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in reply to: herniated disc L5/S1 Surgery #4467
It seems that you have undergone the appropriate treatment for your herniated disc at this point. You do not mention physical therapy, but I assume you have undergone that treatment without relief. I also assume there is no weakness in your leg as you probably would have undergone surgery before this point.
Your inability to sit is the most common complaint for this herniated disc. Sitting tethers the nerve root to the herniated disc and causes more pain. Most patients with a disc herniation in my office can almost be diagnosed simply by their desire to undergo the history by requesting to stand only.
Every surgeon has a different algorithm for recovery. There is an old saying that if you ask 10 spine surgeons for their opinions, you will get 15 different answers- but now I digress.
You must check with your surgeon but in my practice, you could travel 4 weeks after surgery with some significant stipulations. (Many individuals travel to Vail for surgery and go home in a week). Lifting is not allowed, so travel with a suitcase has some challenges. You must valet the suitcase and use no carry-ons. In my practice, you can use a stationary bike or get into a pool (but not the ocean) as soon as the incision is healed in 10-14 days. In the pool, you can walk but not swim (twisting needs to be curtailed for 3-4 weeks). Walking is encouraged but not hiking as uneven ground can cause twisting or stumbling- a problem for recurrent disc herniations.
If you desire, you could call Howard Head Sports Medicine at Vail Valley Medical Center- the physical therapy group I use to get a more complete description of the post-operative rehab protocol but check with your surgeon first.
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: mri results #4465Remember that the probable source of your mother’s pain is canal narrowing or spinal stenosis. An anterolysthesis in the radiologist’s eyes is most likely a degenerative spondylolysthesis. These two levels at L3-4 and L5-1 are therefore more likely to be associated with stenosis (see section of degenerative spondylolysthesis on the web site).
The radiologist mentions L3-4 where the “Central canal stenosis” is moderate to severe. He also mentions L5-S1 where foraminal stenosis is significant. Your mother’s symptoms could be from either level but foraminal stenosis causes lep pain in a specific pattern and not a general bilateral pattern. More likely than not, the stenosis at L3-4 is where the pain is generated.
Good Luck
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: pain in both calves #4463Your mother’s symptoms are consistent with neurogenic claudication caused by spinal stenosis. To make that understandable, this condition causes a significantly narrowed spinal canal. The spinal canal normally narrows in diameter by 30% with standing in every human on the face of this earth. We never notice it because there is capacious room in the canal with most individuals and 30% is never normally a problem.
However, with age, some individuals develop a narrowed canal. this occurs because of bone spur, a vertebral shift (degenerative spondylolysthesis), hypertrophy of the ligamentum flavum or a disc herniation (see website descriptions and pictures of this).
Treatment for this condition can be injections and physical therapy. Patients on anticoagulants, with proper care, can be temporarily taken off, given an injection and then placed back on. That is unless there is a significant danger posed to the patient by being off anticoagulation for 24 hours.
This condition can be treated surgically. A decompression laminotomy can be performed or an interspinous device can be implanted. There are times a fusion may be 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: On Coumadin prior to surgery #4461Any spinal injection should not be performed with anticoagulation. The risk of bleeding in the canal is increased which can cause significant pressure and possible nerve injury. Discograms are included in the list of spinal injections.
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.Just getting an MRI scan for back pain that is “not serious” without other significant symptoms doesn’t make sense. There must be more going on to require an MRI. Is the pain severe? Are you impaired with your activities or work? Do you have weakness or bowel and bladder symptoms? Has the pain persisted for more than three months without relief from physical therapy, chiropractic or medications?
You mention contrast injection with the MRI. Contrast (Gadolinium) enhances blood vessels and is useful if you have had a prior surgery or are suspected of having an inflammatory condition but is normally never used on the first MRI if either of those are not present.
The term “slipped disc” is a poor one for a diagnosis. The disc cannot “slip” as it is firmly attached to the bone of the vertebra. The top vertebra can slip on the bottom one but this is easily seen on an X-ray and can be made more apparent on flexion-extension X-rays. The doctor may think you have a disc herniation.
Ask your doctor why you need an MRI. He will probably be able to give you the indications for this imaging study. Ask why you need contrast also. Make sure the MRI machine is at least 1.5 Tesla strength. There are “open” MRIs that have much lower strength (0.3 Tesla) and many times, the imaging is poor and will need to be repeated.
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: On Coumadin prior to surgery #4457Surgery when on Coumadin is not advisable unless an emergency. As you already know, Coumadin (Warfarin) interferes with the clotting cascade. This cascade is important to prevent bleeding with injury or if a stomach ulcer exists. Patients on Coumadin most likely have a clotting disorder or have had a previous condition like atrial fibrillation or prior blood clots.
For patients undergoing elective surgery, the normal procedure is to stop Coumadin for about 2-3 days before surgery and start Lovenox- an injectable anticoagulant that has immediate onset and lasts 12 hours. This is then used for 2-3 days until the Coumadin has worn off and then the Lovenox is discontinued. 12 hours after being discontinued, surgery is performed. For spine surgery, normally Lovenox is started 24-36 hours after surgery. There is still a risk of bleeding at the surgery site.
Donating blood prior to surgery while on Coumadin is not generally recommended unless a serious reason is present for the need for blood.
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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