gm1973

Dear Dr

Thank you for your kind reply. I have another question following up from this.
I have had some pain injections done at T12-L2. These have helped with the back pain. I still seem to be experiencing sensory disturbance in the front and inside of my thigh that stops around the knee. It isn’t painful, more of a fuzzy sensation, if that makes sense. I also get some needle like stabbing sensations in the waistline between the navel and groin, on the path of the psoas muscle.
I suppose these are due to nerve irritation L1-L2?
I am worried about the leg sensations. My diagnosis suggests foraminal narrowing. On my scan, I can see a shadow that appears to be a piece of disc or bone material that has extruded at L1-2. Is it possible that this will be resorped over time? (What is the natural history?) Or am I looking at a surgery to fix that?

thanks as always

Dear Dr. Corenman

I had cause to contact you last year about an injury to my back and the subsequent post-traumatic kyphosis. I wonder if I could get your opinion on the following?

It seems my case was worse than originally thought. I fractured L5 this year and it was revealed to be an osteoporotic fracture which was surprising given my age. This was treated successfully with a kyphoplasty to restore the bone and a lumbar epidural to relieve the buttock pain that I was getting when standing up following the fracture. I am still awaiting treatment for the osteoporosis. The suspicion is that it is hormone related.

I was also diagnosed with early degenerative scoliosis and forminal stenosis at L2-L3 which was also a result of my original injury. I have had an L2-L3 xlif with lordotic cage and plate and that seems to have cleared up the referred pain from the stenosis very well. Now I am left with my original T12 injury to deal with.

About two weeks ago (which was six weeks post-xlif), I was putting out the trash and started pulling backwards on the wheelie bin. I had done this several times already without incident but on this occasion I felt/heard a click in the thoracolumbar area (I am not sure if it was the T12 or above or below). I was seeing my current surgeon for a follow-up that day and he punched me in the back a few times for a percussion test and it seemed negative. Okay I felt him punching me but it didn’t hurt. He said to report back if it gets worse and I can get an MRI.

However since the ‘click’ I have had severe mid-back mobility problems. All the problems seems focused in a halo around the T12. If I am standing or with a straight back, it isn’t too bad, but anything involving a slight trunk rotation or lateral bending is extremely stiff, painful and uncomfortable. Lying down used to be extremely comfortable but now getting out of bed or off the floor is really slow and difficult and is accompanied by a wave of pain that takes 10-20 seconds to dissipate. I tried swimming but found it difficult. Ibuprofen helps but I am reluctant to take it because of my fusion. I am not sure that I am any worse but I don’t seem to have got any better either.

Do these symptoms suggest anything to you? I wondered if it could be the facet joints but flexion/extension doesn’t seem too bad. The aggravation comes from rotation and lateral movement. How long would be reasonable to wait to see if symptoms improve before getting an MRI?

One other question if I may. The proposed treatment for my T12 is a reconstruction with expandable cage done through a lateral extra-cavitary approach. My surgeon wants to avoid it but I still think that I want my back to be straight. I don’t want to live like this for the rest of my life. How long is the recovery from such a procedure in your experience and how successful is it? I have been told that I would be off work for 6-9 weeks on one occasion and 6-9 months on another. And what are my prospects for returning to a reasonably active life-style again? I would at least like to scuba dive and ski again (sticking to the groomed runs only).

Thank you very much for your help. I bought your book and found it really useful.

Best regards

Dear Dr. Corenman

I would like to thank you for your time in reading and replying to my previous message.

In the last couple of months, I have been referred to another specialist and had a new CT scan.
The standing segmental kyphosis is about 32 degrees. Is that the same thing as cobb angle? Apparently I am not particularly out of balance sagitally but I do notice the more rounded shape of my mid-back. I find I get progressively fatigued during the day and frequently have to lie down.

The T12 is crushed into a trapezoid. The crush and kyphosis is more marked on the right versus the left. There is also marked degenerative change at L2/3 but also L1/2 and L3/4. Given the more widespread change, the specialist would prefer to avoid surgery since it should also include those levels and would be extensive.
I am curious what type of surgery that would be or what you might consider? From our conversations, I think the suggestion for the repair of T12 would be osteotomy or corpectomy of T12 with cage reconstruction done via transpedicular approach. I was a little surprised by that since I thought you would have to approach this level through the ribs. As for the lumbar region, what would have to be done in that area? I understand degenerative changes are common from age 30 onwards but I was shocked to see the black on the scans and the reduced disc space. I am aware that some changes have developed over years but is it also possible for trauma to produce a drastic change or acceleration in the degeneration?

Finally, do you have any opinion on how successful surgeries of this type are? I worry that I might be able to get by now but what about later life? So would I be better off doing something now and going through the recovery while I am still young and strong enough to do so?

Thank you again for your generosity and time.