Discusión entre pares / 65/M backpain for 10months and right S1 radiation for 5months, with S1 dermatomal hypoestesia...

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Ramachandran Govindasamy

65/M backpain for 10months and right S1 radiation for 5months, with S1 dermatomal hypoestesia and absent ankle jerk. Failed conservative! Management options? Discectomy Vs Fusion!?

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  Ramachandran Govindasamy Srinivas Daravathu sir opinion?

  Ayer a las 8:23 · Me gusta
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  Srinivas Daravathu Fusion with decompression

  Ayer a las 8:26 · Me gusta · 1
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  Srinivas Daravathu Dr Ahmad Fayyaz Bajwa,ur opinion pls

  Ayer a las 8:26 · Me gusta · 1
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  Awaad Mohamed Elkholy TLIF L5S1

  Ayer a las 8:33 · Me gusta · 1
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  Abhishek Sarraf if back pain is too much tlif can be considered otherwise MED or microdicectomy.

  Ayer a las 9:06 · Me gusta · 1
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  Guevara Hamo Microdicectomy no need for fusion if there is no instability

  Ayer a las 9:35 · Me gusta
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  Ramachandran Govindasamy Guevara Hamo How do you consider instability? By radiological criteria or clinical criteria????

  Ayer a las 10:06 · Me gusta
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  Srinivas Daravathu Lateral Flexion extension X-ray views is a must

  Ayer a las 10:11 · Editado · Me gusta · 1
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  Arvind Verma Jangid dissectomy and fusion

  Ayer a las 10:17 · Me gusta
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  Ramachandran Govindasamy X rays posted are flexion and extension ones....

  Ayer a las 11:46 · Me gusta · 1
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  Abhishek Sarraf i think its a stable joint as we can see in flexion ext view,no full facet sign,disc height is less ,facet joint orientation ...so m still in favour of med.

  Ayer a las 12:01 · Me gusta · 1
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  Ramachandran Govindasamy Abhishek Sarraf What do you mean by MED ???

  Ayer a las 12:14 · Me gusta
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  Jwalant Mehta Can you put up a t1 weighted image to know type 1 or 2 modic changes. Pain in back as well or radicular?

  Ayer a las 12:32 · Me gusta
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  Vishal Gupta L5-S1 microdiscectomy

  Ayer a las 12:44 · Me gusta
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  Sanjay K Rajan Failed Root Blocks too?!
  
  ...now that's a decent option in such cases.
  
  If that too fails a simple micro discectomy will sort out the issue. One may add facet blocks (as there is facetal arthropathy) if the back pain is characteristic of facetal origin.
  
  If the back pain is of mild-moderate grade, it should resolve simultaneously as there is no evidence of instability to warrant a fusion/fixation (atleast from the info made available to us)

  Ayer a las 13:21 · Editado · Me gusta
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  Abhishek Sarraf micro endoscopic discectomy or microdiscectomy

  Ayer a las 13:08 · Me gusta
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  Sanjay K Rajan Either one Dr Abhishek

  Ayer a las 13:09 · Me gusta
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  Vishal B Peshattiwar Tlif mis or open

  Ayer a las 13:11 · Me gusta
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  Abhishek Sarraf why tlif Vishal B Peshattiwar sir

  Ayer a las 13:13 · Me gusta
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  Vishal B Peshattiwar End plate change on the mri and back pain

  Ayer a las 13:15 · Me gusta
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  Ramachandran Govindasamy Initially, I was planning for Micro discectomy when my PG brought the case as S1 radiculopathy alone. But when I spoke with the patient he was very particular about the backpain, he wants it to be releived more than the leg pain and numbness. His pain is more of instability in nature clinically aggravated on sitting for long time, with movements of back, extensor catch etc.. Can I relieve his back pain with simple discectomy? Is the back pain because of the prolapse or because of abnormal mobility happening because of sclerosed end plates, which are not going for autofusion?

  Ayer a las 13:17 · Me gusta
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  Ramachandran Govindasamy Jwalant Mehta sir. will post the T1 image tomorrow

  Ayer a las 13:18 · Me gusta
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  Sanjay K Rajan As was stated...if back pain is the prominent symptom...then fusion should be offered.

  Ayer a las 13:19 · Me gusta · 2
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  Vishal B Peshattiwar With his back pain a fusion might be a better option.

  Ayer a las 13:20 · Me gusta
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  Vishal B Peshattiwar Abhishek Sarraf sag cut shows a listhesis

  Ayer a las 13:21 · Me gusta
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  Abhishek Sarraf totally agreed...does any one think such modic change can be due to infection..

  Ayer a las 13:23 · Me gusta
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  Sanjay K Rajan Why propose TLIF as the means of fusion folks?
  
  ...any pressing need for opening up an already severely collapsed disc space & then jacking it up and then placing a cage?....or can't a simple fixation with ITF (Inter Transverse Fusion) rather than IBF (Inter Body Fusion) suffice in this elderly male with a low demand back?

  Ayer a las 17:16 · Editado · Me gusta · 1
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  Abhishek Sarraf Jwalant Mehta sir why you wanted to see t1 image ...i mean how was it going to change your plan

  Ayer a las 13:25 · Me gusta
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  Jwalant Mehta Type 1 or 2 modic changes. The threshold for fusion should be much higher than it is.

  Ayer a las 13:30 · Me gusta
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  Abhishek Sarraf Jwalant Mehta Vishal B Peshattiwar sir do you think patient will be relieved of back pain after tlif/plf in this case.

  Ayer a las 13:33 · Me gusta
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  Vishal B Peshattiwar What Abhishek Sarraf can you offer which is better?

  Ayer a las 13:38 · Me gusta
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  Abhishek Sarraf no sir i was just confused so wanted to take opinion from senior faculty that how to proceed in such kind of cases..i will go ahead with tlif only....

  Ayer a las 13:43 · Me gusta
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  Vishal B Peshattiwar No black n white here buddy Abhishek Sarraf. Jwalant Mehta sirji your thoughts to guide us on this?

  Ayer a las 14:36 · Me gusta · 1
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  Vishal B Peshattiwar Lots of shades of grey!!!

  Ayer a las 14:37 · Me gusta
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  Jwalant Mehta Need to differentiate back pain and leg pain. Back pain can be treated in various ways. Fusion is the last resort. You can promise relief of leg pain but not back pain

  Ayer a las 14:45 · Me gusta · 4
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  Jwalant Mehta More when we meet in Pune

  Ayer a las 14:45 · Me gusta · 1
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  Sanjay K Rajan Any opinion on the type of fusion Dr Vishal, Dr Mehta, Dr Abhishek in this elderly male with a already largely collapsed disc space and a low demand back?
  
  Will ITF (Inter Transverse Fusion) suffice or is IBF (Inter Body Fusion) (TLIF) must?

  Ayer a las 17:28 · Editado · Me gusta
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  Ramachandran Govindasamy T1 image Jwalant Mehta sir. Modic 1 changes

  

  22 horas · Me gusta
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  Ramachandran Govindasamy

  

  22 horas · Me gusta
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  Ramachandran Govindasamy A much better stress X ray

  

  22 horas · Me gusta
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  Vishal Garg Micro Discectomy. Fusion only if there is instability

  22 horas · Me gusta
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  Vishal B Peshattiwar 65 in my opinion isn't old unless physiologically he is infirm. I would try to restore disc height with a good sag n coronal balance. How is the axial at l45?

  19 horas · Me gusta · 1
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  Jwalant Mehta The thresholds for doing a micro disc and a fusion are very different. If the problem is radicular then do a microdsic and not even talk about a fusion. If the problem is of back pain then put the patient through a non-op process for at least 6 months, maybe more. Then talk of fusion but have a high threshold for doing it. Surgeons take a fusion lightly just because of the perceived benefits of doing it MIS etc....there is more to it than just a few screws and a cage.

  12 horas · Me gusta · 5
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  Jwalant Mehta It is always possible to do a micro disc....do the rehab for a year or so and only then go for the fusion....MIS or open is another matter.

  12 horas · Me gusta · 3
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  Jwalant Mehta Type 1 modic changes and a positive disco gram have a high PPV as a pain generator. (Type 1: nonfatal; type 2: fatty and type 3: sclerosis)

  12 horas · Me gusta · 3
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  Ahmad Fayyaz Bajwa Decompression n fusion.. or Plif

  10 horas · Me gusta · 1
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  Dr.Nikhil N.Joshi I think patient has got rt sided foraminal and lateral recess compression. If this is aggreable by all then microdiscectomy may not be sufficient to relieve his leg pain. Same is true for intertransverse PLF. My choice would be TLIF considering modic changes and his age... open or MIS depends on budget....my choice MIS TLIF..

  19 min · Me gusta