Concern of long-term nerve damage.

Tagged: Prior lumbar fusion surgery with old and new symptoms

Viewing 4 posts - 1 through 4 (of 4 total)

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4thLumbar
Participant

August 30, 2017 at 7:26 am

Post count: 3

#26239

Dr. Corenman,

I underwent a PLIF on my l5-s1 in 2012 and have been struggling with pain ever since.

A few weeks ago I began to get full foot numbness and just found out I have a new herniation (extrusion) at my l4l5 and my l3l4 disc is not doing so well.

Below I have pasted the findings for those discs.

I am curious about your opinion as to whether you think that conservative methods will help or likely lead to surgery (note I have had 1 injection a few days ago and 2 steroid packs and no change). I know that everyone is different just want to get your feedback on how bad the problem is in the description below.

Thank you,

———————————-

LUMBAR DISC LEVELS
L3-L4: Disc desiccation and loss of disc height. Moderate central and right
paracentral disc herniation/protrusion with moderate narrowing of the right
lateral recess and to a lesser extent central canal maximal sagittal diameter
of thecal sac approximately 6 mm. Mild bilateral facet arthrosis, greater left
than right. No left neural foraminal or left lateral recess stenosis

L4-L5: Disc desiccation and loss of disc height. Left paracentral moderate
disk herniation/extrusion which is new since 4/28/2015 with effacement of the
left lateral recess at this level, superimposed on moderate diffuse annular
bulge. There is also mild narrowing of bilateral L4 neural foramen. Moderate
bilateral facet arthrosis
L5-S1: Prior left L5 hemilaminotomy with partial facetectomy. Prior L5-S1
discectomy with interbody fusion cage. Moderate narrowing of left L5 neural
foramen by a ridge of osteophyte. No significant central canal or right neural
foraminal stenosis

Donald Corenman, MD, DC
Moderator

August 30, 2017 at 7:58 am

Post count: 8660

#26241

Did you have this initial nerve pain after your PLIF or before (as the reason for the surgery) and the pain did not improve after surgery? Your new pain is I will assume left sided as you don’t identify the side in your report. What side was your post-PLIF pain?

You have continued to have L5-S1 left foraminal stenosis after your fusion (“Moderate narrowing of left L5 neural
foramen by a ridge of osteophyte”). This possibly could be a cause of your continued pain post PLIF.

You have a new herniation at L4-5 compressing your L5 root here (“Left paracentral moderate disk herniation/extrusion which is new since 4/28/2015 with effacement of the left lateral recess at this level”) which can cause left leg pain and possibly motor weakness. See https://neckandback.com/conditions/home-testing-for-leg-weakness/ to understand how to home test for weakness of the L5 nerve.

If you have no significant lower back pain and mainly left buttocks/leg pain and no motor weakness, you should consider conservative care and if poor results, a decompression of this level. The L3-4 level has right lateral recess stenosi and central stenosis (“right paracentral disc herniation/protrusion with moderate narrowing of the right lateral recess and to a lesser extent central canal maximal sagittal diameter of thecal sac approximately 6 mm”). See both https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/ and https://neckandback.com/conditions/lateral-recess-stenosis/ to see if you have symptoms of these disorders.

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.

4thLumbar
Participant

August 30, 2017 at 8:06 am

Post count: 3

#26242

Thank you so much for the information and the links to documents.

My problem initial was pain in my leg and numbness in my foot (that is what prompted the PLIF).

The reason I got the MRI this time was because I have major radiating pain down the outside of my lower leg and my foot is basically completely numb and has been for weeks. Standing and walking send radiating pain down my leg and walking makes the numbness worse and weakness sometimes.

I am hopeful that the conservative treatment will work because I don’t want to have another surgery.

Thank you so much again for the review and links to information.

I appreciate you taking time to answer peoples’ questions and I am sure others do as well.

Thank you again

Donald Corenman, MD, DC
Moderator

August 30, 2017 at 1:53 pm

Post count: 8660

#26249

It sounds like you at least need PT and an epidural injection (as long as it is left sided pain which you don’t specify). If you have motor weakness, surgery should be considered. You should not need a fusion but a decompression is called for. The recovery is not as significant as a fusion (https://neckandback.com/pre-and-post-op/microdiscectomy-and-lumbar-decompression-recovery/)

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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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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