Oh how my back still hurts

Tagged: Lumbar degenerative spondylolisthesis and central stenosis with foraminal stenosis

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bomar220
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January 25, 2018 at 5:09 am

Post count: 5

#27385

Dr Corenman
I am a 63 yr old man experiencing continued back (5-6 months) of discomfort. After several rounds of anti-inflamtories my severe right sided sciatic has mellowed but I still have continued back thigh and butt discomfort as well as intermittent leg pain that has transferred to my left side. I have been to an orthopedic surgeon , chiropractor, physical therapis(twho streched the heck out of my hamstrings) and been given a ho hum nothing terribly unusual diagnosis. Any recommendations?
History: Back pain

MRI-3T LUMBAR SPINE NON CONTRAST

History: M54.31 Sciatica right side M54.5 Lower Back Pain M54.41 Lower
back pain with right sciatica M79.604 Right Leg Pain

MRI examination of the lumbosacral spine was performed on a 3.0 Tesla ultra high field
wide bore magnet and multiplanar multi-sequential techniques were used.

Examination of the sagittal imaging demonstrates retrolisthesis of L5 on S1 with grade 1
spondylolisthesis of L4 on L5 and mild scoliosis and a degenerative appearance of the
vertebral bodies. The conus medullaris is seen to be normal.

The intervertebral disks demonstrate decreased T2 signal.

At L5-S1 there is a diffuse degenerative bulging disc with left foraminal asymmetry mild
central and moderate left foraminal stenosis is noted.

At L4-5 there is a diffuse degenerative bulging disc with spondylolisthetic shelf and
degenerative posterior change moderate central and foraminal stenosis is noted.

Review of the remaining levels does not demonstrate evidence of focal abnormality, disc
herniation or stenosis.

IMPRESSION:

Spinal malalignment with multilevel degenerative disc disease including stenoses as above.

ICD 10 Codes:
Degeneration L5-S1 level. M51.37
Degeneration L1-L5. M51.36
Spinal stenosis. M48.06 9-7-17
Thank you

Donald Corenman, MD, DC
Moderator

January 27, 2018 at 2:59 pm

Post count: 8660

#27415

The trick always is to fit the symptoms to the pathology and then fit to the physical examination findings. Since we don’t have the physical examination, we will work with what we have.

Your report of radiological findings helps much. “Retrolisthesis of L5 on S1 with grade 1 spondylolisthesis of L4 on L5” indicates a very degenerative disc at L5-S1 along with a degenerative spondylolisthesis at L4-5.

Then; “At L5-S1 there is a diffuse degenerative bulging disc with left foraminal asymmetry mild central and moderate left foraminal stenosis is noted. At L4-5 there is a diffuse degenerative bulging disc with spondylolisthetic shelf and degenerative posterior change moderate central and foraminal stenosis is noted”. This section discusses the canal diameter and nerve compression. You have left foraminal stenosis at L5-S1 compressing the left L5 nerve. You have central and foraminal stenosis at L4-5. Read all these sections to understand what these disorders mean and if any of this applies to you.

https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/
https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/
https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/
https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/

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.

bomar220
Participant

March 3, 2018 at 10:55 am

Post count: 5

#27797

DR Coreman
Thank you very much for the reply. I have been to a spine specialist and he has recommended starting with Epidural injections, fluoro assisted. I am scheduled this Thursday. If this does not bring relief are there any MIS decompression that could be done? I have very good strength and flexion at this point but transient dull pain… I am a bit concerned that a fusion would be necessary to stabilize my back..

Thank you
Bomar

Donald Corenman, MD, DC
Moderator

March 18, 2018 at 10:22 am

Post count: 8660

#27899

Epidurals with physical therapy is a good start for treatment. You might need a fusion based upon your imaging. “MIS” or minimally invasive surgery is a common catch phrase that does not have the implications that are drawn from the phrase. The success rate for MIS fusion surgery is much lower than minimal incision surgery and the MIS incision are actually longer when added up.

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.

bomar220
Participant

March 29, 2018 at 2:35 pm

Post count: 5

#27987

Dr Corenman
Thank you for the explanation . It has been about 2 1/2 weeks since my epidural. Pain is significantly less., but I seems to get aggravated easily. Still taking maloxicam and tylenol as needed. Starting PT tomorrow. Guess there is no easy out of this.
BM

bomar220
Participant

August 14, 2018 at 6:34 pm

Post count: 5

#28942

Dr Corenman
I have had my third epidural injection . I get immediate relief but I have re injured myself a couple of times. Is there any way around spinal fusion ( rods and screws) to fix me. Would any sort of tissue, disc removal that may provide some space or decompression?
Thanks
Bomar
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Donald Corenman, MD, DC

Average rating:

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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