Jtal19305

I just want to add the burning pain in the sole of left foot started as very severe burning pain in what seemed like the whole bottom of the foot. Today, a little less than five months later, the burning pain is now mainly in the heel of the left foot and less intense but still very aggravating.

So is this an indication that the cord irritation is getting better? Is this something my body can come back from and expect to be “normal”? Or am I looking at a permanent injury? I imagine doctors avoid retraction for a reason but I wonder why my doctor would even entertain this surgery knowing any amount of retraction may cause permanent pain. He indicated the area was very compressed and he felt confident in time the pain would go away. When someone is in pain everyday like myself and I was not in this pain prior to surgery, you can imagine the frustration and concern I have. I am looking for a hope but also the truth on what to expect.

I also get some burning pain in my left calf. There have been fasiculations in my calves that started two months prior to surgery and I still have them but they come and go.

Since I am five months post surgery I would imagine the vertabrae are fused together. I understand it may be two years before that area is fully healed and I will not feel like myself until that time period.

Thanks
Jerry

The surgical report indicated that the surgical approach to t12 l1 was from a posterior latereal approach. I imagine it was far lateral as my incision in my back was 4-5 inches down the center of my spine. L2/L3 hemi laminectomy was about an inch incision slightly off to the left side of the center. For t12 l1 the surgical report indicated he did not touch the dura sleeve or spinal cord and no retraction was necessary to inset the cage. I also asked him this in person and he stated the same thing. Neuro monitoring was performed during surgery and nothing unusual was reported. The surgeon was entertaining an anterior approach but felt that approach had greater chance for issues

I’m not a surgeon so I would not know if the fusion with interbody 10 mm peek cage can be inserted without manipulation of the cord (thecal sac). Can you shed light on this? If it is likely he had to manipulate the cord would that explain waking up with the burning pain in the sole of my left foot? And does this get better or heal in time? I am dealing with multiple pain patterns that I’m trying to diagnose and find a solution. It’s hard to get feedback from my doctor as he is probably protecting himself and is biased. I want to believe him but why the protracted pain in my feet, back of calves and genital area. I also noticed from the ct scan that he did not remove any of the bone spurs behind the cord that are still encroaching the canal area. Although I’m decompressed from the posterior side, I don’t know if the Spurs are causing issues. I had one doctor indicate it would be too risky to get them from the posterior side as retraction would be necessary and they are so close to the cord. Also he stated if I have been living with them for so long, the may not be the issue.

I feel a little better with your assessment that fusion is preferred after that procedure I had at t12 l1 as the facet joint is removed and the area could become unstable. I also recall my doctor indicating I was slightly over kyphotic at that level and fusion would prevent any collapse. Other doctors indicated fusion should of been avoided and just do a plain laminectony or disectomy. I have also wondered why he didn’t approach from the side just to remove the bone spurs. I have good cat scan images (saggital and axial) of these spurs. Since the vertebrae are now fused, would the spurs dissolve on their own? I imagine the spurs were forming as the body’s means of self correcting an instability that was forming at my thoracolumbar spine. I did have slight curvature of the spine (scoliosis) toward the left (recall curve being not more than 15 degrees). Although scoliosis can cause rotation as well of the spine. I suppose my body found an equilibrium point for a while but eventually due to all these factors and a bad back due to genes things went south quickly.

So is it best to leave the hardware in place? I’m told by my physicians assistant that the fused vertabrae will be very strong. I understand adjacent segment disorder and I hope I can avoid it by keep healthy body weight and strong core. I’m only 48. Of course, this would be easier and so would my life if the nerve pain and foot burning fully resolves. So I take it the best thing to do is leave t12 l1 alone.

As for L23, I have not had post surgery standing x rays. Are these the flex extend 3 foot x rays? I have an appointment with my doctor who did the surgery so I will ask for these. I must admit I not feeling confident he has a good diagnostic plan for me. This is why I’m seeking outside opinions and help form other specialists. I have had post surgical mri and cat scan but not standing up if that is what you mean. I would imagine I am due for another Mri and/or cat scan. Is one better than the other ? Would a ct myelogram be better although I know doctors do not like to order these unless planning for surgery?

The pain in my left outer thigh comes and go; sometimes it is very minor while other times it is very numb and sharp. If it’s scar tissue adhering wouldn’t the pain be more constant? This is the area where I think I can find benefit but I must follow the appropriate algorithm to diagnose the issue. If it is determined to be punched by something other than scar tissue, is the approach directly over the existing incision or can it be a transforminal endoscopic approach? Or something else as to minimize more scar tissue and a procedure that can decompress that side ares without requiring fusion? I had one orthopedic surgeon suggest an alif st L23; I was skeptical.

I would love to visit your clinic but you are far away from me. I am looking at university of Pennsylvania spine doctors as I will be in that area soon. I am in south Florida now but cannot find someone with the attention to detail and knowledge such as yourself.

Does your clinic offer a service where mri / cat scans / reports can be reviewed with a telephone or Skype consult? I understand it’s best to be fully examined in person with new imaging but wanted to check. I appreciate your time and attention into my case. I’m ready to do anything to find solutions to my issues and get pain free. I believe if I have the right medical professionals working for me I would have a plan to solve this. I will keep at it until I have fully resolved this. I deserve to be better.

Thanks
Jerry