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  • EMG Post Fusion, How accurate and a few questions

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    Old 10-26-2011, 07:24 AM   #1
    painnback
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    EMG Post Fusion, How accurate and a few questions

    Hi Everyone,
    I am scheduled to have an EMG on 11/28, I had a TLIF Fusion 3/15/2011 and had a complication of a fluid filled cyst developing under my L3 nerve, which I had to have surgically removed 8/31/2011, my L3 nerve is the nerve that was compressed by disc material pre-fusion, so my L3 nerve was compressed for a long time, after I had the cyst removed I was feeling a little better, my back had ached (right side only)as well as right thigh pain and burning, still had a little of these symptoms, as I became more active and started PT(Very light) My pain in my back has become worse again on the right side and having right thigh nerve pain and burning, it also runs through my rearend, which it did before, I start back to work 4 hours a day and are kept on the 4 hours until I can do more, Doctor gave me prednisone for a 5 day stint followed by Ibuprofen, I helped very little, I had an MRI 10/20 and a doctors appointment right after, he doesn't see any cyst formation and I do not have a disc at the L3-4 level, he removed that during the fusion and put in the metal spacer, so that can't be the problem, he said it looks like some scar tissue forming around the nerve and I probably have some nerve interuption(nerve damage i guess), he said that nerve would affect my back as well as my leg. He doesn't think the pain is related to recovery from last surgery, he said that should be well healed by now. So he uped my Neurontin and gave me a muscle relaxer Zanaflex, we also talked about a spinal cord stimulator, but he said we will have to talk more about that later in time, he said he will probably do a repeat MRI in a couple of months, my question to you who have had an EMG, how accurate was it at telling the doctor what was going on with the nerves and the DR doing the EMG said I did not have to stop the neurontin or the Zanaflex before hand, but I have read on the web that they can interfere with the readings? Any comments would be appreciated, thanks.
    __________________
    L3-4 Cyst Removal 8/31/11
    TLIF Fusion L3-L4 March 2011
    Micro-Lami L3-L4 March 2010
    Broad Based Disc Buldges L4-5, L5-S1
    Osteoarthritis
    Left Knee Surgery x2, Meniscus Tears, Arthritis

     
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    Old 10-26-2011, 07:57 AM   #2
    teteri66
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    Re: EMG Post Fusion, How accurate and a few questions

    I am very familiar with that right thigh pain, and I sympathize with you! Mine developed 24 hours after my PLIF at L4-L5.

    I was told that my nerve was probably permanently damaged and that it might not ever get better. I was told that my next step was a SCS trial. (I refused.) I was told that I had scar tissue causing the nerve pain. I was told I had arachnoiditis. I was told it might just be "as good as it gets" and I needed to learn to live with the pain. I saw spine specialists in 3 states to collect these words of wisdom. It took 2 more surgeries, but I got rid of the pain...and the nerve was not permanently damaged.

    The EMG will give a snapshot of the condition of the nerve at the time the test is given. The results are considered subjective, in part because the results depend on the experience of the person administering the test, and of the person interpreting the results. You can find out some information, but it doesn't really show you the condition of the nerve, or whether it is capable of healing.

    There is a relatively new form of MRI that is called MR Neurography that was developed to be able to study nerves. It was available only in southern CA but the doctor who invented it has recently been opening centers around the country. I don't know where you live so don't know if this might be an option for you. If interested, just look for Neurography - Aaron Filler.

    I did not have to stop taking any medications when I had EMGs...but I have no idea what the norm is in that regard. I personally don't think EMGs are all that helpful. It cannot provide the information we want to know -- what is wrong with the nerve, will it reconnect and start to work properly or is it going to malfunction like this forever?

    It is still fairly early in your surgery for the cyst. It may be that the nerve was badly irritated during that surgery and it will just take time for it to calm down and/or regenerate. I had many conversations with my surgeon about this topic. Apparently, the nerve itself can become scarred. When this happens, it continues to "fire" and continues to send off signals, but it isn't making the proper connection...so you end up with the brain interpreting these signals as PAIN.

     
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    Old 10-26-2011, 01:57 PM   #3
    painnback
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    Re: EMG Post Fusion, How accurate and a few questions

    I feel the same way of EMG testing from what I have read online, my doctor pretty much uses them all the time, I did ask him if it was too early to tell after surgery if the pain was from the surgery, it just seemed to me he was jumping the gun a little early, when the disc herniated the first time and discovered in 2010 it was compressing the L4 nerve root, but because of the way it herniated the 2nd time it was extraforaminal and compressing the L3, I often wonder if the 2 discs below are causing some of the nerve pain because they are buldging and after my fusion showing to be in the foramen causing a little stenosis, he said no because it fits the L3 dermatone, thank you for your thoughts on this, maybe the EMG might be able to tell him if more than 1 nerve is involved, I am also not sure if I would want a spinal cord stimulator down the line, I have a friend who has a daughter who has one for RSD is has done fine with hers, it would be a long time and other opinions before I would consider it, and I live on the other side of the country from CA so that special MRI would not be possible for me, My doctor is very thourogh and I think since I had the cyst complication wants to check all avenues and tests to make sure nothing else is going on.
    __________________
    L3-4 Cyst Removal 8/31/11
    TLIF Fusion L3-L4 March 2011
    Micro-Lami L3-L4 March 2010
    Broad Based Disc Buldges L4-5, L5-S1
    Osteoarthritis
    Left Knee Surgery x2, Meniscus Tears, Arthritis

     
    Old 10-26-2011, 04:25 PM   #4
    bracer
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    Re: EMG Post Fusion, How accurate and a few questions

    I've had three of those marvelous procedures to which you refer since my surgery in June and they all reached somewhat different conclusions. If you'd like more specifics, you can do a search of my posts or ask some specifics and I'll do my best to answer.

    To sum it up right here, it all depends on the doctor performing the procedure and how he/she decides to do the job. You can find out the general area of damage, the general amount of severity and not too much more. In some cases, more info can be discovered, but please don't go in expecting to know any exact info. You won't know when things will heal or even if they will heal. I heard fantastic news the first time, horrible news just 3 weeks later, and a prognosis in-between just a few days ago. Let your doctor decide what things mean. A patient trying to decipher an EMG/nerve conduction study is asking for confusion, false hopes and/or a boatload of anxiety.

    Of course, your mileage may vary. To me, that statement sums up the EMG.

     
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    Old 10-26-2011, 05:42 PM   #5
    teteri66
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    Re: EMG Post Fusion, How accurate and a few questions

    Bracer ~ I think you'd agree, to take your statement a bit further, not only can a patient not decifer the results of an EMG, but it also seems that most doctors aren't much better at it. When two doctors can look at the same test results, and come up with completely different opinions, I would conclude the test results are open to interpretation.

    painback ~

    The MR Neurography I mentioned is now available at about 20 locations around the country, and in London.

    Dermatomes are only a guide. Most of my issues appeared to be coming from L5-S1. Luckily the surgeon performed an open fusion and was surprised to see that the facet at L3 was worn down to a nub. This had not shown up on any imaging I had done, and would still be unknown if I'd had a minimally invasive procedure.

     
    Old 10-27-2011, 06:02 AM   #6
    painnback
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    Re: EMG Post Fusion, How accurate and a few questions

    Bracer, thanks for your input, I have followed your posts on here and I hope you will continue to get better. I was just trying to get an idea of what kind of results people on this board have gotton from the EMG test, I wouldn't even try to decifer what the test results mean, it's pretty much confusing to me, my doctor said it is only one tool in trying to figure out things, the doctor performing the test is my pain doctor who I haven't seen since last December, he is suppose to be highly educated in electrodiagnostic medicine so I am hoping that between him and my neurosurgeon they will know if it is just healing pain or if something else, I don't know how they can tell if it is scar tissue that is affecting the nerve, but I will leave that up to them.
    Tetonteri66,
    I will mention the MR Neurography to my neurosurgeon and see what he says, of course after he gives me the results of the EMG, also I'm not sure if he examined the L4-5 and L5-S1 levels during my fusion, I will have to ask him at my next appointment, I don't think mine was altogether minimally invasive, I have a midline incision of about 5 inches, maybe slightly more and 2 side incisions of about 3 inches and of course 2 small incisions maybe 1/2 inch above those on the left about the bra line, I know he took the facets completely out. Thank you for sharing with me your experience, thats why I come to this board, it is great to get other experiences, I often wonder if he should have done the level below as well but at the time of fusion the disc was just buldging some but was contained, now it is causing a little foraminal stenosis, according to my MRI. He thinks its not enough to be a problem so I am hoping the EMG will tell us if other nerves are involved.
    __________________
    L3-4 Cyst Removal 8/31/11
    TLIF Fusion L3-L4 March 2011
    Micro-Lami L3-L4 March 2010
    Broad Based Disc Buldges L4-5, L5-S1
    Osteoarthritis
    Left Knee Surgery x2, Meniscus Tears, Arthritis

     
    Old 10-27-2011, 10:24 AM   #7
    teteri66
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    Re: EMG Post Fusion, How accurate and a few questions

    Hopefully you will obtain the information you need. Nerves are very frustrating and unpredictable. Let us know what you find out!

     
    Old 10-27-2011, 02:19 PM   #8
    painnback
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    Re: EMG Post Fusion, How accurate and a few questions

    I will post what the results are, they have me on the cancellation list so I might get in sooner.
    __________________
    L3-4 Cyst Removal 8/31/11
    TLIF Fusion L3-L4 March 2011
    Micro-Lami L3-L4 March 2010
    Broad Based Disc Buldges L4-5, L5-S1
    Osteoarthritis
    Left Knee Surgery x2, Meniscus Tears, Arthritis

     
    Old 10-28-2011, 10:09 AM   #9
    bracer
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    Re: EMG Post Fusion, How accurate and a few questions

    Quote:
    Originally Posted by painnback View Post
    I will post what the results are, they have me on the cancellation list so I might get in sooner.
    I'd love to hear your results. Maybe we can compare what our doctors say and see how close their thinking is. I do know that if I take the EMG results as only a part of the diagnosis process, it makes a whole lot more sense. Hoping for results that will answer the big questions seems fruitless (unless you've been involved in some major trauma to the peroneal nerve or something like that). Please don't let me discourage you -- shoot, I'll be pushing for another EMG come April or so, but only for comparative purposes. The ones I've had so far have only sent me on emotional roller coasters. One doctor think this, another thinks that, they have the same info in some places and completely different in others -- it is so subjective that I think the doctor who did the actual surgery and have seen the same things before can really offer correct info.

     
    Old 10-28-2011, 03:12 PM   #10
    cheryl1213
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    Re: EMG Post Fusion, How accurate and a few questions

    I hope you get some answers...the type that say "we know it and we can help make it better"!

     
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