10 months post L5-S1 micro, still severe weakness

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ward
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March 18, 2014 at 9:00 am

Post count: 6

#10559

Had mild sciata on/off for several years, then out of the blue had severe rupture. One week later I had a L5-S1 microdiscectomy. I only had the weakness for the 1 week before the surgery. 10 months after surgery and still can’t do the single leg toe raise. Since I can’t push off when I walk, my calf is always sore, and I walk with a limp. My foot (heel and edge of foot) is still numb. I have some pins and needles, but I cant tell if that is from stressing my leg in unnatural ways when I walk. Surgeon says, be patient it will come back, but I’m getting worried. My strength has only improved a little bit since after the surgery.

I do not have sciata or back pain.

I have not had a MRI after my surgery.

My questions are this:

Is there anything that can be done to improve the chances of the nerve coming back and my strength returning?

Does it make sense to get a new MRI?

Is there another type of doctor I should see about this rather than my ortho spine surgeon, maybe a nuerologist or a physiatrist?

thanks

Donald Corenman, MD, DC
Moderator

March 19, 2014 at 1:35 am

Post count: 8660

#10564

The problem with motor weakness from a lumbar disc herniation is that it is impossible to determine what the damage to the nerve is. See “Nerve damage and healing” to understand how nerves heal.

The S1 nerve is the normal injured nerve with an L5-S1 nerve injury from a disc herniation. This S1 nerve goes to the calf muscles (gastroc-soleus) and allows you to tip-toe (walk on the ball of your foot). Since you cannot “push off” when you walk, I will assume that the calf muscles are weak and you have difficulty with “tip-toeing”.

The weakness in the inability to heel walk (cannot lift the toes when walking) is called foot drop and originates from the L5 nerve. This nerve normally is injured with a disc herniation from the L4-5 herniation.

In either case, weakness almost a year out is not a very good finding. The nerve might have been permanently injured even with surgery only a week out from the herniation.

You do need to exercise the muscle by using calf raises. These exercises can be performed on the stairs or step stool just by standing on the front part of your foot and letting your heel “fall off” the back of the stair or step. Simply raise your heel up as far as you can multiple times.

If this is too much initially, use a theraband (a large rubber band-like tool found at sporting goods stores. Hold the looped band around your forefoot and push the foot down as many times as you can. If the muscle is really weak, these therabands come in different durometers (stiffnesses). Use the most pliable to start.

Without leg symptoms other than weakness, I do not think you need a new MRI.

A neurologist can perform an EMG (electrical nerve test) to determine the health of the nerve but this will not help with healing, just prognosis.

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.

ward
Participant

April 30, 2014 at 1:42 pm

Post count: 6

#10853

Dr. Corenman,

Thank you for your reply. I found that doing the calf raises were too much, so I got the thermabands, and have been using them daily.

I have heard of some physical therapists using electrical stimulation on the calf muscle to help regain strength. Do you think this could possibly help in my case?

Thanks

Donald Corenman, MD, DC
Moderator

April 30, 2014 at 8:17 pm

Post count: 8660

#10856

Electrical muscle stimulation (EMS) can be effective after some time (maybe six to nine months). You do not want to use EMS in the early period (up to six months) as this might disrupt the nerve budding process that occurs with denervation. See “nerve damage and healing” to understand the concept of nerve budding.

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.

ward
Participant

June 4, 2014 at 1:27 pm

Post count: 6

#10951

Dr. Corenman

Several weeks ago, I started to get some moderate leg pain (1st time since surgery last May), so a went to a new Doctor (physiatrist) and got a MRI. Main MRI finding: “L5-S1 mild disc buldge eccentric to the left with superimposed broad based focal disc protrusion at least abutting the transversing S1 nerve roots. There may be posterior displacement and possible impingement upon the left S1 nerve root”.

So since then I havent had any more leg pain, but I still have the foot numbness which makes it uncomfortable (not painful) to walk. New Doctor said MRI findings would explain foot numbness and prescribed Epidural steriod injection to help with this.

Does this seem reasonable? Is it possible that the foot numbness is a permanent symptom due to the initial trauma to the S1 nerve when I originally herniated last May?

thanks

genwhy1
Participant

June 5, 2014 at 2:10 am

Post count: 16

#10953

Greetings …ward and Dr Corenman.

I had a procedure done…micro nucleoplasty that later failed.

Although all of my symptoms that we were trying to fix were on my left side/left leg, the post surgical bruising and inflammation caused me to have foot drop in my right foot.

My rehab guy picked up on it right away and use an electrical stim unit along with physical manipulation to help me reconnect the neuropathic signal to my foot so that once it realized it could communicate with the head, it responded well to rehab. It went away.

I still have my left side injuries that have been mostly untreated for over a decade….but hay is for horses.

Keep your mind fit and everything else will follow.

Putting the muscle back on can be rough and frustrating.

Hang in there and keep your thoughts positive, and remember that there are some real docs out there that do care.
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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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