Jtal19305

De Corenman

I know I’m getting ahead of you with a lot of questions but a things came to my mind reading your last post. You indicate another surgery at t12 l1 is fraught with complications, and you mention the lateral portion of the procedure to remove other compressive elements. Why is such a surgery fraught with complications ? If something else had to be done to further decompress, is the risk too great ?

In my case the surgeon did not remove the bone spurs and the protruding disc annulus is still encroaching the canal. I wish I could email you a photo of sag and axial views and you could see what I mean. My spinal cord or canal actually bends somewhat across t12 and l1 due to the protruding disc there. So it appears the surgeon only decompressed from the posterior side with a laminectomy. Yes he removed the disc (the jelly like material inside) but nothing else was removed such as the bone spurs or annulus. I’m not sure if that is normal for my kind of procedure. I did have one doctor comment about the slightly bending or kinking cord as not a good thing. This doctor recommened further surgery to remove the bend by jacking up the space between the vertabrae (distraction) and he even suggested that a partial corpectomy would be beneficial to remove the bone spurs and anulus on the back side of the cord which could be causing more compression. Somehow he said he could do the procedure in two stages in the same day. One to remove the hardware from behind, the other to use endoscopic approach from the left side for the partial corpectomy and then re-install the hardware. He was a younger surgeon who seeemd very confident. I was not too eager to have such a procedure performed this early after my original surgery. I have had other doctors suggest to do nothing and that the bone spurs were there before are probably not hurting anything.

So I’m left with a constant diffuse burning pain in my feet mainly on the left but can affect the right foot at times and the pain works into the calves again left side being worse but occasional pain on right side. The pain seems flat lined; I have better and worse days but never been quite pain free days. It’s been almost 6 months post surgery.

This is where I hope the medical professionals at Univ of Miami Miller school of medicine can look over my case and images and give me a definitive opinion. I don’t have a lot of faith in my current doctor. He did x rays for the spinal fusion follow up but I don’t believe you can confirm fusion from X-rays. Also the x rays seemed too bright, over exposed, so I don’t know how valuable they are. I’m not sure why he did the flex extension x rays with me laying down and he did not order a thin slice ct scan.

I hope I have better luck with the folks at Univ of Miami. They first want to review my images and case before they agree to take me on as a patient.

Thanks

Hi Dr Corenman

Your explanation makes a lot of sense. I know that I had a disc bulge with bone spurs from the back (behind the thecal sac) that were not removed at T12/L1. I’m not sure why hey we’re not removed. Probably because the doctor did one approach from the posterior side and did not want to retract the cord to get to the Spurs. He may of felt it was not necessary since he removed all the lamina and other bone for the laminectomy. I know in his surgical report he did not call it a TLIF. I have a single incision down the middle of my spine for the T12/L1 procedures that is about 5 to 6 inches long. Then I have a much smaller 1 inch incision offset to the left slightly for the L23 hemi laminectomy.

Like I said I awoke with a burning pain in the sole of my left foot. This pain is still present but is less than right after surgery. I also still have calf fasiculations from time to time.

I’m trying to get an appointment with a major doctor at the university of Miami to have me checked out again. I’m afraid I cannot get objective diagnosis from my current doctor. My current doctor insists he did not have to touch or retract the cord to get the fusion cage in. He wants to order a new MRI. If I get into Miami, they may have their own set of diagnostics for my case. I just hear that most back surgery patients are better after about three months. I’m going on six months so this is why I’m concerned about my condition. I have the burning pain in my left foot still and pain and numbness in my left outer thigh. I also get pain in my calves. I just want to make sure nothing else can be done to help me. I am really at the mercy of the doctors now. I’m desperate to get better. I don’t want necessarily want another surgery unless their is complete consensus and the benefits are worth the risks.

Thanks for all of your insights
Jerry

I had a follow up appointment today with my doctor. They performed X-rays with me laying on a table curled up and bent back as far as I could both on my left side in addition to an X-ray laying flat on my back. I suppose those are the flex extension x Ray. I asked the tech why these were not done standing up and she did not have an answer. The doctor didn’t go over them in detail with me as I was his last appointment of the day and he seemed exhausted. I have the images on a cd.

After I mentioned the chronic burning pain in the soles of my left foot and neuropathic pain in my left calf and leg, he did not have an answer. I asked again about the surgical approach and he insisted that he did not have to retract the thecal sac to get the cage in. He also noted that many surgeons are now using a far lateral posterior approach for the thoracic spine versus anterior or side approaches. He also stated to me that he presented my case and images at a recent conference. I asked him to review my x rays for any instability and compression. He said he would order a current MRI with contrast of my spine and look over all the images then. He seemed confident nothing was off during his surgery.

This is the quagmire I find myself in. I have to use this doctor because he is handling my disability claim but I’m not getting the level of diagnosis that my pain deserves. He feels the pain will still go away in time. When I mentioned that the burning pain in the foot could be due to the cord being irritated during surgery, he was not in agreement but offered no other explanation. The PA mentioned that the pressure on the spinal cord was released and the painful feelings I have in my legs and feet are in response to that. I find that hard to believe and I did not have this pain prior to their surgery.

So I hope insurance approves my additional MRI. I will here him out but I’m really eager to find another doctor who will revisit my case objectively and with the detail it needs. I need a doctor that will go through my images in painstaking detail like that of the outside independent expert I hired. I really need to find another doctor that will provide answers and a path forward. If there is something wrong that can be corrected I would like to know this sooner than later. If nothing is anatomically wrong I would like to know this as well. This pain I feel is about constant and I know it is not normal. I can’t be the only out there who has this type of pain. There must be an explanation. Medical science and technology in the right hands should be able to solve this puzzle. I know nerves are complex and much is not known, however, this pain I have started right after the surgery. So this should be the first place to start looking at.

I’m trying to get an appointment at Penn Medicine but I have send my MRI and surgical reports with a brief history to them so they can decide whether they want to see me or not. It’s not an automatic appointment. This is frustrating because they may decide not to see me. I will have to wait and see. Well thanks for hearing me out and providing sound advice as I continue through this ordeal. I greatly appreciate your time and contributions toward my cause.

Jerry