disc herniation surgery

Tagged: disc herniation nerve compression, how to work-up a disorder surgically

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mackendw
Participant

April 16, 2018 at 8:34 am

Post count: 4

#28077

Hi:

I watched one of your surgery videos on youtube (presume that was you doing it) for disc herniation. I’m having
an awful time with my back. I’m 53, male and experienced a very bad set of back spasms which I’m attributing to my
back injury I experienced in 1992. Lifting a freezer bent over and twisted. Felt a tear/pop when it happened.
Ever since, depending on what I’m doing, my back will just go out and back spasms will set in. This time I’ve been
prone for a week and a half. Very sore with pain when attempting to move at all. I’ve been icing it to quell the
inflammation and taking tordol for the pain.

I had an MRI done in 2004 on one of my relapses and the dr I saw at the time said I had a disc bulge between
the L4/L5 discs. So, I’m guessing that this is a recurring thing.

Over the past 10 years I’ve been living with constant numbness in my right thigh. When standing for more than
30 minutes, my right leg will feel like it’s on fire and I’ll have to sit.

In your video of the disc herniation, the surgeon removes the pieces of fragments from the disc that have
escaped into the area around the nerve root. Once this is done, is the hole/opening of the disc just left open?
If so, won’t that lead to further leakage of the pulpous material in the disc remaining to freely escape and
cause repeated nerve compression?

thx.
Wendell

Donald Corenman, MD, DC
Moderator

April 22, 2018 at 11:33 am

Post count: 8660

#28119

You have to understand what causes pain in the lower back region. Pain can occur from the disc itself, from compression of a nerve or both. Disc pain generally causes central lower back pain. Back pain that favors one side but does not centralize might be either nerve or disc/facet. Buttocks/leg pain is generally caused by nerve compression. Nerve compression is subdivided by disc herniation pain which typically causes pain with sitting and relieved by standing (not always) and stenosis (nerve hole narrowing) pain which is worse with standing/walking and relieved by sitting or bending forward.

As you can see, differential diagnosis of this pain takes time to understand exactly where the pain originates, where it refers and what actions cause pain to be come worse and better. After, that careful assessment (called the “history”), then a careful physical examination hones down the potential painful structures. An imaging review then confirms the surgeons suspicion and diagnostic blocks (injections) then are specific tools to reaffirm the diagnosis. This algorithm is used generally to identify what needs to be done to surgically “fix” the disorder.

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.

mackendw
Participant

May 1, 2018 at 2:49 pm

Post count: 4

#28207

I had an MRI performed at a private clinic. The radiologists conclusion is:

– at T12/L1, discopathy with mild disc space narrowing that predominates on the left side. diffuse disc
bulging with a focal small protrusion, representing a small posteromedian disc herniation, provoking
mild impression on the anterior aspect of the thecal sac without foraminoral narrowing.

– at L2-L3, L3-L4 disc are within normal limits

– at L4/L5, discopathy with mild disc space narrowing and hypointensity of the nucleus pulposus. A
hyperintensive signal on T2 weighted images is present on the posterior aspect of the annular fissure
representing a small annular tear accompanied by a small broad-based posteromedian disc herniation
that provokes a mild impression on the anterior aspect of the thecal sac and that contributes to mild
narrowing of the neural foramina bilaterally without nerve root compression.

– at L5-S1, discopathy with mild disc space narrowing and hypointensity of the nucleus pulposis.
Presence of a left posterior paramedian disc herniation of moderate size displacing posteriorly the
proximal left S1 nerve root that appears to be mildly compressed against the left L5/S1 facet joint.
No foraminal stenosis or L5 nerve root compression.

No bone pathology, spondylolysis or spondylolisthesis present. No significant facet joint osteoarthrosis.

Conclusion:

– Left posterior paramedian disc herniation at L5/S1 which may be involved in the left S1 radiciculopathy.

– Small posteromedian disc herniations at L1-L2 and L4-L5.

So, I’m 5 weeks in, still largely immobile unable to work, walk or sit more than 10 minutes without pretty severe pain/weakness in my legs. I tried chiropractic care, but that didn’t help.

Does this warrant surgery for discectomy on the L5/S1?

Donald Corenman, MD, DC
Moderator

May 3, 2018 at 6:40 am

Post count: 8660

#28215

Your symptoms are not specific enough (“largely immobile unable to work, walk or sit more than 10 minutes without pretty severe pain/weakness in my legs”). You have a left herniation at L5-S1 affecting the left S1 nerve root. You note symptoms in both legs. Is this accurate or did you really mean only severe left leg pain? Do you have weakness of the calf muscles? See https://neckandback.com/conditions/home-testing-for-leg-weakness/.

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.

mackendw
Participant

May 3, 2018 at 8:32 am

Post count: 4

#28217

Hi:

Thx for replying. My pain and weakness is largely going from my lower back and into the left leg. From my
MRI, the disc protrusion/herniation is largely in the thecal sac – central portion. When I drove home from Ottawa – around 13 hrs, when we stopped for the night and I tried to get out of the vehicle, my legs were literally non-functional feeling like dead weights. Laying flat for a few hours seems to relieve the symptoms but they return when I’m upright or sitting for any length of time.

I don’t know what else to say at this point. I have my full MRI on google drive which I’m willing to share with you for your insight, if you are willing.

Many thanks,
Wendell

mackendw
Participant

May 3, 2018 at 9:47 am

Post count: 4

#28219

I just read thru the link provided for doing the various tests to determine which nerve is compressed. I don’t think any of these apply in my case. The pain/discomfort I get starts in the lower back near L5 and radiates into the left buttock but doesn’t go any further than my thigh.

The paragraph talking about Nerve Compression Motor Strength Weakness would best describe how I get after standing/sitting for any length of time followed by attempting to walk.

My family dr did a test of my reflexes on both legs/feet using the hammer test on the knee and ankle. She noted some left leg weakness on the test.
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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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