Is having an L5 S1 related to having sciatic pains?

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Jerome0374
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June 21, 2014 at 3:57 am

Post count: 2

#11079

Dear Dr. Corenman.

Ever since I got a herniated disc in my L5 S1 area, I’ve been getting these excruciating pain in my
right leg. This usually happens whenever i try to do a 90 degree angle with my body (ex: bending over, sitting with my legs straight out). My doctor said it was the sciatic nerve that was pinched by the disc. This all happened due to kicking in karate. I don’t know if I should get surgery for it or go back to physical therapy. Going to physical therapy did help a lot, but the pain is still there that goes down my right leg and stop below my knee cap. Is this related to the herniated disc problem I have? Or it’s a different one?

Donald Corenman, MD, DC
Moderator

June 22, 2014 at 2:34 am

Post count: 8660

#11081

The S1 nerve is compressed from the front with a disc hernation. The S1 nerve travels behind the pelvis and attaches to the foot. The nerve acts like a cable on a pulley (the pelvis). When you bend forward or you raise your leg up, you lengthen the nerve. This pulls the nerve into the herniation which causes increased leg pain.

You probably feel better when you stand up or bend backwards. These two actions reduce the nerve stretch and therefore reduce the leg pain.

Surgery is indicated for three reasons; bowel and bladder involvement (rare and you do not have this-called cauda equina syndrome), motor weakness (which is also somewhat rare and you don’t note weakness), and finally pain that you cannot tolerate.

You fit into the third category. Then, timing of surgery is the question. In my practice, conservative measures are instituted for three months. These measures are therapy, medications, injections and activity modifications. If the patient has substantial improvement, then we continue on this path. If the patient has unacceptable improvement, then we tend to go to surgery.

By the sounds of your current complaints, you have continued unacceptable pain that you call “excruciating” when you bend your back or leg. This sounds like a surgical situation. There was one study that indicated surgery prior to six months from onset of event has a better success rate than after the six month period.

I have operated on many patients with pain from an HNP after this six month period with good results but there probably is some increased percentage of chronic radiculopathy (see website). Whether you want to undergo surgery is going to have to be your decision.

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.

Jerome0374
Member

June 24, 2014 at 3:27 am

Post count: 2

#11096

Is there any chance that you might know of what type of surgery they will do? Will they fuse my spine together or take out some parts of the disc due to the leg pain?

Thank You Dr. Corenman.

Donald Corenman, MD, DC
Moderator

June 26, 2014 at 6:42 am

Post count: 8660

#11101

If you only need the nerve root decompressed, then a simple microdiscectomy is all that is required.

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.

Anglosaxon
Member

January 10, 2015 at 7:13 am

Post count: 6

#11975

Dear Dr Coleman

Thank you for setting up this website.

I damaged my back (spasm QL) in Aug 13 and partially recovered via, painkillers and some chiropractor help. In early Sept 14 after going for a jog, my hamstring gave me some problems resulting in gradual severe pain from sitting down. After seeing a chiropractor and sports masseur and no relief, I was referred for an MRI and now have been diagnosed with a disc herniation and sequestered fragment that is impinging on S1 nerve.

The fact 5 months have passed do you think I should go straight for a Disectomy? and not mess with conservative treatment and injections.

Is there any possibility of recurrent of the disc herniation?
What happens to those part of the disc when the soft tissue being removed would it regrow or remain as empty ?

Will I recover in time to go skiing within 2 months?
Thank you

Donald Corenman, MD, DC
Moderator

January 11, 2015 at 12:55 am

Post count: 8660

#11982

If you have a disc herniation without motor weakness, I would try the epidural steroid first. If you have motor weakness, I would go with the surgery.

Recurrence of disc herniation is about 10% with or without surgery. The disc will not regrow and the space will remain empty. However, the disc will narrow to fill in the empty space like letting some air out of a car tire.

An epidural injection might allow you to ski in two months. A surgery if performed today will also allow you to ski in 2 months.

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.
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Donald Corenman, MD, DC

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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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