have a significantly increased exposure by “living” at 35,000 feet for a percentage of their lives and incidence of cancer is not significantly higher.
Just be aware and ask if the test is really 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: Spinal x-rays #4657Standard X-ray series for lower back pain varies from doctor to doctor. The very basic X-ray series is an AP and lateral lower back image. This will give basic data on disc, alignment and degenerative changes. If the series is performed in a standing position, so much the better as now there is evidence of gravity’s affects the spine.
I include a standing flexion and extension lateral x-ray for a 4 view series as instability can be determined by these additional X-rays and cannot by any other means.
The scoliogram X-rays (full spine front and back view) are normally reserved for patients with deformity by examination (scoliosis, increased kyphosis, old fractures). In the States, it is not common for those images to be included unless suspicion of deformity or imbalance is suspected.
I do not use oblique films much anymore as these are designed to look at the pars of the vertebra and rarely yield much new data.
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: Neck Pain for over 3 months #4655I cannot recommend anything as the information is incomplete. You need a consult from a good spine surgeon who can put all the pieces together including history, physical examination, review of all images, tests, consults and anything 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.in reply to: Neck Pain for over 3 months #4653Two images are never enough to diagnose a problem. The images are at the C7-T1 level and there may be no pathology, cervical ribs or ??? I’m sorry but I can’t help you with such limited data.
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: Neck Pain for over 3 months #4651You complain of neck, shoulder and arm pain into the hand bilaterally- left greater than right. You also complain of numbness at night that awakens you in your upper extremities. You also mention an EMG/NCV test by a neurologist and an MRI but do not reveal the results.
Your symptoms could be anything from thoracic outlet syndrome to malabsorption syndrome to peripheral neuropathy to radiculopathy to rotator cuff inflammation to Parsonage Turner syndrome. Your information does not differentiate between any of these diagnoses.
You mention something abnormal on the MRI that was overlooked but do reveal what that finding is. Much more information needs to be supplied.
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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