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  • AvatarDonald Corenman, MD, DC
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    Post count: 7481

    As long as you have a solid fusion, manipulation of the SI joint by a chiropractor can be helpful. You can even try it before an SI injection.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    I am somewhat confused. You note first a decompression at one level (L5-S1) then a fusion I would imagine due to recurrent herniation or collapse. 3 years later, a pseudoarthrosis was noted???? (“revised fusion”) and now the fusion extends to T10??? Why? Did you have a degenerative scoliosis that was getting worse?

    Then “within the first 9 months post op of that I developed pain in my mid back where I never had pain”. This can occasionally happen spontaneously above a 7 level lumbar fusion but possibilities of adjacent segment breakdown, increased thoracic kyphosis or surgical mal-alignment are possibilities too.

    Diagnostic blocks should be considered before ablations are considered. These might include selective nerve root blocks or facet blocks.

    A 4 level cervical fusion sounds like it was helpful to you. Would you agree? What was the surgery for?

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Your pars defect at left L5-S1 is possibly related to a spina bifida occulta (SBO) but there is generally an intact pars with an SBO. It appears if I read this correctly that you have a floating left facet (not connected). You note; “The follow-up CT scan (2/4/20) agreed with the MRI findings regarding herniation but also revealed a “Left L5-S1 spondylolysis.” (later explained by the Neuro as an elongated pars interarticularis) and “bony gap/defect right lamina of S1 resulting in an independent S1 posterior spinous process and left lamina, not contiguous with the rest of the S1 lamina.”

    The microdisectomy was most likely successful as you experienced leg pain relief. I am worried about the stability of that side if your facet is not supporting the left. This could lead to foraminal collapse or lateral recess stenosis recreating left buttocks and leg pain. You do need an updated MRI to rule out seroma or recurrent HNP but even standing 4 view X-rays can be helpful to look for angular collapse (the AP) or slip (the lateral and flexion-lateral).

    Let me know what the new MRI notes.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    MRIs don’t live in a vacuum. I need to know why you had the MRI performed. There is a clue (“Pain across her bra line into the right anterior rib cage” in the report above), but you have had fusions of the cervical and lumbar spines. What symptoms were you having before these procedures, how did these symptoms change and what symptoms are you having now?

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Your back pain is not atypical for the aftermath of a large herniation in the lumbar spine. About 10% of individuals with a disc herniation will develop chronic lower back pain. You might be a candidate for a fusion but you need a workup to determine the pain generator. This includes standing X-rays, an MRI and a diagnostic block to help indicate what is painful. Treatment could be a simple as physical therapy, chiropractic care or injections. Depending upon the source of pain, radio frequency ablations, or even fusion surgery can be quite helpful.

    Your new complaint; “For the past 4 to 5 weeks my left arm has been aching extremely bad. i have never felt this pain before…but what scared me is earlier today the ache was accompanied with the loss of the use of my arm (lifting it) and my index finger and thumb were numb. I got the feeling back, arm is still weak”.

    This sounds like either a radiculopathy or Parsonage Turner syndrome. Both of these would not be related to your lower back but commonly, the genetics of this disorder in your lower back are similar to the genetics of your neck. See: https://www.neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/, https://www.neckandback.com/conditions/parsonage-turner-syndrome-neck/ and https://www.neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ (the C6 nerve).

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Meralgia paresthetica is uncommon but not rare after spine surgery. It is more uncommon with an ALIF (anterior lumbar interbody fusion) as you normally are lying on your back during the procedure. This position (as compared to lying on your stomach) does not pressure the front of the pelvis where this nerve (lateral femoral cutaneous nerve) lives. There are occasions where an injection of some steroid over the nerve can be helpful and rare occasions that a surgical decompression can be helpful although I have never had to refer a patient for that procedure.

    “The other issue is one I have had since before surgery and that is pain in my left waistline/hip/SI region. It is basically a deep ache, and a somewhat painful grinding feeling when I flex up my leg and return it to normal”. This could be from the hip on that side, a pseudoarthrosis (lack of fusion), especially if you did not have screws from the back of the spine to “back up” the ALIF, or more uncommonly, the sacroiliac joint.

    The hip is diagnosed by an examination and diagnostic injection, the pseudoarthrosis by X-eays and a CT scan and the SI joint by a diagnostic injection.

    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.
Viewing 6 posts - 13 through 18 (of 7,480 total)