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Sent to Health Experts February 04 02:47 PM

I would like this question to go to Niraj Kalore if possible. If you remember me I asked you a question on 1/18/08 about grade one spondyloisthesis that I have. I want to clarify the pain, I have some aching in my ankle and weakness in the knee and ankle area, but it is not radiating. However the proublem is stading which I cannot do for more than five minutes. Last time we talked mostly about fusion. My first question will a discectomy work with spondyloisthesis and releave the pain. The second part of my question is not wanting to rush into unneccasary back surgery is that I am very bowlegged(knees manageable) but could the alignment of the legs going into the spine be causing my proublem?

 

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Male, Age: 60, Iowa

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Physcal Therpy, Cortizone Injections

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February 4 10:07 PM (7 hours and 20 minutes and 45 seconds later)
         
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DoogleNK -- Doctor (MD) -- 98% Positive Feedback on 1093 Health Accepts
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February 5 11:32 AM (13 hours and 24 minutes and 18 seconds later)
         
I agree that I think my pain is coming from the spondyloisthesis I guess my first question was could my symtoms be caused by the low legged knees as opposed to the back? On the second part where a laminotomy would not work due to instabilty a disectomy might , is that assumption correct? Thanks!
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February 5 12:02 PM (30 minutes and 2 seconds later)
         
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Hi Customer (name blocked for privacy),

Your problem-"some aching in my ankle and weakness in the knee and ankle area, but it is not radiating. However the proublem is stading which I cannot do for more than five minutes."-- can very well be caused by a knee problem. the description of bow-leggedness in your age is a very strong pointer to severe osteoarthritis of the knees with genu vara deformity. The weakness can be due to pain. This would also explain the difficulty standing. If there is no back pain then u should forget about the listhesis. A lot of people of your age would have Gr I listhesis.

I think that we are trying to bypass the clinical process of patient evaluation . This gives rise to loss of objectivity & accuracy in assessment. You should use the knowledge gained here for making informed decisions rather than to bypass the clinical evaluation process. I completely agree with you that ur symptoms could be due to the knee. i would advice standing anteroposterior & lateral xrays of both knees.

the second part--

First-- laminotomy, forminotomy or laminectomy or distraction laminoplasty or endoscopic technique are different ways of approaching the neural elements for decompression. A laminectomy removes entire lamina, foraminotomy removes only ligamentum flavum, distraction laminoplasty removes Lig. flavum & part of lamina & uses interlaminar distraction for exposure, a laminotomy removes only ligamentum flavum.

The ultimate goal of disc surgery is decompression of pinched nerve roots. Only those fragments of the disc, osteophytes, hypertrophied facet capsule or buckled ligaments that pinch roots are removed to ensure complete decompression.These root decompression surgeries are wrongly labeled as discectomies-which means excision of entire disc-- which is only done after a decision for replacement or fusion of disc is made.

Laminotomy or discectomy are not alternatives to each other. They are part of the same procedure.

The less destructive the decompression--the lesser will be the instability produced. And this can only be judged intraoperatively.

Hope this helps.

Thank you for asking your question on Just Answer.

Your follow up questions are welcome.

Dr.NK
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DoogleNK -- Doctor (MD) -- 98% Positive Feedback on 1093 Health Accepts
Professional online medical help - Orthopedics, General medicine
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