SEEKING A SPORT MEDICINE MINDED DOC TO PUT ME BACK TOGETHER AGAIN

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Dangerous Donna
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November 25, 2014 at 11:49 pm

Post count: 19

#11781

I am a professional, ACSM fitness trainer for athletes, physicians and the corporate athlete for many years. Over the past 4 years, I have been searching for the answer to why no spine specialist seems to be able to put me back together again so my body may heal. I truly believe due to my advanced fitness level that I am not taken seriously. I have been working on repairing for 4 years now. I am performing with a L3-4 mild broad-based disc protrusion & small annular tear, a L4-5 moderate broad-based disc protrusion prominent on the right, grade 1 spondylolistheses & small annular tear & moderately severe central canal stenosis AND L5-S1 was ruptured but it took over a year to find a neuro that performed a laminotomy 2 years ago on the right of disc. However, my right leg continues with muscle atrophy and daily nerve pain and over last couple months the left leg is showing similar symptoms in same areas. So I am frustratingly perplexed on why I am walking around with all 3 discs still injured and no one has a clue what to do. I have seen 4 docs in Memphis. In addition, it was my research and suggestion to twice get a “upright MRI” in birmingham, AL because I was feeling more pain in spine over last 2 years. This past Oct upright MRI proved to show the L3-4 bulge which the physicians could not see on the lying MRI. My spine injury is due to extreme sports and being thrown off the back of a golf cart did not help the healing process. I greatly appreciate your time. Big thank you. I will travel for repair. ;)

Donald Corenman, MD, DC
Moderator

November 30, 2014 at 9:45 am

Post count: 8660

#11799

So-to sum up your symptoms and history, you have had a disc hernation at L5-S1 years ago and then a microdisectomy at that level. I am unclear if the residual weakness and atrophy stems from your previous nerve compression or from your current situation.

You have a slip at L4-5. I assume it is a degenerative spondylolisthesis but an isthmic spondylolisthesis is also possible. You have “moderately severe central canal stenosis” so this is associated with a degenerative spondylolisthesis. You have developed left leg pain in the last couple of months which is what I assume to be continued compression in the canal at L4-5.

An upright MRI is unnecessary and probably a waste of time as long as you have a good standard MRI. You will need flexion/extension standing lumbar X-rays.

Your problem is not mysterious nor is it a diagnostic dilemma. You simply need a good spine surgeon to diagnose you and plan the appropriate treatment.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Dangerous Donna
Participant

November 30, 2014 at 10:17 am

Post count: 19

#11801

Wow, I am appreciative of your quick response, moreover, while on vacation. In 2011, L5S1 extruded, L4L5 herniated. L3L4 could have been herniated at that time but Neuros did not see until this year. On initial injury, I could barely stand or walk on right leg. Did PT. Upon right calve muscle showing 1/2 inch of atrophy over 6 months and right leg pain never letting up went to second Neuro. This physician performed the surgery on L5S1. L5L4 was herniated then but not touched. Several weeks after this surgery the pain returned in back and right leg. Right Calve continued to atrophy and pain is a constant with standing and sitting with slight forward flexsion. No pain when exercising. I have flexsion and extension x rays taken again just this Oct. Thank you!

Donald Corenman, MD, DC
Moderator

November 30, 2014 at 8:44 pm

Post count: 8660

#11803

If you had significant leg pain over six months and associated atrophy, you might have developed a permanent nerve root injury prior to surgery. If you had pain relief after surgery but the pain had returned two weeks later, I am suspicious of a recurrent herniation at that level. If the leg continued to atrophy further, there was probably continued compression of that root.

Does the L4-5 level move (change in slip amount) with flexion/extension X-rays? How significant is the nerve root compression at this level?

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Dangerous Donna
Participant

December 1, 2014 at 4:46 am

Post count: 19

#11813

The L4L5 level xray comparison of Oct 2013 vs Oct 2014 shows no slip, no movement. I am happy about that. Both past Neuros looked at x rays and were in agreement of no movement.

Oct 2013 report L4-5: is severe bilateral facet joint arthropathy with grade 1 anterolisthesis. There is moderately severe central canal and bilateral foraminal stenosis.
Oct 2014 L4-5 report: grade 1 spondylolisthesis, severe facet arthrosis, moderate broad-based disc protrusion, more prominent paracentrally on the right, small annualar tear, moderately severe central canal stenosis and moderately severe bilateral foraminal encroachment.

Oct 2013 report L5-S1: there is disc desicaation an dmild reactive signal changes at the surrounding endplates. There is suggestio of prior right-sided surgery. There is a small, focal right paracentral disc protusion with questionable encroachment on the right S1 nerve root. There is mild to moderate bilateral foraminal narrowing.
Oct 2014 L5-S1 report: Prior laminotomy on the right. Mild braod-based disc protrusion, slightly more promiment on the right, bilateral facet arthrosis, mild right lateral recess encroachment, mild bilateral foraminal encroachment.

Oct 2013 L3-4 report: is disc desiccation and a circumferential disc bulge with a small annular tear posteriorly. There is mild to moderate central canal and mild bilateral foraminal stenosis.
Oct 2014 L3-L4 report: mild broad-based disc protrusion, small annular tear, facet arthrosis, mild bilateral lateral recess and mild bilateral foraminal encroachment.

Unfortunately, I also believe that nerve root injury is discouragingly permanent at this time. I went from partial plantar flexion of right foot to none. Moreover, I believe that continued damage is happening due to pain and healing is not able to take place. About 2 months after the 2012 L5-S1 surgery, I showed Neuro a place just above the surgery area where it felt like a knife was stabbing in the back. No advice was given.
I have followed every protocol that has been suggested: 3 properly spaced out epidurals, nerve stim unit, chiropractic decompression (25 sessions), acupuncture. This month of Dec I planned to have laser surgery on soft tissue by North American Spine using the Accurascope method. After reviewing my new x-ray and mri reports, N. American Spine turned me down. Back to the square one.
Thank you very much,

Dangerous Donna
Participant

December 1, 2014 at 4:50 am

Post count: 19

#11814

Oh! I also continue to get nerve conduction assessment. Have had 3 now I believe. Last one showed “slightly” more nerve conduction. I look at it as the body is trying to heal but there are other problems in the way.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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